Psychological and cognitive approach to facilitating shared decision-making for patients with cancer

Abstract

Patients with advanced cancer face the psychological and cognitive challenges of receiving “Bad News,” which includes confronting death, processing complex medical information, and making critical treatment decisions. These high-stress situations can lead to cognitive biases that impair rational decision-making, yet some patients remain optimistic and engaged in treatment. While many patients seek discussions that balance hope with reality, individual differences in hope make these conversations challenging for healthcare providers. Understanding the psychological and cognitive mechanisms underlying decision-making is essential for supporting informed choices that enhance survival and quality of life. In Japan, cancer remains the leading cause of death, with an increasing incidence due to population aging. While medical advancements have improved survival rates, psychological distress, such as depression and anxiety among cancer patients remains a significant issue. Suicide risk is elevated, particularly within the first year post-diagnosis. The psychological process of accepting a terminal illness follows a non-linear trajectory, influenced by cognitive biases such as status quo bias, loss aversion, and optimism bias. These biases impact patients’ and physicians’ decision-making, sometimes leading to unrealistic expectations or treatment refusals. Effective patient-provider communication, particularly in delivering Bad News, is crucial in mitigating the negative aspects of cognitive bias and supporting shared decision-making. Communication strategies that foster trust, provide balanced information, and encourage collaborative discussions can help patients align treatment choices with personal values. The psychological and cognitive factors influencing decision-making in advanced cancer are explored, and strategies to improve SDM and patient well-being are highlighted.