title: "Well, I think there is great variation...": a qualitative study of oncologists' experiences and views regarding medical criteria and other factors relevant to treatment decisions in advanced cancer.
abstract: BACKGROUND
  Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment.
  
  
  METHODS
  Qualitative in-depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed.
  
  
  RESULTS
  Physicians reported that a number of nonmedical factors influence professional decisions about the offering or limiting of cancer treatment in advanced cancer in addition to medical criteria. Physicians' individual judgments about the benefit of treatment, as well as the amount of their clinical experience, were cited as such factors. In addition, the physicians' perceptions of the patient's age and life circumstances were reported to influence their treatment decisions. Multiprofessional team discussions and the systematic collection of relevant clinical data regarding the outcomes of different treatment approaches in advanced cancer were suggested as strategies to improve the quality of treatment decisions.
  
  
  CONCLUSIONS
  The findings of this study provide explanations for the variation in treatment in advanced cancer. Making value judgments explicit and gathering more appropriate clinical data on the outcomes of treatment near the end of life are prerequisites for improved ethical and evidence-based treatment decisions in advanced cancer.
authors.affiliation: Institute for Medical Ethics and History of Medicine, Ruhr-Universitaet Bochum, Malakowturm-Markstraße 258a, D-44799 Bochum, Germany. jan.schildmann@rub.de
authors.forename: Jan
authors.initials: J
authors.lastname: Schildmann
authors.forename: Jacinta
authors.initials: J
authors.lastname: Tan
authors.forename: Sabine
authors.initials: S
authors.lastname: Salloch
authors.forename: Jochen
authors.initials: J
authors.lastname: Vollmann
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000941:ethics*; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics