What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a752 (Published 31 July 2008) Cite this as: BMJ 2008;337:a752
- Suzanne Audrey, research associate1,
- Julian Abel, consultant in palliative care2,
- Jane M Blazeby, professor of surgery and honorary consultant surgeon34,
- Stephen Falk, consultant clinical oncologist5,
- Rona Campbell, professor of health services research1
- 1University of Bristol, Department of Social Medicine, Bristol BS8 2PR
- 2Weston Area Healthcare Trust, Uphill, Weston-super-Mare, BS23 4TQ
- 3University of Bristol, Clinical Sciences at South Bristol and Department of Social Medicine, Bristol BS8 2PR
- 4Divison of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW
- 5Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED
- Correspondence to: S Audrey Suzanne.Audrey{at}bristol.ac.uk
- Accepted 13 June 2008
Abstract
Objective To examine how much oncologists tell patients about the survival benefit of palliative chemotherapy during consultations at which decisions about treatment are made.
Design Qualitative study in which consultations were observed and digitally recorded.
Setting Teaching hospital and district general hospital in south west England.
Participants 37 patients with advanced non-small cell lung cancer (n=12), pancreatic cancer (n=13), and colorectal cancer (n=12); and nine oncologists, including four consultants and five registrars.
Main outcome measures All recordings were transcribed completely, anonymised, and electronically coded with ATLAS.ti. Constant comparison was used to identify themes and patterns. The framework method of data management, in which data were charted, was used to aid transparency of interpretation.
Results During the consultations, information given to patients about survival benefit included numerical data (“about four weeks”), an idea of timescales (“a few months extra”), vague references (“buy you some time”), or no mention at all. In most consultations (26/37) discussion of survival benefit was vague or non-existent.
Conclusions Most patients were not given clear information about the survival gain of palliative chemotherapy. To aid decision making and informed consent, we recommend that oncologists sensitively describe the benefits and limitations of this treatment, including survival gain.
Footnotes
We thank all the patients and their families who shared their experiences with us. Their contribution to the research is invaluable. We are also grateful to the oncologists who were willing to be observed and recorded. Polly Nugent drafted an initial literature review. Jen Jamieson transcribed the recordings and was a source of considerable support during the fieldwork.
Contributors: JA had the initial idea for the ASPECTS study. RC, JA, and JMB designed the study and wrote the successful research proposal. JA and RC undertook pilot interviews. JA and JMB helped with patient recruitment. SA undertook the fieldwork for the main study and coded, charted, and analysed the data for this paper, which was scrutinised and discussed by the other authors. SA wrote the first draft. All authors commented on and contributed to the final draft. RC is guarantor.
Funding: Cancer Research UK, C17713/A6132.
Competing interests: None declared.
Ethical approval: North Somerset research ethics committee, ref 05/Q2003/46.
Provenance and peer review: Not commissioned; externally peer reviewed.
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