Introduction Shared decision-making (SDM) remains a key aspect of the patient-centred care paradigm in patients with lymphomas and CLL. It involves not only patient inclusion in key decisions regarding their care but also requires healthcare providers (HCP) to understand the preferences and needs of their patients. Previous research has demonstrated differences in patient-reported outcomes (PROs) by biological sex in this population, however, research into differences in perception of patient's involvement in decisions regarding their care is limited. Our aim with this study was to investigate the variances in the areas of shared decision-making by biological sex in patients with diffuse large B-cell lymphoma (DLBCL).

Methods A cross-sectional, anonymous online global survey directed at patients with lymphoma or CLL was deployed in 2024. This analysis only included people with lived experience (PWLE) of DLBCL. The survey asked specific questions regarding SDM including treatment preferences, perceived involvement in decision-making, and patient/healthcare provider communication. Responses from PWLE of DLBCL to these questions were categorised by biological sex (female, male) and analysed descriptively to explore variances in SDM experience.

Results At total of 1106 PWLE of DLBCL from 44 countries were included in the analysis with 63% (n=697) identifying as female. The median age of respondents was 58 [range 22-92]. 99% of males and 97% of females indicated they wanted to be involved in decisions about their care, meaning SDM is vitally important to integrate into clinic. When looking at both genders together, 50% of PWLE of DLBCL do not feel adequately involved in their treatment decisions. The survey asked questions on clinic behaviours related to productive SDM. Again, analysing the whole cohort, 57% of PWLE of DLBCL do not feel their HCP always encourages questions, 59% say their doctor doesn't routinely check that they understand answers to questions, and 45% say their doctor interrupts them when they are speaking. When analysed separately, notable gender-based variances were observed in several key areas related to SDM. Male respondents were more likely to report feeling highly involved in their treatment decisions than female respondents, (57% vs. 46%). More male respondents than females felt their HCP alwaysencouraged them to ask questions regarding their care, (48% vs. 40%). Related to this, 45% of males said their HCPs always ensured they understood answers to their questions, compared to 39% of females. Males were more likely to say their doctor spoke to them in a kind and sensitive way (67% vs 60% for females) and allowed them to express themselves without the doctor interrupting (59% vs 53% for females). Additionally, 71% of males felt their HCP discussed with them lifestyle factors which were important to maintaining a high quality of life, compared to 58% of females. A greater proportion of male respondents also reported being offered more than one treatment option than females, (22% vs. 14%). Finally, a greater proportion of female respondents (25%) indicated they preferred to make their healthcare decisions entirely on their own compared to 18% of male respondents. Males, on the other hand, were more likely to want their doctor to make the final decision (27% vs 19% of females).

Conclusion Within the shared decision-making continuum, notable variances exist in communication, perceived- patient involvement and decision-making preferences between biological sexes. Male respondents more frequently reported feeling highly involved in their care, consistently encouraged to ask questions, and presented with multiple treatment options. In contrast, a higher percentage of female respondents felt they alone wanted ultimate responsibility over their final healthcare decisions. It is also important to note that there are gaps in SDM for all PWLE of DLBCL and engagement remains suboptimal, with only half of respondents feeling highly involved in care decisions despite almost all patients wanting this kind involvement. This indicates room for improvement in clinic behaviours that encourage SDM overall. These findings highlight the need for HCPs to proactively engage in SDM in general and to also recognise and address differences between biological sexes when communicating with patients to ensure they feel equally engaged, informed and supported in making treatment and healthcare decisions.

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2025
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