Table 2 Observed material (extract)

Choice Talk^a

Making need for decision explicit

The member of ethics committee asks what decisions need to be made that day

Introducing joint decision-making

The palliative care physician mentions the possibility of asking the patient to make a choice about chemotherapy

Checking preferred decision-making style

Oncologist quotes patient as saying: "I have no choice"

Discussing decision-making abilities

The department physician provides input on the interaction with the patient, who is very passive

Options Talk^a

Benefits and risks

The oncologist says that the patient still has a chance to get better if he has the chemotherapy

Checking understanding

The oncologist thinks the patient realises what is happening

Checking knowledge

Verify in the patient’s record that they understand the prognosis and current treatment plan

Decision Talk^a

Making the decision

The referring oncologist makes the decision not to do chemotherapy (Clinical contraindication)

Patient preference

The referring oncologist reports that the patient's comments lead her to think that he agrees with the continuation of chemotherapy

Reviewing the decision

The referring oncologist will confirm continuation of chemotherapy in consultation

Role of palliative care professionals^b

Moderating role

The palliative care physician summarises the discussion

The member of ethics committee asks the team for their opinion. The member of ethics committee asks what decisions need to be made today

Acculturation—team support

The palliative care physician provides tools to help the oncologist to speak with the patient

The palliative care physician provides support to the team

Patient advocate

The member of ethics committee emphasises the importance of informing the patient about the possibility of whether or not to carry out a chemotherapy treatment

The palliative care physician emphasises the importance of sharing decision-making with the patient and family