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Equal cancer treatment regardless of education level and family support?: A qualitative study of oncologists’ decision-making
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
2012 (engelsk)Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, nr 4, s. e001248-Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Treatment gradients by socioeconomic status have been observed within cancer care in several countries. The objective of this study was to explore whether patients' educational level and social network influence oncologists' clinical decision-making. Design: Semi-structured interviews on factors considered when deciding on treatment for cancer patients. Interviews were transcribed and analysed using inductive qualitative content analysis. Setting: Oncologists in Swedish university-and non-university hospitals were interviewed in their respective places of work. Participants: Twenty Swedish clinical oncologists selected through maximum-variation sampling. Primary and secondary outcome measures: Elements which influence oncologists' decision-making process were explored with focus on educational level and patients' social support systems. Results: Oncologists consciously used less combination chemotherapy for patients living alone, fearing treatment toxicity. Highly educated patients were considered as well-read, demanding and sometimes difficult to reason with. Patients with higher education, those very keen to have treatment and persuasive relatives were considered as challenges for the oncologist. Having large groups of relatives in a room made doctors feel outnumbered. A desire to please patients and relatives was posed as the main reason for giving in to patients' demands, even when this resulted in treatment with limited efficacy. Conclusions: Oncologists tailor treatment for patients living alone to avoid harmful side-effects. Many find patients' demands difficult to handle and this may result in strong socioeconomic groups being over-treated.

sted, utgiver, år, opplag, sider
2012. Vol. 2, nr 4, s. e001248-
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-172518DOI: 10.1136/bmjopen-2012-001248ISI: 000315049300078OAI: oai:DiVA.org:uu-172518DiVA, id: diva2:514843
Tilgjengelig fra: 2012-04-11 Laget: 2012-04-11 Sist oppdatert: 2017-12-07bibliografisk kontrollert
Inngår i avhandling
1. Factors Influencing Selection of Treatment for Colorectal Cancer Patients
Åpne denne publikasjonen i ny fane eller vindu >>Factors Influencing Selection of Treatment for Colorectal Cancer Patients
2012 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown.

The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV.

In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients.

In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2012. s. 45
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 774
Emneord
colorectal cancer, socioeconomic status, clinical trials, education level, family support, living alone, patient-physician interaction
HSV kategori
Forskningsprogram
Onkologi
Identifikatorer
urn:nbn:se:uu:diva-172533 (URN)978-91-554-8363-0 (ISBN)
Disputas
2012-06-13, Skoogsalen, Akademiska Sjukhuset Ingång 78, 1 tr, Uppsala, 09:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2012-05-21 Laget: 2012-04-11 Sist oppdatert: 2012-08-01bibliografisk kontrollert

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