Decision of palliative chemotherapy in late-stage cancer: The doctor-patient relationship and the decision-making process as seen by an oncologist.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 48-48
Author(s):  
Florian Scotte ◽  
Marie Pechard ◽  
Ivan Krakowski ◽  
Christophe Tournigand ◽  
marcel-Louis Viallard
Keyword(s):  
Decision Making ◽  
Late Stage ◽  
Palliative Chemotherapy ◽  
Specific Treatment ◽  
Decision Making Process ◽  
Patient Relationship ◽  
University Hospitals ◽  
Doctor Patient Relationship ◽  
Medical Progress ◽  
Late Stage Cancer

48 Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. Methods: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists. Results: The study are consistent with the literature showing that factors are in favor of treatment continuation: the patient's age, his desire to continue treatment and his life expectancy. The decision making process of chemotherapy discontinuation is marked by uncertainties, personal representations of the doctor and subjectivity in front of the objective facts that could make this decision difficult. The working conditions in cancer care and the valuation of the chemotherapy prescription can impact the decision. The constant medical progress in oncology make more complex the decision of stopping specific treatments. This study showed the singularity of the doctor-patient relationship in oncology. This can explain the difficulty to stop chemotherapy. Conclusions: The oncologist can use the collegiality which are necessary for decision to limit specific treatment. The objective is to propose the adequate care to the patient in all its dimensions. Some actions can be proposed to improve our practice: early use of palliative care for patients, analysis of practices and training to deal with uncertainty and the limits of possibilities in clinical practice.

scholarly journals Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Jennifer Wrede-Sach ◽  
Isabel Voigt ◽  
Heike Diederichs-Egidi ◽  
Eva Hummers-Pradier ◽  
Marie-Luise Dierks ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Older Patients ◽  
Self Determination ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Good Doctor ◽  
Patient Decision Making

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

1992 ◽  
Vol 1 (1) ◽  
pp. 11-31 ◽  
Author(s):  
David C. Thomasma
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Ethics Committee ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patient Decision Making ◽  
Deontological Ethics ◽  
Ethical Discussion ◽  
Patient Decision

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.

Deprescribing in Psychiatry

2019 ◽  
pp. 3-22
Author(s):  
Swapnil Gupta ◽  
Rebecca Miller ◽  
John D. Cahill
Keyword(s):  
Decision Making ◽  
Geriatric Medicine ◽  
Patient Relationship ◽  
Doctor Patient Relationship

This chapter introduces the concept of deprescribing in psychiatry, along with the rationale for its importance. Emerging from geriatric medicine, the reduction or stopping of medications in psychiatry goes beyond deciding which, when, and how to decrease a medication to also encompass psychological and social considerations. Settings for deprescribing, along with the involved ethics, are also touched upon. Deprescribing is placed in the context of recovery-oriented care as a broad-ranging intervention encompassing the complexity of decision-making and the doctor–patient relationship. The chapter sets the foundation for the rest of the book, laying out the rationale, structure, and goals of the text.

scholarly journals Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

2018 ◽  
Vol 111 (11) ◽  
pp. 407-413 ◽  
Author(s):  
Andreas Fontalis ◽  
Efthymia Prousali ◽  
Kunal Kulkarni
Keyword(s):  
Decision Making ◽  
Legal Aspects ◽  
Hippocratic Oath ◽  
Moral Issue ◽  
Assisted Dying ◽  
Patient Relationship ◽  
Current Position ◽  
Doctor Patient Relationship ◽  
Moral Principles ◽  
Constitutional Right

Summary Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship, which is fundamentally based on trust, mutual respect and the premise of ‘first do no harm’. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

Patient Satisfaction With Treatment of Breast Cancer: Does Surgeon Specialization Matter?

2007 ◽  
Vol 25 (24) ◽  
pp. 3694-3698 ◽  
Author(s):  
Jennifer F. Waljee ◽  
Sarah Hawley ◽  
Amy K. Alderman ◽  
Monica Morrow ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Patient Satisfaction ◽  
Cancer Patients ◽  
High Volume ◽  
Breast Disease ◽  
Decision Making Process ◽  
Patient Relationship ◽  
Breast Cancer Patients ◽  
Low Volume

Purpose Experience and practice setting vary greatly among surgeons who treat breast cancer patients. However, less is known about how these factors influence patient satisfaction with their care. Patients and Methods We surveyed all ductal carcinoma in situ patients and a 20% random sample of invasive breast cancer patients diagnosed in 2002 reported to the Detroit, MI, and Los Angeles, CA, Surveillance, Epidemiology, and End Results registries. Attending surgeons were surveyed, yielding dyad information for 64.6% of patients (n = 1,539) and 69.7% of surgeons (n = 318). Logistic regression was used to examine the associations between surgeon specialization (percentage of practice devoted to breast disease) and hospital cancer program status, with four domains of patient satisfaction: (1) the surgical decision, (2) decision-making process, (3) surgeon-patient relationship, and (4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage. Results In this sample, 34.5% of patients were treated by surgeons who devoted less than 30% (low volume) of their practice to breast disease, 32.5% by surgeons who devoted 30% to 60% (medium volume) of their practice to breast disease, and 33.0% by surgeons who devoted more than 60% (high volume) of their practice to breast disease. Compared to patients treated by low-volume surgeons, patients treated by higher volume surgeons were more satisfied with the decision-making process (medium volume, odds ratio [OR], 1.16; 95% CI, 0.80 to 1.67; high volume: OR, 1.79; 95% CI, 1.14 to 2.80) and with the surgeon-patient relationship (medium volume: OR, 1.13; 95% CI, 0.72 to 1.76; high volume: OR, 1.98; 95% CI, 1.08 to 3.61). Treatment setting was not associated with patient satisfaction after controlling for other factors. Conclusion Surgeon specialization is correlated with patient satisfaction. Examining the processes underlying these associations can inform strategies to improve breast cancer care.

