{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:00:35Z","timestamp":1782313235122,"version":"3.54.5"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T00:00:00Z","timestamp":1536192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Georgius Agricola Stiftung Ruhr"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Shared decision-making (SDM) has been advocated as an ethical framework for decision-making in cancer care. According to SDM, patients make decisions in light of their values and based on the available evidence. However, SDM is difficult to implement in cancer care. A lack of applicability in practice is often reported. This empirical-ethical study explores factors potentially relevant to current difficulties in translating the concept of SDM into clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was conducted with nonparticipant observation of the decision-making process in patients with gastrointestinal cancers for whom the benefit of adjuvant chemotherapy was uncertain according to clinical guidelines. Triangulation of qualitative data analysis was conducted by means of semistructured interviews subsequent to the observation. Observation notes and interview transcripts were analyzed according to the principles of grounded theory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Deviating from the concept of SDM, oncologists initiated a process of eliciting values and medical information prior to conveying information. The purpose of this approach was to select and individualize information relevant to the treatment decision. In doing so, the oncologists observed used two strategies: \u201cbiographical communication\u201d and a \u201cmetacommunicative approach.\u201d Both strategies could be shown to be effective or to fail depending on patients\u2019 characteristics such as their view of the physicians\u2019 role and the relevance of value-related information for medical decision-making.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In contrast to the conceptual account of SDM, oncologists are in need of patient-related information prior to conveying information. Both strategies observed to elicit such information are in principle justifiable but need to be adapted in accordance with patient preferences and decision-making styles.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice<\/jats:title>\n                  <jats:p>This study showed that knowledge of patients\u2019 values and preferences is very important to properly adapt the giving of medical information and to further the process of shared decision-making. Shared decision-making (SDM) trainings should consider different strategies of talking about values. The right strategy depends largely on the patient's preferences in communication. To be aware of the role of values in SDM and to be able to switch communicative strategies might prove to be of particular value. A more systematic evaluation of the patient's decision-making preferences as part of routine procedures in hospitals might help to reduce value-related barriers in communication.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2017-0615","type":"journal-article","created":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T15:05:25Z","timestamp":1536246325000},"page":"555-562","source":"Crossref","is-referenced-by-count":31,"title":["\u201cI need to know what makes somebody tick \u2026\u201d: Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology"],"prefix":"10.1093","volume":"24","author":[{"given":"Joschka","family":"Haltaufderheide","sequence":"first","affiliation":[{"name":"Department for Medical Ethics and History of Medicine, Ruhr-University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"W\u00e4scher","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Bertlich","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Vollmann","sequence":"additional","affiliation":[{"name":"Department for Medical Ethics and History of Medicine, Ruhr-University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Reinacher-Schick","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schildmann","sequence":"additional","affiliation":[{"name":"Institute for History and Ethics of Medicine, Martin Luther University, Halle-Wittengerg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,9,6]]},"reference":[{"key":"2021122506331353000_onco12676-bib-0001","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1136\/medethics-2015-103047","article-title":"Is risk stratification ever the same as \u2018profiling\u2019?","volume":"42","author":"Braithwaite","year":"2016","journal-title":"J Med Ethics"},{"key":"2021122506331353000_onco12676-bib-0002","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/0272989X16670639","article-title":"Disclosing the uncertainty associated with prognostic estimates in breast cancer","volume":"37","author":"Engelhardt","year":"2017","journal-title":"Med Decis Making"},{"key":"2021122506331353000_onco12676-bib-0003","first-page":"14","article-title":"The prospects for personalized medicine","volume":"40","author":"Yurki","year":"2012","journal-title":"Hastings Cent Rep"},{"issue":"suppl 1","key":"2021122506331353000_onco12676-bib-0004","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/j.metabol.2012.08.016","article-title":"Personalized oncology: Recent advances and future challenges","volume":"62","author":"Kalia","year":"2013","journal-title":"Metabolism"},{"key":"2021122506331353000_onco12676-bib-0005","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.pec.2015.05.004","article-title":"Physician attitudes toward shared decision making: A systematic review","volume":"98","author":"Pollard","year":"2015","journal-title":"Patient Educ Counsel"},{"key":"2021122506331353000_onco12676-bib-0006","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.urolonc.2013.09.002","article-title":"Essential elements of personalized medicine","volume":"32","author":"Burke","year":"2014","journal-title":"Urol Oncol"},{"key":"2021122506331353000_onco12676-bib-0007","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0277-9536(96)00221-3","article-title":"Shared decision-making in the medical encounter: What does it mean? 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