CONCLUSION

This study identified two beliefs regarding the patient’s acceptance of death among breast surgeons treating recurrent/metastatic cancer, and constructed a model of the terminal stage treatment process, consisting mainly of palliative chemotherapy and patient-doctor communication, based on relationships with these two beliefs. We propose that doctors who hold these beliefs, even partially, heed three points in the course of clinical practice: the need to share the patient’s value system, the need to consider how best to make use of the palliative care team, and the need to be conscious of individual differences in what the patient regards as a good death. We believe this would contribute to the ability of doctors, who make decisions about chemotherapy at the end stage for breast cancer patients in the absence of clearly-defined guidelines, to offer patients optimal care.

Acknowledgments

The authors wish to thank the 21 breast surgeon informants who took part in this research for sharing their experiences and opinions. This work was supported by ‘Support of Academic Researchers from The Uehiro Foundation on ethics and education’.


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Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Taichi Hatta reports grants from Supporting Program for InteRaction-based Initiative Team Studies (SPIRITS), Research Institute of Science and Technology for Society (RISTEX), outside the submitted work. The authors report no other conflicts of interest in this work.


Reina Ozeki-Hayashi,1 Misao Fujita,2 Atsushi Tsuchiya,3 Taichi Hatta,2 Eisuke Nakazawa,1 Yoshiyuki Takimoto,1 Akira Akabayashi1,4
1Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan; 2Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan; 3Industrial and Social Science, Tokushima University Graduate School of Technology, Tokushima, Japan; 4Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, NY, USA


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Source: Breast Cancer: Targets and Therapy.
Originally published July 17, 2019.

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