Hard choices: a qualitative study of influences on the treatment decisions made by advanced lung cancer patients

Objective: Most patients with non-small cell lung cancer (NSCLC) present with an incurable, advanced disease, and treatment decisions may be hard. This study explored the factors that influence patients' choice of treatment during the oncologist-patient consultation. Design: Semi-structured interviews conducted within 1 month of a consultation with an oncologist. Participants: Five patients newly diagnosed with incurable NSCLC and facing a treatment decision following a consultation with an oncologist. Setting: A regional oncology unit in the UK. Results: Some of the participants who opted for chemotherapy had made a decision before seeing the oncologist, presented with fewer symptoms, had been more active in seeking information before the consultation, and were willing to accept the risk of side effects. Participants opting for radiotherapy were not willing to accept the risk of side effects for the possibility of a small survival gain and instead focused on symptom relief. Conclusion: Some participants sought information before the consultation from various formal and informal sources. This may undermine the oncologist-patient consultation as the information may be incomplete or inaccurate. Patients vary in their willingness to accept risks for small potential gains. More research is required into methods to communicate the extent of the risks of treatment. The Clinical Nurse Specialist performed a valuable role for the patients and was seen as a trusted source of information.