Nudging in nursing

2018 ◽  
Vol 26 (6) ◽  
pp. 1601-1610
Author(s):  
Anne Helene Mortensen ◽  
Marita Nordhaug ◽  
Vibeke Lohne
Keyword(s):  
Decision Making ◽  
Medical Ethics ◽  
Free Will ◽  
Political Theory ◽  
Patient Autonomy ◽  
Current Knowledge ◽  
Decision Making Process ◽  
Patient Relationship ◽  
Behavioural Science ◽  
Ongoing Debate

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions (rational and pre-rational decisions, major and minor decisions) are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals.

Advanced Breast Cancer Patients' Perceptions of Decision Making for Palliative Chemotherapy

2006 ◽  
Vol 24 (7) ◽  
pp. 1090-1098 ◽  
Author(s):  
Elizabeth A. Grunfeld ◽  
E. Jane Maher ◽  
Susannah Browne ◽  
Pippa Ward ◽  
Teresa Young ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Advanced Breast Cancer ◽  
Palliative Chemotherapy ◽  
Decision Making Process ◽  
Second Line ◽  
First Line ◽  
Second Line Chemotherapy ◽  
Patient Interviews ◽  
Line Chemotherapy

Purpose To examine advanced breast cancer patients' perceptions of the key decision-making consultation for palliative chemotherapy. Patients and Methods One hundred two women with advanced breast cancer, who were offered palliative chemotherapy, participated in a study-specific semistructured interview examining perceptions of the information they had received and their involvement in the decision-making process. One hundred seventeen interviews included 70 in relation to first-line chemotherapy and 47 in relation to second-line chemotherapy (15 patients were interviewed in relation to both first- and second-line chemotherapy). Results Eighty-six percent of patient interviews (n = 101) reported patient satisfaction with the information they received, and 91% (n = 106) reported satisfaction with the decision-making process. Factors most influential in decisions to accept chemotherapy were the possibility of controlling the tumor (45%, n = 53 of patient interviews) and providing hope (33%, n = 28 of patient interviews; 19%, n = 13 being offered first-line chemotherapy v 43%, n = 20 being offered second-line chemotherapy; P = .006). Thirty-eight percent of patient interviews (n = 44) reported the patient as taking an active role in the decision-making process (33%, n = 23 at first-line chemotherapy v 43%, n = 20 at second-line chemotherapy; P = .06). Conclusion Women offered second-line chemotherapy were more likely to undergo chemotherapy because of the hope it offers and were more likely to take an active role in that decision compared with women who were offered first-line chemotherapy. Compassionate and honest communication about prognosis and likelihood of benefit from treatment may help to close the gap between hope and expectation and enable patients to make fully informed decisions about palliative chemotherapy.

Involving Minors in Medical Decision Making: Understanding Ethical Issues in Assent and Refusal of Care by Minors

2018 ◽  
Vol 38 (05) ◽  
pp. 533-538 ◽  
Author(s):  
Abigail Lang ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Pediatric Patients ◽  
Ethical Issues ◽  
Medical Decision ◽  
Decision Making Process ◽  
Patient Relationship

AbstractWhen caring for minors, the clinician–patient relationship becomes more ethically complex by the inclusion of parents in the clinician–parent–patient triad. As they age, children become more capable of participating in the decision-making process. This involvement may lead them to either accept or refuse proposed care, both of which are ethically acceptable positions when the minor's capacity to participate in decision making is carefully considered in the context of their age, development, and overall health. Certain conditions may be more likely to impact their capacity for participation, but it is important for clinicians to avoid categorical presumption that minors of a certain age or with certain conditions are incapable of participating in decisions regarding their care. Understanding the ethical bases for decision making in pediatric patients and considerations for the involvement of minors who both assent to and refuse proposed treatment will equip clinicians to respect the growing autonomy of minor patients.

Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer

2018 ◽  
Vol 49 (3) ◽  
pp. 364-375 ◽  
Author(s):  
Nuworza Kugbey ◽  
Kwaku Oppong Asante ◽  
Anna Meyer-Weitz
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Cross Sectional ◽  
Patient Relationships

Decreased quality of life is a major challenge among women living with breast cancer due to treatment effects and other psychosocial comorbidities. However, shared decision making and doctor–patient relationship have been linked to improved quality of life, but the mechanism linking shared decision making and quality of life is poorly understood. This study therefore examined both the direct and indirect influences of shared decision making on quality of life through doctor–patient relationship among 205 women living with breast cancer in Ghana with a mean age of 52.49 years. Using a cross-sectional design, participants were administered questionnaires which measured quality of life, doctor–patient relationship, and shared decision making. Results showed that shared decision making had significant indirect influence on overall quality of life via doctor–patient relationships ( b = 4.69, 95% confidence interval = [0.006, 9.555]). Shared decision making had a significant effect on doctor–patient relationships ( b = 7.63, t = 6.76, p < .001) but no significant direct effect on quality of life ( b = 2.72, t = 0.510, p = .61). Findings suggest that shared decision making results in improved doctor–patient relationships which probably lead to better quality of life among women living with breast cancer. These findings underscore the need for increased patient involvement in medical decisions to improve interpersonal relationships and consequently quality of life.

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