title: Phase 1 clinical trials in end-stage cancer: patient understanding of trial premises and motives for participation.
abstract: BACKGROUND
  In cancer, phase 1 clinical trials on new drugs mostly involve patients with advanced disease that is unresponsive to standard therapy. The purpose of this study was to explore the difficult ethical problems related to patient information and motives for participation in such trials.
  
  
  METHODS
  A descriptive and explorative qualitative design was used. Fourteen cancer patients from three different phase 1 trials in end-stage cancer were interviewed. The interviews were analysed using qualitative content analysis.
  
  
  RESULTS
  The patients expressed unrealistic expectations of therapeutic benefit and inadequate understanding of the trials' purpose, so-called therapeutic misconception. However, they reported a positive attitude towards participation. Thus, the patients valued the close and unique medical and psychological attention they received by participating. Participation also made them feel unique and notable.
  
  
  CONCLUSIONS
  Patients with end-stage cancer participating in phase 1 clinical trials are unaware of the very small potential for treatment benefit and the risk of harm. Trial participation may offer hope and social-emotional support and a strategy for coping with the emotional stress associated with advanced cancer and may, consequently, improve emotional well-being.
authors.affiliation: Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden, tove.godskesen@crb.uu.se.
authors.forename: Tove
authors.initials: T
authors.lastname: Godskesen
authors.forename: Peter
authors.initials: P
authors.lastname: Nygren
authors.forename: Karin
authors.initials: K
authors.lastname: Nordin
authors.forename: Mats
authors.initials: M
authors.lastname: Hansson
authors.forename: Ulrik
authors.initials: U
authors.lastname: Kihlbom
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017321:Clinical Trials, Phase I as Topic / Q000941:ethics* / Q000523:psychology*; D003430:Cross-Sectional Studies; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology*; D036301:Qualitative Research; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D013548:Sweden
chemical_list: D000970:Antineoplastic Agents