Clinical Report: Collaborative Decision-Making in Neurosurgical Brain Tumor Care

Overview

This study evaluated the impact of shared decision-making (SDM) implementation in a neuro-oncology center treating brain tumors. Patient satisfaction, measured by CollaboRATE scores, improved after team training in SDM, and healthcare staff attitudes were assessed using the AquA questionnaire. The introduction of decision aids and structured team training facilitated SDM as the standard of care.

Background

Shared decision-making (SDM) is a patient-centered approach that incorporates patients' values and preferences into healthcare decisions. In the UK, SDM has become a legal requirement following the 2015 Montgomery ruling, emphasizing informed consent and patient involvement. Despite its recognized importance, SDM is not yet universally adopted in cancer care, including neuro-oncology. Effective SDM requires training healthcare teams and using tools such as decision aids to support patient-clinician collaboration.

Data Highlights

Key Findings

• SDM was introduced as the standard of care after targeted team training involving role play and classroom teaching.
• Patient satisfaction with decision-making improved post-training, as measured by the CollaboRATE score.
• Healthcare staff attitudes toward SDM were assessed using the AquA questionnaire, marking the first such evaluation in neuro-oncology.
• Decision grids for high-grade glioma, low-grade glioma, and metastases were developed based on NICE guidelines to facilitate patient understanding.
• Successful SDM implementation relied on organizational support, local ownership, and involvement of the entire clinical team, not just physicians.

Clinical Implications

Implementing SDM in neuro-oncology requires structured team training and the use of decision aids tailored to tumor types. Engaging the entire multidisciplinary team enhances patient involvement and satisfaction. Clinicians should prioritize honest conversations about risks, benefits, and alternatives to align treatment with patient values.

Conclusion

This study demonstrates that structured SDM training and decision aids can improve patient satisfaction and staff engagement in brain tumor care. Integrating SDM as standard practice supports personalized, legally compliant, and patient-centered neuro-oncological treatment.

References

1. Montgomery v Lanarkshire Health (2015) UKSC 11 -- Legal ruling on medical consent
2. Joseph-Williams et al. 2017 -- Implementation of SDM in the NHS
3. NICE Guideline on Shared Decision-Making, 2021
4. Option Grid™ -- Decision aid development guidance