Understanding provision of chemotherapy to patients with end stage cancer: qualitative interview study
- Hilde M Buiting, researcher1,
- Mette L Rurup1, researcher,
- Henri Wijsbek1, ethicist,
- Lia van Zuylen, medical oncologist2 and
- Govert den Hartogh, professor in ethics1
- 1University of Amsterdam, Department of Philosophy, Oude Turfmarkt 141-147, 1012 GC Amsterdam, the Netherlands
- 2Erasmus MC, University Medical Center, Department of Medical Oncology, PO Box 2040, 3000 CA Rotterdam, the Netherlands
- Correspondence to H M Buiting h.m.buiting{at}uva.nl
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Contributors HMB, MLR, HW, and GdH designed the study. HMB carried out the study. HMB, MLR, HW, GdH, and LvZ were involved in interpreting the study findings. HMB wrote the manuscript, which was critically read by all the authors. HMB is guarantor of the study. All authors had full access to all the data in the study and can take responsibility for their integrity and the accuracy of their analysis.
Abstract
Objective To examine health professionals' experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer.
Design Purposive, qualitative design based on in-depth interviews.
Setting Oncology departments at university hospitals and general hospitals in the Netherlands.
Participants 14 physicians and 13 nurses who cared for patients with metastatic cancer.
Results Physicians and nurses reported trying to inform patients fully about their poor prognosis and treatment options. They would carefully consider the (side) effects of chemotherapy and sometimes doubted whether further treatment would contribute to patients' quality of life. Both groups considered the patients' wellbeing to be important, and physicians seemed inclined to try to preserve this by offering further chemotherapy, often followed by the patient. Nurses were more often inclined to express their doubts about further treatment, preferring to allow patients to make the best use of the time that is left. When confronted with a treatment dilemma and a patient's wish for treatment, physicians preferred to make compromises, such as by “trying out one dose.” Discussing death or dying with patients while at the same time administering chemotherapy was considered contradictory as this could diminish the patients' hope.
Conclusions The trend to greater use of chemotherapy at the end of life could be explained by patients' and physicians' mutually reinforcing attitudes of “not giving up” and by physicians' broad interpretation of patients' quality of life, in which taking away patients' hope by withholding treatment is considered harmful. To rebalance the ratio of quantity of life to quality of life, input from other health professionals, notably nurses, may be necessary.
Footnotes
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We thank K Davis, M Stapel, FE Witkamp, and MA Buiting for their valuable contributions to the study design and in the interpretation of the study findings. We also thank the physicians and nurses who participated in this study.
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Funding This study was supported by a grant from ZonMw, the Netherlands Organization for Health Research and Development (grant No 70-71300-98-048). The study sponsor had no role in the study design; collection, analysis, and interpretation of the data; or in the writing of the article and decision to submit the article for publication.
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Competing interests All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: HMB, MLR, HW, and GdH have support from the University of Amsterdam for the submitted work; the authors have no relationships with any company that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
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Ethical approval Not required.
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Data sharing No additional data available.
- Accepted 20 March 2011.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
