title: Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases.
abstract: OBJECTIVE
  To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers.
  
  
  METHODS
  Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns.
  
  
  RESULTS
  Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice.
  
  
  CONCLUSIONS
  Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.
authors.affiliation: Princess Margaret Hospital, University of Toronto, 5th Floor, 610 University Avenue, M5G 2M9, Toronto, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Sze
authors.forename: Stephen
authors.initials: S
authors.lastname: Marisette
authors.forename: Diane
authors.initials: D
authors.lastname: Williams
authors.forename: Joyce
authors.initials: J
authors.lastname: Nyhof-Young
authors.forename: Dauna
authors.initials: D
authors.lastname: Crooks
authors.forename: Amna
authors.initials: A
authors.lastname: Husain
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Rebecca K S
authors.initials: RK
authors.lastname: Wong
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D001932:Brain Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary*; D017028:Caregivers / Q000523:psychology; D003110:Colonic Neoplasms / Q000473:pathology; D016371:Cranial Irradiation; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000473:pathology; D008654:Mesothelioma / Q000473:pathology; D008875:Middle Aged; D010166:Palliative Care