Document Detail


[Treatment decisions in advanced cancer. An empirical-ethical study on physicians' criteria and the process of decision making].
MedLine Citation:
PMID:  21046529     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND RESEARCH QUESTION: Physicians' decisions regarding the indication of medical treatment are central to the application or limitation of medical measures in advanced cancer. This qualitative study explores criteria and procedural aspects of treatment decisions with patients with cancer near the end of life from the perspective of oncologists.
RESEARCH PARTICIPANTS AND METHODS: In this qualitative interview study physicians working in the field of oncology were asked about their decisional criteria and procedural aspects of treatment decision making in cases of patients with advanced cancer. All interviews were audiotaped and transcribed. Qualitative data analysis was conducted in accordance with principles of "Grounded Theory".
RESULTS: 17 research interviews had been analysed. Next to medical criteria the life-circumstances of the patients with respect to age and social situation as well as the perceived quality of the physician-patient-relationship were named as foundation for decisions about the application or limitation of medical treatment at the end of life. In addition situational factors such as time pressure or the available technical equipment were cited as relevant factors for the decisions. "Silent acquiescence" as the predominant decision making model which has been reconstructed on the basis of the narratives means that decisions about the limitation of medical treatment are not communicated explicitly within the physician-patient-relationship. This approach was justified by the interviewees in light of the long standing relationship between physicians and patients.
CONCLUSIONS: The decisional criteria and procedural aspects of decision making in patients with advanced cancer which have been elicited in this qualitative study inform the current scientific and societal debate on ethically relevant aspects of end-of-life decision making in medicine.
Authors:
J Schildmann; J Vollmann
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Publication Detail:
Type:  English Abstract; Journal Article     Date:  2010-11-02
Journal Detail:
Title:  Deutsche medizinische Wochenschrift (1946)     Volume:  135     ISSN:  1439-4413     ISO Abbreviation:  Dtsch. Med. Wochenschr.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-03     Completed Date:  2010-11-30     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  0006723     Medline TA:  Dtsch Med Wochenschr     Country:  Germany    
Other Details:
Languages:  ger     Pagination:  2230-4     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Affiliation:
Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Bochum, Germany. jan.schildmann@rub.de
Vernacular Title:
Behandlungsentscheidungen bei Patienten mit fortgeschrittenen Tumorerkrankungen. Eine empirisch-ethische Untersuchung zur ärztlichen Indikationsstellung und Entscheidungsfindung.
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MeSH Terms
Descriptor/Qualifier:
Adult
Advance Directives / ethics
Age Factors
Aged
Attitude of Health Personnel*
Clinical Competence
Communication
Data Collection
Disease Progression
Ethics, Medical*
Family Relations
Female
Germany
Humans
Interview, Psychological
Male
Medical Futility / ethics*
Medical Oncology / ethics
Middle Aged
Neoplasm Staging
Neoplasms / pathology,  therapy*
Palliative Care / ethics
Physician-Patient Relations / ethics
Withholding Treatment / ethics*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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