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Shared Decision Making — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyShared Decision MakingSCE Medical Oncology

A patient with refractory gastric cancer is considering trifluridine/tipiracil. The trial median overall-survival gain was modest, toxicity is material and his priority is remaining well enough to attend a family event. How should the oncologist use ESMO-MCBS in this consultation?

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Correct answer: E — Explain benefit and harm and uncertainty and no treatment before using his goals in a joint decision

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

E is correct. ESMO-MCBS provides a structured description of benefit, including survival, quality of life and toxicity; it does not replace an individual treatment discussion. NICE shared-decision guidance requires absolute benefits, harms, uncertainty, alternatives and the option of no anticancer treatment to be explained in terms the patient can use. A statistical hazard ratio is not a personal survival prediction, so A and B miscommunicate evidence. C turns a population-level grading tool into a compulsory bedside threshold. D displaces a capacitous patient from his own decision. Different patients can reasonably choose differently from the same evidence.

Reference: ESMO Magnitude of Clinical Benefit Scale booklet: https://dam.esmo.org/image/upload/ESMO-MCBS-Booklet.pdf; NICE NG197 shared decision-making recommendations: https://www.nice.org.uk/guidance/ng197/chapter/Recommendations