title: Fit and misfit.
abstract: This article presents an interpretive case analysis of an older adult's experience with treatment decision making for acute myeloid leukemia. Interview and observational data were compared and contrasted with key constructs in behavioral decision theory to analyze theoretical utility and fit. Decision making involved a complex interplay among the patient, treating clinicians, and family members. While some constructs of decision theory, such as trade-offs, avoidance-avoidance, and the certainty effect, showed utility for decision making in geriatric oncology, this case demonstrated that individual preferences for treatment may be expressed in quality of life preferences rather than a specific treatment decision. The Cage, a major theme in this case, represented the trap of two undesirable choices in treatment decision making, as well as the imprisoning consequence of aggressive medical treatment for advanced cancer. Further decision making research is needed to develop practice-level theory that can more effectively support and guide treatment decision making in geriatric oncology.
authors.affiliation: Department of acute and Tertiary Care, Department of Health and Community System, University of Pittsburg School of Nursing, Pittsburg, PA 15261, USA. mhapp@pitt.edu
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Crighton
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lingler
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Happ
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003662:Decision Theory; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents