Treatment choices and decision making (Q&A) with Doctor Gavin Marx and Robert Palmer

Q: Your role as a doctor, explaining patient’s cancer, their options, what each treatment means for them, and what outcomes they will have?

A: I think it’s important that the patient comes to the appointment with someone else who will support and listen. An extra set of ears comes in handy.

It is important to explain things slowly often with written information to take away and digest the issues as sometimes it can be overwhelming, and it is hard to recall all the details.

I often then ask them to come back for a follow up session and to discuss any questions they have.

I also try to understand what the patient’s wishes are and make sure they understand the extent of their disease. I make it very clear to them that they have choices and together we weigh up the pros and cons of the various choices. Hopefully by the end of the appointment they have enough information to form choices of what treatment and options are best for them, taking into account all of those factors and options.

Q: Your explanation of clinical trials and how they can improve outcomes and treatment of patient’s cancer?

A: I see clinical trials as part of a standard treatment and option for patients. I appreciate that not all patients have a disease that is suitable or a trial that is relevant for them, but as with any treatment paradigm that we consider, we should always include consideration of a clinical trial as one of those options if that is appropriate.

I always talk to patients about what their standard treatment options are and if there is a suitable trial at my centre or at another centre that is accessible to them. I talk to them about those options and if it would be worthwhile for them to consider.

The importance of clinical trials is twofold. Trials are how we improve the outcomes for future patients but I think more importantly it is a way that gives our patients today, an opportunity to access some treatments that they may not be able to otherwise access, which may potentially improve their outcome.

Q: When Rob was referred to you, what steps did you take to assist with his decision making process?

A: I went through all of Rob’s information from a general overview, his interests, psycho social, general health and if he was fit and well. I tried to get a full understanding of the disease from the biopsies, the surgical reports, reviewing the tumour, any investigations undertaken, the extent of the spread of his disease. Essentially trying to get a clear understanding of the nature and extent of his disease.

We discussed the standard treatment options and that there were other options such as a clinical trial. In this case the ENZAMET trial. I provided Rob the patient information sheet for his consideration of the trial.

We organised a follow up appointment to go through all the information and make sure he had a good understanding of what was involved in participating on the trial and the opportunity to discuss with his family. Once he felt comfortable and understood the implications we organised for him to sign the forms to get started.