Engaging Long-Term HR Positive Metastatic Patients in Shared Decision Making

Shared decision making for patients receiving long term therapy for hormone receptor positive metastatic breast cancer focuses on clarifying goals, balancing efficacy and tolerability, and co-creating a dynamic care plan. Panelists recommend eliciting patient priorities early by asking about unacceptable side effects, functional aims, and treatment goals. Clinicians should present individualized absolute and relative benefits, outline expected monitoring and clinic frequency, and describe realistic sequences such as endocrine based options, targeted therapies, and ADCs. Decision aids, plain language summaries, and input from nursing, palliative care, and relevant specialists support informed choices. Routine reassessment at each response or progression allows dose modifications, supportive management, or sequencing changes to preserve quality of life. Financial toxicity, travel burden, and caregiving constraints must be addressed and services such as social work or financial navigation offered. Documenting preferences and revisiting them creates a partnership that aligns treatment intensity with the patient’s priorities and life context.