The treatment that a doctor recommends for advanced cancer does not depend only on medical aspects. The doctor’s relationship to individual patients and the doctor’s own view of his or her life situation at the patient’s age also plays a role, according to recent research.
“Treatment decisions in advanced, life-threatening diseases are among the most difficult challenges in medicine,” said PD Dr. med. Jan Schildmann, MA, of the Ruhr-Universität Bochum (RUB), who heads the North Rhine-Westphalian junior research group “Medical Ethics at the End of Life: Norm and Empiricism.” Often scientific data on the benefits and harm of therapies in such situations is scarce.
Scientists investigated what criteria the doctors based their decisions on and how the cancer patients evaluated the explanation of potential therapies. This was accomplished by interviewing physicians working in medical oncology and cancer patients, and then qualitatively evaluating the discussions.
When making decisions for or against a therapy, doctors considered the age and life situation of a patient, such as whether they had a family, in addition to medical factors. One of the participating doctors said, “I think instinctively you feel that this is a young patient with a young family. You need to make even more effort to try and help them live for a bit longer.”
The doctors also made comparisons to their own age and their own life situation. “I most recently had a young woman … with teenage daughters, the same age as my daughters, so there was a sense of … it shouldn’t influence, but you can picture the person the same as yourself,” said a physician-interviewee.
The research team explored the wishes of patients by interviewing people with pancreatic cancer. They found that, at the start of treatment, patients hardly processed the information they received. Their confidence in the doctor was crucial. One patient said, “I placed my life and my illness in the hands of the specialists and said you will do this right.”
Over the course of the disease, however, the patients learned to process the doctors’ words better. Then, they wanted more information and to be involved in the decision on possible therapies.
“The results of this qualitative study cannot be applied to the entire cohort of oncologists, or all patients with cancer,” said Schildmann. However, results of other research groups have also pointed out that doctors’ treatment recommendations are based not purely on medical aspects. “Doctors should reflect on the value judgments that play a role in the recommendations. They should also consider what information really enables patients to participate in decision-making according to their wishes at a certain time.”
The research on oncologists was published in The Oncologist (2013; doi: 10.1634/theoncologist.2012-0206), and that on patients was published in Annals of Oncology (2013; doi: 10.1093/annonc/mdt193).