Exploring personal values of patients with advanced lung cancer in the hospital setting: a mixed-methods study

Abstract

Purpose Guidelines recommend the discussion of treatment and care goals of patients with advanced cancer according to their values and preferences. Little is known about the value system of these patients and how to address them in the hospital setting. Methods Convergent mixed-methods design: collection of quantitative data of patients with advanced lung cancer from a German University Hospital (n = 66) using the Human Values Scale, group comparison after a propensity score matching with the German cohort of the 9th European Social Survey, semi-structured interviews (n = 17) and qualitative content analysis, integration of data using side-by-side display. Results Quantitative analysis shows that lung cancer patients prioritize significantly more the value dimensions of self-transcendence (universalism, benevolence; p = .02) and openness to change (self-direction, stimulation; p = .03). While values of conservation (conformity, tradition, security; p = .04) and self-enhancement (power, achievement; p = .02) are notably less important. Besides the affirmation of self-direction, qualitative data, contrastingly, shows strong “conformity” with medical treatment decisions and the importance of “security”, while revealing the systematic neglect of values in patient-physician conversations. Conclusions The values guiding lung cancer patients differ from the general population. Despite the expressed importance of self-direction strong conformity arises in regard to medical treatment decisions. This may show the need of feeling secure in a complex and uncertain setting but has also the risk of over-treatment, hazarding goal-concordant care and the timely integration of palliative care, particularly when considering the neglect of values exposed.