Shared decision-making about uveal melanoma treatment in the Netherlands: non-neutral framing of medical information

Background: A subset of uveal melanomas can be treated using either enucleation or proton beam therapy (PBT), which offer similar oncological outcomes. The most appropriate treatment depends on a patient's preference. To allow patients to genuinely determine their preference, it is recommended to describe options as neutrally as possible. This study assesses to what extent ocular oncologists use and perceive non-neutral framing behaviour, and if it is related to patient satisfaction with decision-making. Methods: Consultations of ocular oncologists with patients newly-diagnosed with uveal melanoma were audio recorded, transcribed verbatim, and coded for ocular oncologists' explicit and implicit non-neutral framing behaviours. Explicit non-neutral framing was defined as: explicitly mentioning a preferred option at least once, without relating it to the patient. Implicit non-neutral framing was defined as: describing an option (un)favourably, without providing a medically substantive clarification alongside. Results: 110 patients provided consent for the audio recordings. Non-neutral framing was found in 84% (n=92/110) of consultations. We found explicit behaviour in 38% (42/110) and implicit behaviour in 76% (84/110, median=1, range, 0-4) of consultations. The most frequent implicit framing was presenting options by positively or negatively emphasizing one option. Non-neutral framing behaviours were not significantly related to patient satisfaction with decision-making. Conclusion: This study shows that in most consultations some non-neutral framing was present, which did not impact patients' satisfaction with decision-making. Nonetheless, ocular oncologists should be aware that how they describe options may influence preferences in ways that do not align with the patient's values.