Conversations on Cancer Chemotherapy Cessation in Patients With Advanced Cancer: Qualitative Findings From a Multi-Institutional Study.
Jeremiah Stout, Ashok Kumbamu, Jon Tilburt and 5 others
PMID 32495676WHAT IT FOUND
Conversations about stopping chemotherapy near the end of life ranged from direct to indirect.
Direct talk did not seem to lead to stopping treatment; patients and accompanying persons sometimes appeared to guide the discussion.
Key findings
01Only 14 of 525 audio-recorded oncology visits were relevant to stopping chemotherapy.
02The conversations fell into direct and indirect types, but the types were not mutually exclusive.
03No relationship seemed to emerge between conversation elements and final chemotherapy administration.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 14 of 525 recordings were relevant, so these themes may not represent most oncology visits. The conversations occurred at academic medical centers, where clinicians may have had more time than in private practice. The design was cross-sectional, so the researchers could not confirm final chemotherapy decisions, survival, or whether stopping was truly appropriate. Because all participants had to consent to audio recording, clinicians may have declined enrollment when an end-of-life discussion was imminent. The analysis did not test relationships between patient or clinician characteristics and the themes or chemotherapy outcomes. The conversation categories were not mutually exclusive, so the paper cannot show that one style caused a particular outcome.
The easy way to misread this
Do not read these themes as proof that direct communication makes patients stop chemotherapy. The study found no relationship between conversation style and whether chemotherapy was given, and it described only 14 conversations.