Shared decision-making in the care of patients with cancer is an approach in which the patient, the oncologist and, if needed, the psycho-oncologist are involved in the process of exploring treatment options, possible outcomes, individual preferences, values, concerns, and the patient's capacity for active participation. In cancer treatment, medical decisions may be complex, multi-staged, and uncertain, and the patient may sometimes find themselves in situations where anxiety, fear of death, fear of complications, fatigue, impairment of concentration, or feelings of powerlessness reduce their ability to process information and express real preferences. In such a situation, the presence of a psycho-oncologist alongside the oncologist can help to establish a more effective connection between medical information and the patient's psychological needs, without replacing the specialized role of the physician in clinical decision-making.
The oncologist is responsible for explaining the diagnosis, disease status, treatment options, potential benefits and risks, and medical consequences of each choice, while the psycho-oncologist examines factors that may affect the patient's understanding, choice, and participation. Anxiety, depression, fear of complications, false beliefs about cancer, negative past experiences, family pressure, economic concerns, communication problems, and feelings of lack of control can limit the patient's participation. Therefore, psychological evaluation is an integral part of the decision-making process and helps the treatment team understand how the patient receives the information, what concerns they have, and what factors may be preventing them from expressing their true preferences.
One of the most important roles of a psycho-oncologist is to help create a situation in which the patient can ask questions and discuss treatment options without pressure or fear. True participation is formed when the patient is not only the recipient of medical advice, but is able to understand the information related to the treatment to the best of their ability, talk about their priorities, and play a role in choosing the course of treatment. This participation does not mean transferring responsibility for the medical decision to the patient, but rather combining the specialized knowledge of the treatment team with the patient's individual values, goals, and preferences. The psycho-oncologist can facilitate more active patient participation by teaching communication skills, reducing anxiety, and helping to organize thoughts.
Self-efficacy is also important in this process. A patient who feels that he or she has no control over the treatment process may avoid asking questions, expressing concerns, or participating in decisions. Psychological interventions can increase patient engagement by fostering a sense of empowerment, teaching problem-solving skills, setting achievable goals, and correcting dysfunctional beliefs. The goal, of course, is not to create an unrealistic sense of control, but rather to help the patient identify areas where they can really play a role, such as expressing preferences, managing certain symptoms, adhering to treatment recommendations, seeking support, and participating in a care plan.
Empathetic therapeutic communication between the oncologist and the patient is also one of the foundations of shared decision-making. The way information is presented can affect the patient's perception of the disease and his or her ability to make decisions. Highly specialized information, a high speed of dialogue, or the use of medical terminology without explanation may cause confusion. A psycho-oncologist can help the treatment team identify the patient's communication needs, their psychological readiness to receive information, and the appropriate way to talk. Using understandable language, checking the patient's understanding, giving them the opportunity to ask questions, and recounting information in the patient's own language are important elements of effective communication.
In this context, attention to the patient's preferences should be accompanied by ethical and professional considerations. Some patients tend to know a lot of details about the disease and treatment, while others prefer to receive information gradually. Some people may also need family support in making decisions. The job of a psycho-oncologist is not to impose a decision-making style, but to help identify the patient's preferences and provide a safe space for them to be expressed. Also, in situations where severe anxiety, cognitive impairment, or psychological distress has affected decision-making capacity, specialized evaluation becomes more important, and close cooperation with the medical team is essential.
Patient involvement can also continue throughout treatment and not become an event limited to the time of treatment selection. After starting chemotherapy, radiation therapy, systemic therapies, or other interventions, the patient will continue to face various decisions regarding symptom management, lifestyle, rehabilitation, psychological support, and follow-up. A psycho-oncologist can help the patient recognize their emotional changes, voice their concerns, and stay active in communication with the treatment team during these stages. Such an approach is especially important during the long stages of treatment when fatigue and burnout increase.
Another important aspect is to pay attention to the conflict between the patient's preferences and the expectations of the family. In some cases, the family may want to continue or choose a specific type of treatment due to concerns about the patient's condition, while the patient has a different priority. The psycho-oncologist can help clarify the patient's values and preferences and reduce communication conflicts by creating structured dialogue. The goal is not to eliminate the role of the family, but to ensure that family involvement is within the framework of the patient's wishes and rights.
Despite the advantages of this model, the implementation of shared decision-making faces challenges such as time constraints for physicians, high volumes of medical information, cultural differences, health literacy, severe anxiety, limited access to specialized mental health services, and differences in patients' willingness to participate. Patient participation should also not be confused with accepting all therapeutic responsibilities. The patient should be able to make informed choices, but the medical decision still requires expert evaluation and professional responsibility of the treatment team. Therefore, psycho-oncologist collaboration will be more effective when it is based on continuous communication, respect for patient autonomy, providing understandable information, assessing distress, enhancing self-efficacy, and paying attention to individual values and preferences. In such a model, the patient transforms from a passive recipient of services to an informed and active participant in the path of treatment, and cancer care, in addition to paying attention to disease control, also includes psychological, relational, family, and quality of life dimensions.