scholarly journals Conflict and User Involvement in Drug Misuse Treatment Decision-Making: A Qualitative Study

2016 ◽  
pp. 141-162
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
User Involvement ◽  
Treatment Decision ◽  
Drug Misuse ◽  
Treatment Decision Making

Treatment decision-making for older adults with cancer: A qualitative study

2020 ◽  
pp. 096973302094575
Author(s):  
Ni Gong ◽  
Qianqian Du ◽  
Hongyu Lou ◽  
Yiheng Zhang ◽  
Hengying Fang ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Family Members ◽  
Treatment Decision ◽  
Chinese Society ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
The Family ◽  
Older Cancer Patients

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.

Key elements of optimal treatment decision-making for surgeons and older patients with colorectal or pancreatic cancer: A qualitative study

2017 ◽  
Vol 100 (3) ◽  
pp. 473-479 ◽  
Author(s):  
Noralie H. Geessink ◽  
Yvonne Schoon ◽  
Hanneke C.P. van Herk ◽  
Harry van Goor ◽  
Marcel G.M. Olde Rikkert
Keyword(s):  
Pancreatic Cancer ◽  
Decision Making ◽  
Qualitative Study ◽  
Older Patients ◽  
Treatment Decision ◽  
Optimal Treatment ◽  
Treatment Decision Making

scholarly journals Is race medically relevant? A qualitative study of physicians' attitudes about the role of race in treatment decision-making

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Shedra Amy Snipes ◽  
Sherrill L Sellers ◽  
Adebola Odunlami Tafawa ◽  
Lisa A Cooper ◽  
Julie C Fields ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Treatment Decision ◽  
Treatment Decision Making

scholarly journals Qualitative Study of Factors That Influence Treatment Decision-Making Among Community Oncologists and Older Patients with Acute Myeloid Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2246-2246 ◽  
Author(s):  
Kah Poh Loh ◽  
Sindhuja Kadambi ◽  
Supriya G. Mohile ◽  
Jason H. Mendler ◽  
Jane L. Liesveld ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Real Life ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Treatment Decision Making

Abstract Introduction: Despite data supporting the safety and efficacy of treatment for many older adults with AML, <40% of adults aged ≥65 receive any leukemia-directed therapy. The reasons for why the majority of older patients with AML do not receive therapy are unclear. The use of objective fitness measures (e.g. physical function and cognition) has been shown to predict outcomes and may assist with treatment decision-making, but is underutilized. As most patients are initially evaluated in community practices, exploring clinical decision-making and the barriers to performing objective fitness assessments in the community oncology setting is critical to understanding current patterns of care. We conducted a qualitative study: 1) to identify factors that influence treatment decision making from the perspectives of the community oncologists and older patients with AML, and 2) to understand the barriers to performing objective fitness assessments among oncologists. The findings will help to inform the design of a larger study to assess real-life treatment decision-making among community oncologists and patients. Methods: We conducted semi-structured interviews with 13 community oncologists (9 states) and 9 patients aged ≥60 with AML at any stage of treatment to elicit potential factors that influence treatment decisions. Patients were recruited from the outpatient clinics in a single institution and oncologists were recruited via email using purposive samples (patients: based on treatment received and stage of treatment; oncologists: based on practice location). Interviews were audio-recorded and transcribed. We utilized directed content analysis and adapted the decision-making model introduced by Zafar et al. to serve as a framework for categorizing the factors at various levels. A codebook was provisionally developed. Using Atlas.ti, two investigators independently coded the initial transcripts and resolved any discrepancies through an iterative process. The coding scheme was subsequently applied to the rest of the transcripts by one coder. Results: Median age of the oncologists was 37 years (range 34-64); 62% were females, 92% were white, 38% had practiced more than 15 years, and 92% reported seeing <10 older patients with AML annually. Median age of the patients was 70 years (64-80), 33% were females and all were Caucasian. In terms of treatment, 66% received intensive induction therapy, 22% received low-intensity treatment, and 11% received both. Three patients also received allogeneic hematopoietic stem cell transplant. Eighty-nine percent were initially evaluated and 56% were initially treated by a community oncologist. Factors that influenced treatment decision-making are shown in Figure 1. When making treatment decisions, both patients and oncologists considered factors such as patient's overall health, chronological age, comorbidities, insurance coverage, treatment efficacy and tolerability, and distance to treatment center. Nonetheless, there were distinct factors considered by patients (e.g. quality of care and facility, trust in their oncologist/team) and by oncologists (e.g. local practice patterns, availability of transplant/clinical trials, their own clinical expertise and beliefs) when making treatment decisions. The majority of oncologists do not perform an objective assessment of fitness. Most common reasons provided included: 1) Do not add much to routine assessments (N=8), 2) Lack of time, resources, and expertise (N=7), 3) Lack of awareness of the tools or the evidence to support its use (N=4), 4) Specifics are not important (e.g. impairments are clinically apparent and further nuance is not necessarily helpful; N=5), 5) Impairments are usually performed by other team members (N=2), and 6) Do not want to rely on scores (N=2). Conclusions: Treatment decision-making for older patients with AML is complex and influenced by many factors at the patient, disease/treatment, physician, and organizational levels. Despite studies supporting the utility of objective fitness assessments, these were not commonly performed in the community due to several barriers. Our framework will be useful to guide a larger study to assess real-life treatment decision-making in the community settings. We also identified several barriers raised by community oncologists that could be targeted to allow incorporation of objective fitness assessments. Figure 1. Figure 1. Disclosures Liesveld: Onconova: Other: DSMB; Abbvie: Honoraria. Stock:Jazz Pharmaceuticals: Consultancy. Majhail:Anthem, Inc.: Consultancy; Atara: Honoraria; Incyte: Honoraria. Wildes:Janssen: Research Funding. Klepin:Genentech Inc: Consultancy.

Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making

2016 ◽  
Vol 26 (12) ◽  
pp. 2063-2068 ◽  
Author(s):  
Thomas W. LeBlanc ◽  
Laura J. Fish ◽  
Catherine T. Bloom ◽  
Areej El-Jawahri ◽  
Debra M. Davis ◽  
...  
Keyword(s):  
Decision Making ◽  
Acute Myeloid Leukemia ◽  
Qualitative Study ◽  
Myeloid Leukemia ◽  
Treatment Decision ◽  
Patient Experiences ◽  
Treatment Decision Making ◽  
Acute Myeloid
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