Samenvatting

Background In geriatric oncology, family members frequently accompany older patients with cancer to medical consultations and participate in shared decision-making (SDM) processes. While family involvement can enhance decision-making, it also presents challenges for healthcare professionals. Additionally, much SDM deliberation occurs outside the clinical setting, highlighting the need to understand family dynamics to ensure treatment decisions align with patients' values. This study aimed to explore family members' experiences in decision-making for older patients with cancer and the subsequent impact on roles and family dynamics. Methods Sixteen family members of eleven patients with cancer aged 70 and older were interviewed in the Netherlands using qualitative, in-depth interviews. A thematic analysis was conducted to identify key themes related to their involvement in decision-making and family dynamics.ResultsFour interconnected themes emerged: 1. Roles: Family members provided practical and informational support, and sometimes act as patient advocates. 2. Family Values and Beliefs: A strong sense of unconditional and reciprocal support within families was evident, emphasizing caring for one another as a core value. 3. Family Dynamics: This encompasses, keeping everyone informed, dividing caregiver tasks, dealing with disappointment and sadness, managing different opinions, and coping with uncertainty. 4. Personal Dilemmas: Family members struggled with balancing their own opinions with the patient’s preferences, reconciling hope and fear, weighing trust in medical professionals against their own judgment, and balancing caregiving responsibilities with their personal lives. These dilemmas were shaped by the roles family members assumed, their underlying values and beliefs, and family dynamics. Conclusions Family members take on various supportive roles in medical consultations and decision-making for older patients with cancer. These roles are shaped by family values and dynamics, which can impact the decision-making process and outcomes. Healthcare professionals must recognize these dynamics to better support patients and their families.