Negotiating shared decision making: the psychology of choosing cancer treatment

This PhD will use mixed qualitative methods to investigate how we can improve people’s satisfaction with the choices they make for their cancer treatment. Many cancer patients experience either significant regret over their choice of treatment, or feel that their views have not been fully taken into account before undergoing life-altering or life threatening treatment. The research undertaken for this PhD will be used to help patients and medical staff collaborate in making treatment decisions to achieve the best medical and psychological outcomes for people with cancer.

The background to the project is the increased emphasis upon what is known as ‘shared decision making’ in healthcare and cancer care in particular – a major priority for improvement by the NHS in England (NHS England, 2012). Doctors and nurses are expected to try to understand a person’s values and preferences when sharing information about their cancer and potential treatments, and taking these into account in reaching a shared decision about treatment. Whilst this sounds obvious and straightforward, it is anything but straightforward in practice where decisions are undertaken under conditions of anxiety, time pressure, uncertainty, lack of familiarity between the person with cancer and their healthcare team, and occasional medical paternalism.

The particular contribution of this PhD will be to focus upon how a person’s preferences and values about treatment are elicited and discussed in cancer treatment consultations. Hitherto research has focused largely upon how a people with cancer are provided with information about their condition and treatment, but less is known about how preferences and values can be brought to bear effectively upon shared decision making in practice (Fagerlin et al, 2013; Pieterse, de Vries, Kunneman, Stiggelbout & Feldman-Stewart, 2013).

We expect that the PhD will largely use methods focused upon the use of language in social interaction such as applied conversation analysis (ten Have, 2007), or discursive psychology (Seymour-Smith, Wetherell & Phoenix, 2002) to investigate transcripts of medical and nursing consultations, but there will be an opportunity to take a multi-methods approach by combining this with parallel qualitative data collection and analysis of interviews (Hesse-Biber & Johnson, 2015).

Data collection for the PhD will take place in local cancer centres treating people for blood and urological cancers with whom the supervision team have close links.

Specific qualifications/subject areas required of the applicants for this project (e.g. First degree in specific subject area):

UK 1st Class / 2.1 Bachelor’s degree (or UK equivalent according to NARIC) in Psychology (single or combined honours).