Equal cancer treatment regardless of education level and family support? A qualitative study of oncologists’ decision-making

Abstract

ObjectiveTreatment gradients by socioeconomic status have been observed within cancer care in several countries. The objective of this study was to explore whether patients’ educational level and social network influence oncologists’ clinical decision-making.DesignSemi-structured interviews on factors considered when deciding on treatment for cancer patients. Interviews were transcribed and analysed using inductive qualitative content analysis.SettingOncologists in Swedish university- and non-university hospitals were interviewed in their respective places of work.ParticipantsTwenty Swedish clinical oncologists selected through maximum-variation sampling.Primary and secondary outcome measuresElements which influence oncologists’ decision-making process were explored with focus on educational level and patients’ social support systems.ResultsOncologists consciously used less combination chemotherapy for patients living alone, fearing treatment toxicity. Highly educated patients were considered as well-read, demanding and sometimes difficult to reason with. Patients with higher education, those very keen to have treatment and persuasive relatives were considered as challenges for the oncologist. Having large groups of relatives in a room made doctors feel outnumbered. A desire to please patients and relatives was posed as the main reason for giving in to patients’ demands, even when this resulted in treatment with limited efficacy.ConclusionsOncologists tailor treatment for patients living alone to avoid harmful side-effects. Many find patients’ demands difficult to handle and this may result in strong socioeconomic groups being over-treated.

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

“…EOL conversations with physicians resulted in significantly lower health care costs in the final week of life and led to better quality of death [37]. It is still a challenge many oncologists face when discussing with patients and their caregivers the option of stopping chemotherapy [38,39]. Being hesitant to stop futile palliative chemotherapy may lead to aggressive EOL care and life-sustaining treatment.…”

Palliative Chemotherapy Near the End of Life in Oncology Patients

“…[8][9][10] The American Society of Clinical Oncology recommends avoiding the use of chemotherapy near EOL because there is a lack of evidence supporting its clinical value. 11 Chemotherapy in patients with poor performance status is also associated with a greater probability of dying in the hospital. [12][13][14][15] For patients at EOL, Western countries are using more targeted therapy and immunotherapies that are felt to be less toxic, while data on the real-world situation in China are limited.…”

Chemotherapy and targeted therapy near the end of life affects aggressiveness of palliative care

“…Some physicians from cancer-specialty hospitals have systematically studied palliative care guidelines, but as a rule, physicians overestimate prognosis by at least 30% (11). Those from general hospitals lack professional palliative care knowledge, and it is difficult for many oncologists and caregivers to provide the option of stopping chemotherapy (12,13). Hesitation regarding cessation of futile PCT might lead to more aggressive EOL care and life-sustaining treatment.…”