ReviewPalliative medicine2026
Exploring Pathways to Optimise Care in malignant bowel obstruction (EPOC): A realist review of shared decision-making with people with advanced cancer and severe symptoms.
Review in Palliative medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMalignant bowel obstruction is a life-threatening condition associated with advanced cancer that causes severe pain, nausea and vomiting. Decision-making requires input from multiple specialities, outcomes are uncertain and clinical communication is challenging. Better understanding of the mechanics of shared decision-making would improve the management of this condition.
aimsTo investigate behavioural and structural influences on decisional deliberation during the management of malignant bowel obstruction and develop strategies for improved communication.
designA realist review following RAMESES guidelines; protocol registered in PROSPERO (CRD42022308251). DATA SOURCES: Iterative literature searches were conducted from December 2021 to January 2023, with an update search conducted in January 2024. All relevant data sources relating to shared decision-making in the management of malignant bowel obstruction were included.
resultsSeventy-one papers were included. Realist synthesis led to the development of context-mechanism-outcome configurations in four conceptual areas to explain influences on practitioner, patient and caregiver engagement in shared decision-making: (1) implicit misunderstandings, (2) the nature of the decision, (3) interpersonal dynamics and (4) a fragmented ethos of care. Implicit social mechanisms can affect the transparency of shared decision-making and the value individual decision-makers assign to the process, and motivation to participate is likely to vary as circumstances change.
conclusionsCommunication around patients with advanced cancer and malignant bowel obstruction is characterised by ambiguity, unrealistic expectations and a lack of interdisciplinary coordination. Crucial features of effective decisional deliberations include alignment of goals of care, unambiguous explanation of treatment limitations and iterative communication to facilitate the formation of realistic expectations.
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