Understanding provision of chemotherapy to patients with end stage cancer: qualitative interview study

OBJECTIVE To examine health professionals' experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer. DESIGN Purposive, qualitative design based on in-depth interviews. Setting Oncology departments at university hospitals and general hospitals in the Netherlands. PARTICIPANTS 14 physicians and 13 nurses who cared for patients with metastatic cancer. RESULTS Physicians and nurses reported trying to inform patients fully about their poor prognosis and treatment options. They would carefully consider the (side) effects of chemotherapy and sometimes doubted whether further treatment would contribute to patients' quality of life. Both groups considered the patients' wellbeing to be important, and physicians seemed inclined to try to preserve this by offering further chemotherapy, often followed by the patient. Nurses were more often inclined to express their doubts about further treatment, preferring to allow patients to make the best use of the time that is left. When confronted with a treatment dilemma and a patient's wish for treatment, physicians preferred to make compromises, such as by "trying out one dose." Discussing death or dying with patients while at the same time administering chemotherapy was considered contradictory as this could diminish the patients' hope. CONCLUSIONS The trend to greater use of chemotherapy at the end of life could be explained by patients' and physicians' mutually reinforcing attitudes of "not giving up" and by physicians' broad interpretation of patients' quality of life, in which taking away patients' hope by withholding treatment is considered harmful. To rebalance the ratio of quantity of life to quality of life, input from other health professionals, notably nurses, may be necessary.