Izumi Kohara1, Tomoko Inoue. 1. Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan. ikohara@jichi.ac.jp
Abstract
PURPOSE/ OBJECTIVES: To reveal the decision-making process in patients considering participation in cancer phase I clinical trials. DESIGN: Grounded theory approach. SETTING: Cancer center in a metropolitan area of Tokyo, Japan. PARTICIPANTS: 25 patients with cancer, including individuals who ultimately declined to participate in a phase I trial. METHODOLOGIC APPROACH: Semistructured interviews and unstructured observations were conducted. MAIN RESEARCH VARIABLES: Patients' decision-making process and influencing factors. FINDINGS: The core category of patients' decision-making process was searching for a way to live to the end. The process consisted of four phases: only waiting for death to come if nothing is done, assessing the value of the phase I trial, finding decisive factors, and reminding oneself that this is the right decision. Factors influencing the process included patients' perceptions of physicians' explanations of the phase I trial, patients' perceptions of their families' attitudes toward the phase I trial, patients' experiences with past anticancer therapies, and patients' attitudes toward living with cancer. CONCLUSIONS: Patient decision-making is a challenging process associated with issues about how to live at the end of life. The pattern of searching for a way to live to the end differed depending on the levels of the four factors that influenced patients' decision-making process. IMPLICATIONS FOR NURSING: Nurses play pivotal roles in talking to patients about phase I trials, discussing what is important for the rest of their lives, and recognizing that patients made a satisfying decision for themselves.
PURPOSE/ OBJECTIVES: To reveal the decision-making process in patients considering participation in cancer phase I clinical trials. DESIGN: Grounded theory approach. SETTING:Cancer center in a metropolitan area of Tokyo, Japan. PARTICIPANTS: 25 patients with cancer, including individuals who ultimately declined to participate in a phase I trial. METHODOLOGIC APPROACH: Semistructured interviews and unstructured observations were conducted. MAIN RESEARCH VARIABLES: Patients' decision-making process and influencing factors. FINDINGS: The core category of patients' decision-making process was searching for a way to live to the end. The process consisted of four phases: only waiting for death to come if nothing is done, assessing the value of the phase I trial, finding decisive factors, and reminding oneself that this is the right decision. Factors influencing the process included patients' perceptions of physicians' explanations of the phase I trial, patients' perceptions of their families' attitudes toward the phase I trial, patients' experiences with past anticancer therapies, and patients' attitudes toward living with cancer. CONCLUSIONS:Patient decision-making is a challenging process associated with issues about how to live at the end of life. The pattern of searching for a way to live to the end differed depending on the levels of the four factors that influenced patients' decision-making process. IMPLICATIONS FOR NURSING: Nurses play pivotal roles in talking to patients about phase I trials, discussing what is important for the rest of their lives, and recognizing that patients made a satisfying decision for themselves.
Authors: Diane A J van der Biessen; Merlijn A Cranendonk; Gaia Schiavon; Bronno van der Holt; Erik A C Wiemer; Ferry A L M Eskens; Jaap Verweij; Maja J A de Jonge; Ron H J Mathijssen Journal: Oncologist Date: 2013-02-21