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Avoidable harm: making decisions about chemotherapy with advanced lung cancer patients

Nelson, Annmarie ORCID:, Longo, Mirella ORCID:, Sivell, Stephanie ORCID:, Byrne, Anthony, Lester, Jason, Anagnostou, Despina and Sampson, Catherine 2019. Avoidable harm: making decisions about chemotherapy with advanced lung cancer patients. Presented at: NCRI 2019, Glasgow, UK, 3-5 November 2019.

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Background Most non-small cell lung cancer (NSCL) patients that present with metastatic disease are unsuitable for curative treatment and many receive chemotherapy for symptom control. Some of these patients will die on, or within 30 days, of chemotherapy. Method The PACT study was a five stage, multi-site qualitative study (n=97) using multiple methodologies to observe how decisions around treatment in NSCLC are made. Observations of multidisciplinary team (MDT) meetings, patient consultations, and interviews with patients and oncologists tracked the treatment decision-making process. Mediated discourse, thematic, framework and narrative analysis were used to analyse the data. Results At MDT meetings, patients were not fully visible because patients’ social information were limited and varied between sites. MDT members constructed treatment recommendations mainly around patient pathology, clinical information and imaging. Information on the priorities and preferences of patients was not formally integrated into the oncology consultation. With a rapid disease trajectory, the health of the patient might change significantly. This placed additional stress on the oncologist, who had to re-evaluate the patients, with the potential need to consider a different treatment option to that suggested at the MDT. Patients did not understand the decision-making purpose of the oncology consultation and focused on relationships, placing their disease in the context of everyday life. For the patient, the treatment context was focused on external priorities, such as being able to attend a special family event, prior understanding and experience of particular treatments, and existing relationships with health professionals, such as the chest physician. Conclusion The NHS seeks to place patients’ needs, wishes and preferences at the heart of clinical decision-making; however, the current pathway for NSCLC patients focuses on clinical management at the expense of patient-centred care. Future work will test the feasibility of applying a patient-held communication tool at the different stages of the patient pathway.

Item Type: Conference or Workshop Item (Poster)
Status: Published
Schools: Medicine
Marie Curie Palliative Care Research Centre (MCPCRC)
Last Modified: 24 Jul 2023 13:30

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