Preferences in a Group of Patients with Cancer: A Grounded Theory

Abstract

Purpose: This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia. Methods: A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory. Results: A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life. Conclusion:The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia

“… There is a need to articulate biomedical health care with sociocultural factors of cancer. Factors such as risk perception, search for care, and patients’ preferences are determinants insofar as these are related to morbidity, severity, survival, and other treatment outcomes in patients with cancer [ 13 , 28 , 29 , 30 ]. The recognition of the relationships between the causal attributions and the adherence of patients to the biomedical treatment may have some implications in patient care, treatment, clinical practice, and public health: health workers identify dimensions that affect the effectiveness of their practices and in the doctor–patient relationship it is necessary to promote person-centered medicine with recognition of sociocultural determinants of cancer; health education-communication can identify strategic issues for patients and relatives; health care must be interprofessional to impact the multidimensionality of the etiology and treatment of cancer; health systems and public health policies must be designed, implemented, and evaluated with the knowledge of the community since their attributions are determinants of the outcomes of cancer.…”

“…There is a need to articulate biomedical health care with sociocultural factors of cancer. Factors such as risk perception, search for care, and patients’ preferences are determinants insofar as these are related to morbidity, severity, survival, and other treatment outcomes in patients with cancer [ 13 , 28 , 29 , 30 ].…”

Influence of Positive Thinking Ideology on Physician Representations of Cancer

“…They are presented with therapeutic alternatives that can be difficult to assess rationally, and to this are added moral dilemmas and social difficulties [12]. Therefore, patients prefer (even are forced to) transfer to physicians a good part of the decision making related to their health and their daily life [13].…”