title: Equal cancer treatment regardless of education level and family support? A qualitative study of oncologists' decision-making.
abstract: OBJECTIVE
  Treatment gradients by socioeconomic status have been observed within cancer care in several countries. The objective of this study was to explore whether patients' educational level and social network influence oncologists' clinical decision-making.
  
  
  METHODS
  Semi-structured interviews on factors considered when deciding on treatment for cancer patients. Interviews were transcribed and analysed using inductive qualitative content analysis.
  
  
  METHODS
  Oncologists in Swedish university- and non-university hospitals were interviewed in their respective places of work.
  
  
  METHODS
  Twenty Swedish clinical oncologists selected through maximum-variation sampling.
  
  
  METHODS
  Elements which influence oncologists' decision-making process were explored with focus on educational level and patients' social support systems.
  
  
  RESULTS
  Oncologists consciously used less combination chemotherapy for patients living alone, fearing treatment toxicity. Highly educated patients were considered as well-read, demanding and sometimes difficult to reason with. Patients with higher education, those very keen to have treatment and persuasive relatives were considered as challenges for the oncologist. Having large groups of relatives in a room made doctors feel outnumbered. A desire to please patients and relatives was posed as the main reason for giving in to patients' demands, even when this resulted in treatment with limited efficacy.
  
  
  CONCLUSIONS
  Oncologists tailor treatment for patients living alone to avoid harmful side-effects. Many find patients' demands difficult to handle and this may result in strong socioeconomic groups being over-treated.
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
authors.forename: Nina
authors.initials: N
authors.lastname: Cavalli-Björkman
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Peter
authors.initials: P
authors.lastname: Strang