Cancer care decision-making and treatment consent: An observational study of patients' and clinicians' rights

This study identified ways in which patients and medical specialists negotiated decisions about cancer treatment by observing decision-making discussion in situ. Audio-recordings of cancer care consultations with 18 patients, their support people, and their medical specialists, including medical oncologists, radiation oncologists and surgeons were collected in different regions of New Zealand. Patients were followed up with interviews and specialists provided consultation debriefings. The interpretation of the data drew on the concepts of epistemic and deontic rights to argue that in complex consultations, such as occur in cancer care, we need to reconsider the simple dichotomy of preferred consultations styles as paternalistic or based on shared decision-making. Decision-making is a dynamic process with specialists and patients linked into networks that impact on decision-making and where rights to knowledge and rights to decision-making are interactionally negotiated. The level of information and understanding that patients desire to exercise rights needs to be reconsidered.