Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study

Reina Ozeki-Hayashi,1 Misao Fujita,2 Atsushi Tsuchiya,3 Taichi Hatta,2 Eisuke Nakazawa,1 Yoshiyuki Takimoto,1 Akira Akabayashi1,41Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan; 2Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research an...

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Autores principales:	Ozeki-Hayashi R, Fujita M, Tsuchiya A, Hatta T, Nakazawa E, Takimoto Y, Akabayashi A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Palliative Chemotherapy End-of-life decision-making process Qualitative research Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/de706f0fad4347b189394d203075dd75
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spelling	oai:doaj.org-article:de706f0fad4347b189394d203075dd752021-12-02T04:04:07ZBeliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study1179-1314https://doaj.org/article/de706f0fad4347b189394d203075dd752019-07-01T00:00:00Zhttps://www.dovepress.com/beliefs-held-by-breast-surgeons-that-impact-the-treatment-decision-pro-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Reina Ozeki-Hayashi,1 Misao Fujita,2 Atsushi Tsuchiya,3 Taichi Hatta,2 Eisuke Nakazawa,1 Yoshiyuki Takimoto,1 Akira Akabayashi1,41Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan; 2Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan; 3Industrial and Social Science, Tokushima University Graduate School of Technology, Tokushima, Japan; 4Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, NY, USAIntroduction: Although guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, “recurrent/metastatic”) breast cancer, and determine how these beliefs are related to the process of treating patients.Materials and methods: Semi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process.Results: The process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a “belief that the patient is an entity who cannot accept death,” and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a “belief that the patient is an entity who can accept death.” From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient’s ability to have a good death, they proposed terminating treatment.Conclusion: We demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care.Keywords: palliative chemotherapy, end-of-life, decision-making process, qualitative researchOzeki-Hayashi RFujita MTsuchiya AHatta TNakazawa ETakimoto YAkabayashi ADove Medical PressarticlePalliative ChemotherapyEnd-of-lifedecision-making processQualitative researchNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 11, Pp 221-229 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Palliative Chemotherapy End-of-life decision-making process Qualitative research Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Palliative Chemotherapy End-of-life decision-making process Qualitative research Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Ozeki-Hayashi R Fujita M Tsuchiya A Hatta T Nakazawa E Takimoto Y Akabayashi A Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
description	Reina Ozeki-Hayashi,1 Misao Fujita,2 Atsushi Tsuchiya,3 Taichi Hatta,2 Eisuke Nakazawa,1 Yoshiyuki Takimoto,1 Akira Akabayashi1,41Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan; 2Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan; 3Industrial and Social Science, Tokushima University Graduate School of Technology, Tokushima, Japan; 4Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, NY, USAIntroduction: Although guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, “recurrent/metastatic”) breast cancer, and determine how these beliefs are related to the process of treating patients.Materials and methods: Semi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process.Results: The process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a “belief that the patient is an entity who cannot accept death,” and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a “belief that the patient is an entity who can accept death.” From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient’s ability to have a good death, they proposed terminating treatment.Conclusion: We demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care.Keywords: palliative chemotherapy, end-of-life, decision-making process, qualitative research
format	article
author	Ozeki-Hayashi R Fujita M Tsuchiya A Hatta T Nakazawa E Takimoto Y Akabayashi A
author_facet	Ozeki-Hayashi R Fujita M Tsuchiya A Hatta T Nakazawa E Takimoto Y Akabayashi A
author_sort	Ozeki-Hayashi R
title	Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
title_short	Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
title_full	Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
title_fullStr	Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
title_full_unstemmed	Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
title_sort	beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/de706f0fad4347b189394d203075dd75
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Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study

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