Medical treatment decision-making in rural cancer patients: A qualitative systematic review and meta-synthesis |
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| Institution: | 1. School of Psychology, Brennan-MacCallum (A18), The University of Sydney, Camperdown, NSW 2006, Australia;2. Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia;3. Centre for Medical Psychology & Evidence-based Decision-Making, School of Psychology, Level 6 North Lifehouse (C39Z), Missenden Rd, Camperdown 2006, Australia;4. School of Psychiatry, University of New South Wales, Level 1, AGSM Building, Botany Street, Sydney, NSW 2052, Australia;5. University of Newcastle Department of Rural Health, Faculty of Health and Medicine, 114-148 Johnston St, Tamworth, NSW 2340, Australia;6. Department of Radiation Oncology, North West Cancer Centre, Dean St, North Tamworth, NSW 2340, Australia;1. Department of Medicine, Cooper University Hospital, Camden, NJ, USA;2. Department of Urology, Indiana Health University Hospital, Indianapolis, IN, USA;1. School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia;2. Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia;3. The University of Melbourne, Melbourne School of Health Sciences, Melbourne, Australia;4. School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia;5. School of Public Health, The University of Sydney, New South Wales, Australia;1. St. Mary’s Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada;2. Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada;3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada;4. Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, Quebec H3S 1Z1, Canada;5. Department of Family Medicine, St. Mary’s Hospital Center, 3830 Lacombe Ave, Hayes Pavilion, Montreal H3T 1M5, Quebec, Canada;6. Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada;7. Département de radio-oncologie, Centre hospitalier de l’Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada;8. Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite1800, Montreal, Quebec H3A 2M7, Canada;9. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada;1. Department of Medicine, Duke University School of Medicine, Durham, NC, USA;2. University of Michigan School of Medicine, Ann Arbor, MI, USA;3. Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA;4. Fuqua School of Business, Duke University, Durham, NC, USA;5. Department of Population Health Sciences, Duke University, Durham, NC, USA;6. Duke Cancer Institute, Duke University Health System, Durham, NC, USA;7. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;8. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA;9. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;10. Sanford School of Public Policy, Duke University, Durham, NC, USA;1. Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;2. Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA;3. Division of Nursing, School of Health Sciences, Winston-Salem State University, Winston-Salem, North Carolina, USA;4. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;5. Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;6. Department of Dermatology, University of Southern Denmark, Odense, Denmark |
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| Abstract: | ObjectiveRural cancer patients have unique care needs which may impact upon treatment decision-making. Our aim was to conduct a qualitative systematic review and meta-synthesis to understand their perspectives and experiences of making treatment decisions.MethodsA systematic search of MEDLINE, PsycINFO, CINAHL and RURAL was conducted for qualitative studies in rural cancer patients regarding treatment decision-making. Articles were screened for relevance, and data from the included articles were extracted and analysed using meta-thematic synthesis.ResultsTwelve studies were included, with 4 themes and 9 subthemes identified. Many studies reported patients were not given a choice regarding their treatment. Choice, if given, was influenced by personal factors such as finances, proximity to social supports, convenience, and their personal values. Patients were also influenced by the opinions of others and cultural norms. Finally, it was reported that patients made choices in the context of seeking the best possible medical care and the patient-clinician relationship.ConclusionsIn the rural context, there are universal and unique factors that influence the treatment decisions of cancer patients.Practical implicationsOur findings are an important consideration for clinicians when engaging in shared decision-making, as well as for policymakers, to understand and accommodate the unique rural perspective. |
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| Keywords: | Cancer Decision-making Rural Psycho-oncology Qualitative research |
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