Jeremiah Stout1, Ashok Kumbamu1, Jon Tilburt1, Cara Fernandez1, Gail Geller2, Barbara Koenig3, Heinz-Josep Lenz4, Aminah Jatoi1. 1. 6915Mayo Clinic, Rochester, MN, USA. 2. Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, 1466Johns Hopkins University, Baltimore, MD, USA. 3. Institute for Health Aging, 8785University of California San Francisco, CA, USA. 4. 5116University of Southern California, Los Angeles, CA, USA.
Abstract
PURPOSE: As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer. METHODS: This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively. RESULTS: Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: "…You know this is…always really tough…But I-I think that you may need more help…I think we're close to stopping chemotherapy…And hospice is really helpful to have in place…" In contrast, the second conversation element was more convoluted: "…transplant is not an option and surgery is not an option…The options…are taking a pill…It doesn't shrink the tumor…It may help you live a little longer. But I'm worried if [you] had the pill, it's still a therapy and it still has side effects. I [am] worried if I give it to you now, that you're so weak, it will make you worse." No relationship seemed apparent between conversation elements and chemotherapy cessation. CONCLUSIONS: Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.
PURPOSE: As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer. METHODS: This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively. RESULTS: Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: "…You know this is…always really tough…But I-I think that you may need more help…I think we're close to stopping chemotherapy…And hospice is really helpful to have in place…" In contrast, the second conversation element was more convoluted: "…transplant is not an option and surgery is not an option…The options…are taking a pill…It doesn't shrink the tumor…It may help you live a little longer. But I'm worried if [you] had the pill, it's still a therapy and it still has side effects. I [am] worried if I give it to you now, that you're so weak, it will make you worse." No relationship seemed apparent between conversation elements and chemotherapy cessation. CONCLUSIONS: Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.
Entities:
Keywords:
cessation; chemotherapy; conversations; end of life; qualitative; stopping
Authors: Jon Tilburt; Kathleen J Yost; Heinz-Josef Lenz; María Luisa Zúñiga; Thomas O'Byrne; Megan E Branda; Aaron L Leppin; Brittany Kimball; Cara Fernandez; Aminah Jatoi; Amelia Barwise; Ashok Kumbamu; Victor Montori; Barbara A Koenig; Gail Geller; Susan Larson; Debra L Roter Journal: Oncologist Date: 2019-05-17
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