“There is No Alternative.” Treatment Decision-Making in Lung Cancer Patients with Limited Prognosis: Results of a Qualitative Interview Study

IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES European Journal of Cancer Care Pub Date : 2024-09-05 DOI:10.1155/2024/8889981
Laura Unsöld, Nicole Deis, Anja Siegle, Michael Thomas, Matthias Villalobos
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Abstract

Objective. Decision-making in advanced cancer with a limited prognosis is particularly challenging: constantly evolving therapeutic algorithms with new treatment options that show marginal benefits have to be balanced with end-of-life decision-making. But existing decision support tools for advanced cancer patients are rare, not routinely used in clinical practice and do not sufficiently meet patients’ needs. Therefore, our project explores the experienced decision-making process in advanced lung cancer to derive recommendations for the use of shared decision-making in this context. Methods. 20 semistructured interviews with lung cancer patients, their relatives, and healthcare professionals were conducted. All data were transcribed verbatim and analyzed with a thematic content analysis. Results. The decision-making process of advanced cancer patients is mainly characterized by a lack of perceived options. Physicians do not adequately present palliative care as an alternative or additional support for these patients. Being confronted with limited options that only include active cancer treatment patients tend to choose a more paternalistic decision model leaving the treatment decision to their physicians and accepting aggressive treatments uncritically. Conclusion. A paternalistic decision-making model in advanced cancer may neglect individual wishes, values, and preferences of patients and promote a feeling of powerlessness. Empowerment of these patients is needed with context-specific SDM tools and trainings of professionals to avoid overtreatment and facilitate the timely integration of palliative care. This trial is registered in DRKS00023674.

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"别无选择"。预后有限的肺癌患者的治疗决策:定性访谈研究的结果
目的。预后有限的晚期癌症患者的决策尤其具有挑战性:不断发展的治疗算法和新的治疗方案显示出的边际效益必须与临终决策相平衡。但是,现有的晚期癌症患者决策支持工具非常罕见,没有在临床实践中常规使用,也不能充分满足患者的需求。因此,我们的项目探讨了晚期肺癌患者的经验决策过程,从而为在这种情况下使用共同决策提出建议。方法我们对肺癌患者、其亲属和医护人员进行了 20 次半结构式访谈。对所有数据进行逐字转录,并进行主题内容分析。结果晚期癌症患者决策过程的主要特点是缺乏可感知的选择。医生没有将姑息治疗作为一种替代方案或对这些患者的额外支持进行充分的介绍。面对仅包括积极癌症治疗在内的有限选择,患者倾向于选择一种家长式的决策模式,将治疗决定权交给医生,不加批判地接受积极治疗。结论。晚期癌症患者的家长式决策模式可能会忽视患者的个人意愿、价值观和偏好,使患者产生无力感。需要通过针对具体情况的 SDM 工具和对专业人员的培训来增强这些患者的能力,以避免过度治疗并促进姑息治疗的及时整合。该试验已在 DRKS00023674 中注册。
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来源期刊
European Journal of Cancer Care
European Journal of Cancer Care 医学-康复医学
CiteScore
4.00
自引率
4.80%
发文量
213
审稿时长
3 months
期刊介绍: The European Journal of Cancer Care aims to encourage comprehensive, multiprofessional cancer care across Europe and internationally. It publishes original research reports, literature reviews, guest editorials, letters to the Editor and special features on current issues affecting the care of cancer patients. The Editor welcomes contributions which result from team working or collaboration between different health and social care providers, service users, patient groups and the voluntary sector in the areas of: - Primary, secondary and tertiary care for cancer patients - Multidisciplinary and service-user involvement in cancer care - Rehabilitation, supportive, palliative and end of life care for cancer patients - Policy, service development and healthcare evaluation in cancer care - Psychosocial interventions for patients and family members - International perspectives on cancer care
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