Describing the range and complexity of family influence in cancer treatment decision-making: The TRIO framework — ASN Events
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Describing the range and complexity of family influence in cancer treatment decision-making: The TRIO framework (#80)

Rebekah Laidsaar-Powell 1 , Phyllis Butow 1 , Cathy Charles 2 , Amiram Gafni 2 , Vikki Entwistle 3 , Ronald Epstein 4 , Fran Boyle 5 , Cameron Stewart 6 , Ian Kerridge 7 , Julie Claessens 8 , Ilona Juraskova 1
  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
  3. University of Aberdeen, Scotland, UK
  4. Centre for Communication and Disparities Research, Department of Family Medicine, University of Rochester, NY, USA
  5. Centre for Cancer Care and Research, Mater Hospital, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
  6. Centre for Health governance, Law and Ethics, Sydney Law School, The University of Sydney, Sydney, NSW, Australia
  7. Centre for Values, Ethics & Law in Medicine (VELIM), School of Public Health, The University of Sydney, Sydney, NSW, Australia
  8. Consumer Representative, CanSpeak, Queensland, Australia

Aims
Despite the fact that family are often involved in decision-making (DM), there is very limited conceptual accommodation of family in the current DM literature, which has focused primarily on the physician-patient dyad. To date no frameworks have explained the nature and scope of family involvement in decisions. The aim of this presentation is to describe a new triadic framework (TRIO) which will describe the range of family influence over decisions and capture and explain the complexity and variability of family involvement.

Methods
The TRIO framework development phase was informed by a review of relevant conceptual, ethical, and legal perspectives, and empirical work conducted by our group. Empirical examples of triadic DM dynamics derived from interviews were applied to the framework to test its effectiveness in conveying triadic DM influence. Framework drafts were iteratively reviewed by an expert advisory group comprising ethicists, lawyers, consumers, DM researchers and clinicians.

Results
First the purpose and context of the framework was defined. A range of ‘pure’ DM styles were proposed to highlight the spectrum of triadic DM influence (doctor dominant, patient dominant, family dominant, doctor-patient shared, doctor-family shared, patient-family shared, shared triadic). Next, the framework describes a number of the complexities of family involvement in decision making, such as: i) family influence is variable between triads; ii) family influence is variable within the one triad over time; iii) family involvement in DM underpinned by proximal actions; iv) decision making in not just among three. Finally, a range of factors influencing the extent of family involvement in DM will be highlighted, such as demographic, cultural, and decision factors.

Conclusions
Proposal of a conceptual framework which accommodates and explains family involvement has the potential to expand our current understanding of DM and may be useful for future research and the development of family relevant interventions.

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