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abstract
Purpose: The value of
chemotherapy for patients with cancer in the last weeks of life warrants
examination. Late chemotherapy may
not improve survival or quality of life but
typically precludes hospice enrollment and may result in additional
symptoms,
increased use of other aggressive treatments,
and worsening quality of life. Few studies have explored oncologists’
rationales
for administering chemotherapy near death. This
study examines the self-reported factors that influence oncologists’
decisions
about late chemotherapy.
Methods: In-depth
individual interviews were conducted with 17 oncologists through a
semistructured interview guide. Interviews were
audio recorded and transcribed verbatim.
Transcripts were coded and analyzed using conventional content analysis,
a qualitative
method that allows the detection and analysis of
patterns in the data.
Results: Clinical
factors take priority in determining late chemotherapy decisions when
clear treatment choices exist. When clinical
factors are ambiguous, emotion becomes a highly
salient influence. Oncologists view late chemotherapy to be patient
driven
and use it to palliate emotional distress and
maintain patient hope even when physical benefit is unexpected.
Oncologists
experience unique and difficult challenges when
caring for dying patients, including emotionally draining communication,
overwhelming
responsibility for life/death, limitations of
oncology to heal, and prognostic uncertainty. These challenges are also
eased
by offering late chemotherapy.
Conclusion: The
findings reveal a nuanced understanding of why oncologists find it
difficult to refuse chemotherapy treatment for patients
near death. Optimal end-of-life treatment
decisions require supportive interventions and system change, both of
which must
take into account the challenges oncologists
face.
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