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Breast Cancer Patients’ Preferences for Truth Versus Hope Are Dynamic and Change During Late Lines of Palliative Chemotherapy
Jenny Bergqvist, MD, PhD, and Peter Strang, MD, PhD, Professor
Department of Oncology-Pathology (P.S., J.B.), Karolinska Institutet, Stockholm; Department of Research and Development (P.S.), Stockholms Sjukhem Foundation, Stockholm; and Department of Surgery (J.B.), Capio St G€orans Sjukhus, Stockholm, Sweden
Context. Women with metastatic breast cancer often receive many lines of palliative chemotherapy, which might be beneficial but also harmful. Still, little is known about the patients’ perception of the patient-doctor communication regarding late lines of noncurative treatment.
Objectives. Our aim was to explore breast cancer patients’ preferences and perceptions of patient-doctor communication regarding continuous late lines of palliative chemotherapy.
Patients and Methods. A qualitative study was conducted with semiguided face-to-face interviews with 20 women,
40e80 years old, on at least their second line of palliative chemotherapy (second to eighth line). We used a qualitative
conventional content analysis.
Results. All women knew they had incurable breast cancer but expressed hope for cure. Patients’ definition of a good compassionate doctor was one who gives positive news and leaves room for hope. Ongoing chemotherapy, positive news from the doctors, and support from relatives encouraged hope. The women often expressed they accepted chemotherapy to please their doctor and relatives. The informants appreciated the doctor to be honest, but within positive limits. Over time, they stopped asking questions afraid of getting bad news, and left more and more treatment decisions to the doctor.
Conclusions. The women’s preferences for truth versus hope in patient-doctor communication changed over time, which increase the risk for continuous late lines of palliative chemotherapy by common collusion. Doctors need to individualize information, help patients make sense of their life, and allow hope to endure without further chemotherapy. J Pain Symptom Manage 2019;57:746e752. 2019 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
Communication, breast cancer, palliative chemotherapy, decision making, psycho-oncology