A leading oncology expert from Stanford Medicine has outlined crucial strategies for improving patient-clinician collaboration and addressing healthcare disparities in breast cancer treatment. Dr. Lidia Schapira, professor of medicine at Stanford Medicine and director of the Stanford Cancer Institute, emphasizes the critical role of meaningful dialogue between healthcare providers and patients.
Elements of Effective Shared Decision-Making
"Shared means that both patient and clinician listen to one another, and that both can come to the conversation as experts," explains Dr. Schapira. She emphasizes that while clinicians bring medical expertise and treatment experience, patients contribute essential knowledge about their lives, values, and circumstances.
The process requires clinicians to clearly present:
- Standard of care options
- Available novel treatments
- Potential experimental therapies
- Associated risks and benefits
Dr. Schapira stresses that meaningful shared decision-making often requires multiple conversations, particularly when discussing treatments with significant implications for quality of life or financial well-being. "The process, if we really honor it, takes time," she notes.
Addressing Financial and Personal Considerations
Treatment decisions often extend beyond medical factors to include substantial personal and financial considerations. Dr. Schapira acknowledges that patients may face difficult choices, such as liquidating assets or college savings, to fund their treatment. These factors must be openly discussed and carefully weighed against expected clinical benefits.
"If what we're looking for is a very small expectation of clinical benefit, it may not be worth risking all these other things," Dr. Schapira states, emphasizing the importance of supporting patients through these complex decisions.
Tackling Healthcare Disparities
To address disparities in breast cancer outcomes, particularly among historically underserved populations, Dr. Schapira recommends several systematic changes:
- Investment in community health workers and patient navigators
- Development of relationships with underserved communities
- Regular evaluation of facility demographics against community composition
- Increased representation in healthcare staff
- Creation of more welcoming and accessible healthcare environments
"Health care systems should examine their demographics and try to see if those demographics really mirror the demographics of the community that they're in," Dr. Schapira advises. She emphasizes that curiosity and respect must be fundamental elements of organizational culture.
The expert concludes that successful implementation of these strategies requires sustained commitment from healthcare systems to create more inclusive and accessible cancer care environments while maintaining high standards of clinical excellence.
