Decision-making and autonomy among participants in early-phase cancer immunotherapy trials: a qualitative study.

Autor: Avery J; School of Nursing, University of British Columbia, Vancouver, BC, Canada.; Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada., Bell JAH; Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. Jennifer.bell2@uhn.ca.; Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada. Jennifer.bell2@uhn.ca.; The Institute for Education Research, University Health Network, Toronto, ON, Canada. Jennifer.bell2@uhn.ca.; Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Jennifer.bell2@uhn.ca.; Princess Margaret Cancer Centre, Department of Supportive Care, Research Division, 700 Bay St., 23rd Floor, Toronto, ON, M5G 1Z6, Canada. Jennifer.bell2@uhn.ca., Baryolay K; Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada., Rodin G; Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.; Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Cancer Experience, University Health Network Cancer Program, University Health Network, Toronto, ON, Canada.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada., Nissim R; Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Balneaves LG; Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada.
Jazyk: angličtina
Zdroj: BMC cancer [BMC Cancer] 2024 Mar 25; Vol. 24 (1), pp. 373. Date of Electronic Publication: 2024 Mar 25.
DOI: 10.1186/s12885-024-12119-7
Abstrakt: Background: Participants considering early-phase cancer clinical trials (CTs) need to understand the unique risks and benefits prior to providing informed consent. This qualitative study explored the factors that influence patients' decisions about participating in early-phase cancer immunotherapy CTs through the ethical lens of relational autonomy.
Methods: Using an interpretive descriptive design, interviews were conducted with 21 adult patients with advanced cancer who had enrolled in an early-phase CT. Data was analyzed using relational autonomy ethical theory and constant comparative analysis.
Results: The extent to which participants perceived themselves as having a choice to participate in early-phase cancer immunotherapy CTs was a central construct. Perceptions of choice varied according to whether participants characterized their experience as an act of desperation or as an opportunity to receive a novel treatment. Intersecting psychosocial and structural factors influenced participants' decision making about participating in early-phase cancer immunotherapy trials. These relational factors included: (1) being provided with hope; (2) having trust; (3) having the ability to withdraw; and (4) timing constraints.
Conclusions: Findings highlight the continuum of perceived choice that exists among patients with cancer when considering participation in early-phase cancer immunotherapy CTs. All participants were interpreted as exhibiting some degree of relational autonomy within the psychosocial and structural context of early-phase CT decision making. This study offers insights into the intersection of cancer care delivery, personal beliefs and values, and established CT processes and structures that can inform future practices and policies associated with early-phase cancer immunotherapy CTs to better support patients in making informed decisions.
(© 2024. The Author(s).)
Databáze: MEDLINE
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