Laura Unsöld, Nicole Deis, Anja Siegle, Michael Thomas, Matthias Villalobos
{"title":"\"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","authors":"Laura Unsöld, Nicole Deis, Anja Siegle, Michael Thomas, Matthias Villalobos","doi":"10.1155/2024/8889981","DOIUrl":null,"url":null,"abstract":"<div>\n <p><i>Objective</i>. 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. <i>Methods</i>. 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. <i>Results</i>. 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. <i>Conclusion</i>. 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.</p>\n </div>","PeriodicalId":11953,"journal":{"name":"European Journal of Cancer Care","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8889981","citationCount":"0","resultStr":"{\"title\":\"“There is No Alternative.” Treatment Decision-Making in Lung Cancer Patients with Limited Prognosis: Results of a Qualitative Interview Study\",\"authors\":\"Laura Unsöld, Nicole Deis, Anja Siegle, Michael Thomas, Matthias Villalobos\",\"doi\":\"10.1155/2024/8889981\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n <p><i>Objective</i>. 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. <i>Methods</i>. 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. <i>Results</i>. 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. <i>Conclusion</i>. 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.</p>\\n </div>\",\"PeriodicalId\":11953,\"journal\":{\"name\":\"European Journal of Cancer Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8889981\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Cancer Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/2024/8889981\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Cancer Care","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/8889981","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
“There is No Alternative.” Treatment Decision-Making in Lung Cancer Patients with Limited Prognosis: Results of a Qualitative Interview Study
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.
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