Table 3.

Medical oncologists: Support for using the Best Case/Worst Case (BC/WC) communication tool to facilitate shared decision making (SDM) in geriatric oncology (n = 14 oncologists).

SDM Domain	Theme	Description	Exemplar oncologist quotes
Choice talk	BC/WC framework makes choice explicit	BC/WC tool guides oncologists to routinely present more than one option to help patients understand that they have a choice, including best supportive care.	“The only time I’m more supportive of treatment is if there’s a curative possibility. But, if there’s not, then you’re really just prolonging someone’s life. Then you’ve got to say that from the get go because people need to know that they don’t have to have treatment.”
Option talk	Range of plausible outcomes helps patients/caregivers understand tradeoffs	BC/WC tool provides structure to communicate both the best potential benefit, worst potential harm, and most likely outcome to help patients weigh tradeoffs.	“It’s really important as a prop for the doctor to remember that there is this worst case scenario. There are oncologists who are consistent about sort of painting that picture, but then there are also ones that the natural tendency is to focus on the best-case scenario.”
	Stories help patients/caregivers imagine plausible outcomes	The narrative approach can helps oncologists translate statistical outcome information for patients/caregivers to improve understanding.	“I think rather than giving them just the median survival or median progression free survival, this kind of approach might work better.”
	Graphic aid as a guide and durable reference	Oncologists valued how the graphic aid can guide the discussion and visually communicate where the estimated most likely case falls relative to best and worst case.	“I think that having a prop, [Dr. Artz’s*] flowsheet helped him kind of direct things and guide the conversation. It seems like that could be good strategy to have that, the tool to use to do that, and I think that he by using best case/worst case, it allowed [Mrs. Ellis*] to see the possibilities.”
Decision talk	Encourages deliberation	Oncologists appreciated how the BC/WC tool can help them elicit and understand patients’ goals and preferences as each scenario is described.	“At one point, [Dr. Artz and Mrs. Ellis] were talking about the best case and worst case when [Mrs. Ellis] would chime in about, ‘Oh that sounds like that’s what I want’ or they say, ‘That is what I want to do with my time.’ It helps sort of for them to mention their goals more organically. They are responding to what you’re telling them about the benefits or the side effects. I think they can just actually tell you what makes sense to them, what they like or don’t like about these options, which I think thaťs pretty nice.”

^*In the BC/WC example demonstration video, Dr. Artz was the oncologist and Mrs. Ellis was a 76-year-old woman with metastatic small cell lung cancer.