Abstract
The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to collect data on their feelings and thoughts from the time of diagnosis till they made treatment decisions. The data was analyzed using the Modified Grounded Theory Approach that was modified by Prof. Yasuhito Kinoshita. We found the process to be composed of six categories. The results showed that elderly patients with advanced lung cancer were panicked over unavoidable death when informed of stage IV lung cancer and offered suggestions about anti-cancer treatment. However, trying to accept the situation where death is imminent, patients reconsidered having cancer in older age and recognized a desire to survive even in older age. This process diverged into two paths: one group of patients changed their ideas from radical to life-prolonging treatment by recognizing a desire to survive even in older age and then made anti-cancer treatment decisions by carefully choosing treatment that would allow to carry on their usual way of life; the other group of patients made treatment decisions by carefully choosing physicians to whom they could entrust their life in older age. These findings suggest that it is important for nurses to: 1) encourage patients to talk in order to have them think about what they have valued and want to value in the rest of their life; 2) assess if patients prefer to decide on their own by carefully choosing treatment or entrust treatment decisions to physicians; and 3) offer support according to patients’ preferences.
Highlights
Lung cancer is the leading cause of cancer deaths in Japan; it is a disease whose incidence increases with advancing age [1]
This study aimed to identify the processes of how elderly patients diagnosed with advanced lung cancer make anti-cancer treatment decisions, in order to obtain implications for nursing practice that supports anti-cancer treatment decision-making in elderly patients
The process of decision-making of anti-cancer treatment in elderly patients with advanced lung cancer was composed of six categories, diverged into two paths after recognizing a desire to survive even in older age
Summary
Lung cancer is the leading cause of cancer deaths in Japan; it is a disease whose incidence increases with advancing age [1]. More treatment options for patients with advanced lung cancer without surgery indication have been available owing to the development of anti-cancer drugs and supportive care. More treatment options have been available for elderly patients as well [4] For those who have already had stage IV lung cancer at the time of diagnosis, physicians may offer the option of anti-cancer drug treatment together with the option of no treatment or the suggestion of palliative care. In this case, the patient has to make an extremely difficult choice
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