Muscle-invasive bladder cancer (MIBC) is a serious condition that requires patients to make complex and often time-sensitive treatment decisions, yet the way these decisions are made and experienced is not well understood. Patients with MIBC have been reported to receive less support during treatment decision-making than those with other urological cancers. This observation, together with existing literature that highlights uncoordinated care pathways, clinician bias, and inconsistent information-sharing, prompted an exploration of how treatment decisions are made in practice in this group of patients. This research study focuses on the treatment decision-making experiences of patients with MIBC in a large metropolitan area in the North of England. Using case study methodology, data were triangulated from multiple sources to gain a fuller understanding of the decision-making process. These included mapping patient pathways, observations of clinical consultations and multidisciplinary team (MDT) meetings, and conducting interviews with patients. The findings indicate that MIBC care pathways are often fragmented and difficult for both patients and clinical teams to navigate. MDT meetings, which are intended to guide treatment planning, frequently generated unclear or incomplete recommendations that did not always align with the treatments patients ultimately received. Clinician bias influenced which options were discussed or offered, and patients were often provided with complex information in inconsistent ways. As a result, whilst patients perceived themselves to be involved in shared decision-making, their capacity to make informed choices was constrained, leading to an illusion of choice. These findings suggest that challenges in treatment decision-making in MIBC extend beyond individual communication practices or consultation techniques. Instead, they reflect wider systemic issues within MIBC services, including fragmented care pathways, ambiguous MDT processes, and a lack of standardised information provision. Whilst improving the quality of clinical conversations is important, meaningful reform must also address the organisational and structural conditions that currently limit genuine patient autonomy.
| Date of Award | 5 Jun 2026 |
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| Original language | English |
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| Supervisor | Warren Gillibrand (Main Supervisor) & Mary Turner (Co-Supervisor) |
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