Open Access“Well, I Think There Is Great Variation…”: A Qualitative Study of Oncologists' Experiences and Views Regarding Medical Criteria and Other Factors Relevant to Treatment Decisions in Advanced Cancer
Author(s) -
Schildmann Jan,
Tan Jacinta,
Salloch Sabine,
Vollmann Jochen
Publication year - 2013
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2012-0206
Subject(s) - medicine , nonprobability sampling , qualitative research , family medicine , limiting , cancer , cancer treatment , quality of life (healthcare) , relevance (law) , nursing , population , mechanical engineering , social science , environmental health , sociology , political science , law , engineering
CME Learning ObjectivesList non‐medical factors that influence decisions about limiting treatment in advanced cancer. Discuss the problems associated with value‐based treatment recommendations. Describe possible strategies for improved ethics and evidence‐based treatment decision making in advanced cancer.Background. Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment. Methods. Qualitative in‐depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed. Results. Physicians reported that a number of nonmedical factors influence professional decisions about the offering or limiting of cancer treatment in advanced cancer in addition to medical criteria. Physicians' individual judgments about the benefit of treatment, as well as the amount of their clinical experience, were cited as such factors. In addition, the physicians' perceptions of the patient's age and life circumstances were reported to influence their treatment decisions. Multiprofessional team discussions and the systematic collection of relevant clinical data regarding the outcomes of different treatment approaches in advanced cancer were suggested as strategies to improve the quality of treatment decisions. Conclusion. The findings of this study provide explanations for the variation in treatment in advanced cancer. Making value judgments explicit and gathering more appropriate clinical data on the outcomes of treatment near the end of life are prerequisites for improved ethical and evidence‐based treatment decisions in advanced cancer.