The Role of the Family in Treatment Decision Making by Patients With Cancer

Amy Y. Zhang

Laura A. Siminoff

ONF 2003, 30(6), 1022-1028. DOI: 10.1188/03.ONF.1022-1028

Purpose/Objectives: To examine family disagreements about treatment decisions for patients with advanced lung cancer.

Research Approach: Descriptive, qualitative study.

Setting: A large comprehensive cancer center in Cleveland, OH.

Participants: 37 patients with stage III or IV lung cancer and 40 caregivers (24 primary and 16 secondary) from 26 families were interviewed.

Methodologic Approach: Open-ended audiotaped interviews were transcribed verbatim. NUD* IST (non-numerical unstructured data indexing, searching, and theorizing) computer software (QSR International, Melbourne, Australia) was used to perform content analysis.

Main Research Variables: Vast differences in opinions between patients and family caregivers about treatment decisions and care.

Findings: Sixty-five percent of families reported various family disagreements that mainly concerned routine treatment decisions, discontinuation of therapeutic treatment, and use of hospice care.

Conclusions: Family disagreements about treatment decisions for patients with advanced lung cancer are common and include a wide range of issues. Family members play an important role in the selection of patients' doctors, hospitals, treatment options, and provisions of care.

Interpretation: The findings suggest that nurses need to be aware of differences of opinion between patients with advanced cancer and their caregivers. Knowledge of family disagreements about treatment decisions can help nurses' efforts to integrate families into decision-making processes in clinical settings to facilitate family communications and improve patients' and caregivers' satisfaction with treatment decisions.

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    Akechi, T., Okamura, H., Nishiwaki, Y., & Uchitomi, Y. (2002). Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer, 95, 1085-1093.

    American Cancer Society. (2003). Cancer facts and figures, 2003. Atlanta, GA: Author.

    Cameron, J., Franche, R., Cheung, A.M., & Stewart, D.E. (2002). Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer, 94, 521-527.

    Edwards, B.K., Howe, H.L., Ries, L.A., Thun, M.J., Rosenberg, H.M., Yancik, R., et al. (2002). Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden. Cancer, 94, 2766-2792.

    Grilli, R., Oxman, A.D., & Julian, J.A. (1993). Chemotherapy for advanced non-small cell lung cancer: How much benefit is enough? Journal of Clinical Oncology, 11, 1866-1872.

    Haley, W.E., LaMonde, L.A., Han, B., Narramore, S., & Schonwetter, R. (2001). Family caregiving in hospice: Effects on psychological and health functioning among spousal caregivers of hospice patients with lung cancer or dementia. Hospice Journal, 15(4), 1-18.

    Lederberg, M.S. (1989). The family of the cancer patient. In J.C. Holland & J.H. Rowland (Eds.), Handbook of psycho-oncology: Psychological care of the patient with cancer (pp. 981-993). New York: Oxford University Press.

    Lieberman, M.A., & Fisher, L. (1999). The effects of family conflict resolution and decision making on the provision of help for an elder with Alzheimer's disease. Gerontologist, 39, 159-166.

    Lobchuk, M.M., & Degner, L.F. (2002). Symptom experiences: Perceptual accuracy between advanced-stage cancer patients and family caregivers in the home care setting. Journal of Clinical Oncology, 20, 3495-3507.

    Longman, A.J., Atwood, J.R., Sherman, J.B., Benedict, J., & Shang, T.C. (1992). Care needs of home-based cancer patients and their caregivers. Quantitative findings. Cancer Nursing, 15, 182-190.

    Marino, P., Pampallona, S., Preatoni, A., Cantoni, A., & Invernizzi, F. (1994). Chemotherapy versus supportive care in advanced non-small cell lung cancer. Chest, 106, 861-865.

    Petrisek, A.C., Laliberte, L.L., Allen, S.M., & Mor, V. (1997). The treatment decision-making process: Age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer. Gerontologist, 37, 598-608.

    Porter, L.S., Keefe, F.J., McBride, C.M., Pollak, K., Fish, L., & Garst, J. (2002). Perceptions of patients' self-efficacy for managing pain and lung cancer symptoms: Correspondence between patients and family caregivers. Pain, 98(1-2), 169-178.

    Redinbaugh, E.M., Baum, A., DeMoss, C., Fello, M., & Arnold, R. (2002). Factors associated with the accuracy of family caregiver estimates of patient pain. Journal of Pain and Symptom Management, 23, 31-38.

    Richards, L. (1998). NUD*IST 4: Introductory handbook. Melbourne, Australia: QSR International.

    Silveira, J.M., & Winstead-Fry, P. (1997). The needs of patients with cancer and their caregivers in rural areas. Oncology Nursing Forum, 24, 71-76.

    Siminoff, L.A., Ravdin, P.M., Colabianchi, N., & Sturm C.M. (2000). Doctor-patient communication patterns in breast cancer adjuvant therapy decisions. Health Expectations, 3(1), 26-36.

    Steele, R.G., & Fitch, M.I. (1996). Needs of family caregivers of patients receiving home hospice care for cancer. Oncology Nursing Forum, 23, 823-828.