Patients’ and oncologists’ perspectives on shared decision-making and treatment communication in HR+/HER2 − advanced breast cancer: a multicountry survey

Abstract

Hormone receptor–positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) represents approximately 70% of all cases. In locally advanced or metastatic stages (laBC/mBC), patients’ quality of life (QoL) often worsens, making shared decision-making (SDM) and patient-centered care crucial. Discrepancies persist between patients and oncologists regarding SDM, communication about treatment and adverse events (AEs). This study explores both perspectives to identify unmet needs and priorities in HR+/HER2 − laBC/mBC care. A quantitative, cross-sectional survey was conducted to assess the perspectives of oncologists and postmenopausal women and men with HR+/HER2 − laBC/mBC in France, Italy, and Spain on patients’ knowledge and interest in targeted therapies; SDM; treatment choice and communication about efficacy and side effects; recognition of AEs (i.e., patient-reported symptoms and clinically detected findings) impacting QoL; and preferences regarding the mode of treatment administration. Most patients (< 69%) were willing to undergo biopsy testing and try targeted therapies, although 76% reported limited knowledge about these therapies. The majority of patients wanted full (68%) or partial (20%) involvement in SDM, and 56% also preferred family participation, while few chose psychologists (9%) or nurses (6%, mostly in France). Many physicians (79%) involved patients and families/caregivers (especially in Italy and Spain), but over 78% valued psychological and nursing support. Both groups prioritized overall survival (OS) and progression-free survival (PFS) when choosing treatment options; patients additionally valued treatment-related side effects as a priority during treatment’s choice. Oncologists shared information on safety and expected AEs, less on efficacy outcomes. Physicians identified gastrointestinal AEs as most impactful on QoL, although experienced by few patients. Both groups preferred oral treatments, patients for home convenience, and clinicians for fewer clinic visits. The survey highlighted the need to improve communication about targeted therapies, treatment effectiveness, and AEs. Differences across countries emerged, and greater discussion of nursing and psychological support in SDM is warranted.