Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

Abstract

PurposePatients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives.MethodsMulticenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once).ResultsOur analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians difficulty in coping with patients suffering may limit their access to elements that can improve patients capacity to live as well as possible.ConclusionsDuring cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.

A specific method for qualitative medical research: the IPSE (Inductive Process to analyze the Structure of lived Experience) approach

“…We conducted two studies to explore the lived experience of cancer treatment; one crossed the perspectives of patients ( N = 30), their families ( N = 30), and their oncologist ( N = 10) [ 30 ], while the other one focused on what affects the quality of daily life of patients with cancer ( N = 30) during active treatment [ 110 ]. Our results led to some clinical recommendations to achieve patient-centered cancer treatment, that is, that physicians integrate the dimension of care into the curative treatments performed so that patients to live as well and not simply as long as possible [ 30 ]. To achieve this task, we found an original therapeutic lever that acts like a relational tool for physicians: the support object, defined as an object, a relationship or an activity particularly invested by the patients in their daily lives, which makes them feel good and makes the cancer and its treatment bearable.…”

“…Our group, which has worked more than a decade on the analysis, dissemination, and use of qualitative methods in medicine, has developed expertise in their use for exploring complex questions around the experience of diseases and their treatment [ 28 – 30 ]. We consider that physicians have specific concerns and that their medical training and professional experience enable them to contribute to the field of qualitative medical research differently than nurses and other healthcare professionals do.…”

Ethical perspectives in communication in cancer care: An interpretative phenomenological study

“…This study aimed to explore the experience of patients, caregivers, nurses and physicians on diagnosis and prognosis-related communication with respect to the connected meanings. In the oncological literature, there are not many studies adopting a multi-perspective design, 14 but this kind of design allows for considering the context of relationships in which disease and care are experienced. 26 Moreover, looking at how meanings are attributed and interwoven allows for seeing and comparing the different moral perspectives on diagnosis and prognosis-related communication embraced by the four figures participating in the study.…”

“…13 However, the perspectives of patients, caregivers, physicians and nurses have been seldom studied all together. 14 Dyadic 15 and triadic 16 communicative interactions have been investigated in some previous qualitative studies, but they limit the analysis to a portion of the context of care. Interpretative phenomenological analysis is a qualitative method used in health-related research to understand human experiences that are essential to the participants.…”

“…17 Studies with a multi-perspective design and adopting interpretative phenomenological analysis are quite recent and still few. 14,18 In our research, we focused on the communication experience by investigating simultaneously the perspectives of patients, their caregiver, their attending oncologist and their attending nurse. This study is part of a larger research aimed to explore communication issues related to diagnosis and prognosis in oncological wards.…”