title: Searching for a way to live to the end: decision-making process in patients considering participation in cancer phase I clinical trials.
abstract: OBJECTIVE
  To reveal the decision-making process in patients considering participation in cancer phase I clinical trials.
  
  
  METHODS
  Grounded theory approach.
  
  
  METHODS
  Cancer center in a metropolitan area of Tokyo, Japan.
  
  
  METHODS
  25 patients with cancer, including individuals who ultimately declined to participate in a phase I trial.
  
  
  METHODS
  Semistructured interviews and unstructured observations were conducted.
  
  
  METHODS
  Patients' decision-making process and influencing factors.
  
  
  RESULTS
  The core category of patients' decision-making process was searching for a way to live to the end. The process consisted of four phases: only waiting for death to come if nothing is done, assessing the value of the phase I trial, finding decisive factors, and reminding oneself that this is the right decision. Factors influencing the process included patients' perceptions of physicians' explanations of the phase I trial, patients' perceptions of their families' attitudes toward the phase I trial, patients' experiences with past anticancer therapies, and patients' attitudes toward living with cancer.
  
  
  CONCLUSIONS
  Patient decision-making is a challenging process associated with issues about how to live at the end of life. The pattern of searching for a way to live to the end differed depending on the levels of the four factors that influenced patients' decision-making process.
  
  
  CONCLUSIONS
  Nurses play pivotal roles in talking to patients about phase I trials, discussing what is important for the rest of their lives, and recognizing that patients made a satisfying decision for themselves.
authors.affiliation: Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan. ikohara@jichi.ac.jp
authors.forename: Izumi
authors.initials: I
authors.lastname: Kohara
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D044466:Asian People / Q000523:psychology; D001293:Attitude to Death; D001294:Attitude to Health; D017321:Clinical Trials, Phase I as Topic / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000451:nursing / Q000523:psychology; D015404:Nursing Methodology Research; D009859:Oncology Nursing; D010358:Patient Participation / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology
chemical_list: D000970:Antineoplastic Agents