Understanding provision of chemotherapy to patients with end stage cancer: qualitative interview study
Autor: | Govert den Hartogh, Mette L. Rurup, Hilde M. Buiting, Lia van Zuylen, H.W.J.M. Wijsbek |
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Přispěvatelé: | Public Health, Medical Oncology |
Rok vydání: | 2011 |
Předmět: |
Adult
Male Attitude of Health Personnel medicine.medical_treatment MEDLINE End of Life Decisions (Palliative Care) Medicine (miscellaneous) End of Life Decisions (Geriatric Medicine) Antineoplastic Agents End of Life Decisions (Ethics) Quality of life (healthcare) Sociology Nursing SDG 3 - Good Health and Well-being Neoplasms Medical Staff Hospital medicine Humans Neoplasm Metastasis Physician-Patient Relations Terminal Care Chemotherapy Withholding Treatment Oncology (nursing) business.industry Research Qualitative interviews General Medicine University hospital Assisted Dying Stroke Dilemma Medical–Surgical Nursing Female business Attitude to Health Delivery of Health Care End stage cancer |
Zdroj: | The BMJ British Medical Journal, 342(4):d1933. BMJ Publishing Group |
ISSN: | 0959-535X |
Popis: | 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. |
Databáze: | OpenAIRE |
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