Escalation, maintenance and abstention in oncology A new study design to
identify how individual values of patients impact on the assessment of
risks and benefits of novel therapeutic concepts in cases of
gynaecological tumors and colorectal cancer: A study protocol
Abstract
Being diagnosed with cancer is a pivotal moment in a person’s life and
changes biographies fundamentally, especially in terms of temporality
and physicality. Modern concepts of maintenance therapy or therapeutic
abstinence are at odds with typical desire of patients to fight the
disease radically. Decisions about therapeutic goals are caught between
medical-scientific expertise on the one hand and life-world judgements
and values on the other. This makes it particularly challenging to
reconcile different preferences and norms. This study aims to analyse
values in the context of the challenging human experience of cancer. We
hypothesise that established quantitative measures and even more
patient-centred assessment tools such as PROMs may not be adequate to
capture therapeutic success as understood by patients. Semi-structured
interviews will be carried out with participants with gynaecological or
colorectal cancer. We propose a mixed methods approach to identify
participants’ values, individual treatment goals, and expectations.
Outcomes of the study are defined as: 1) ethical analysis of values in
the context of human experiences with cancer 2) reconstruction of values
triggering individual treatment goals and positive and negative
expectations 3) comparison of ethical concepts of successful life with
situational values of patients with evidence-based (medical-scientific)
preferences. This results in following secondary objectives: 1)
Establishing a strategy for patient-centred adaptation of clinical
evaluation of therapeutic concepts of escalation, maintenance or
abstinence, 2) modelling of a well operationalised clinical strategy for
therapeutic goal setting, 3) teaching this strategy, including the
clinical oncological, ethical and communicative requirements, as part of
medical education.