Factors Influencing Oncologists' Use of Chemotherapy in Patients at the End of Life: A Qualitative Study.
Year: 2011
Type: dissertation
Abstract: Background: There is a trend toward increasing use of chemotherapy among cancer patients during the last two weeks of life, even though chemotherapy is expensive, produces side effects that impact quality of life, and has little benefit in cancer patients near death. Oncologists are the gatekeepers of chemotherapy, yet, little is known regarding how they make decisions about chemotherapy in patients near death. Methods: Seventeen oncologists were individually interviewed about their chemotherapy decision practices in patients with incurable cancer. Recorded interviews were transcribed verbatim and analyzed using qualitative methods. Results: The most frequently reported explanation for late chemotherapy was that it is patient driven. Non-clinical rationales reported most often included palliation of emotional symptoms and it is easy to do. Oncologists’ susceptibility to ordering chemotherapy for non-clinical reasons was associated with their ability and willingness to discuss no treatment with patients. Their ability to have this conversation, in turn, was associated with their emotional burden, sense of personal responsibility, role dissonance, and prognostic uncertainty. Collectively, these experiences represent the emotional impact of caring for dying patients on oncologists. They suggest chemotherapy decisions arise out of and are influenced by the transactional relationship between oncologist and patient and the social context in which it occurs. Dominant models of medical decision making have neglected these factors. Conclusions: Addressing the oncologist’s emotional burden of discussing no treatment presents a new opportunity to develop interventions that may better prepare physicians to take on this difficult task and reverse the trend toward late chemotherapy, while promoting the well-being of oncologists, and improving the care of patients at end of life.
Author: Minnie Bluhm
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W189362471