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    2020-08-24

    r> According to our informants, there was seldom a shared decision making of continuing with palliative chemotherapy. To accomplish shared decision mak-ing, doctors have to present both pros and cons with further chemotherapy and allow no further chemo-therapy to be an option when applicable. At times, we have to let the patient use their coping strategy, n.b. not mistake it for pure denial, and let them rest from thoughts about an imminent death when they find it necessary, to let patients hope consist even without further chemotherapy.
    Interestingly, Weeks et al. reported that patients who by misunderstanding thought they had a curable disease were more content with their doc-tors, compared to those who understood they had an incurable disease.1 In line with these data, we found that women associated a good doctor with one who delivered good news. Furthermore, our data confirm recently published data by Tanco et al. showing that patients found doctors delivering more optimistic messages, more compassionate, and trustworthy.14
    According to our present data, patients would probably acknowledge their doctor as a bad doctor, if presented with an option to stop treatment, in a new situation with progressive disease. This under-lines the importance of communication. Back et al.30 have presented some general advice of how to discuss treatment or no treatment in this context and still give room for hope. To begin with, physi-cians should clarify to the patient that there is ‘‘a new situation’’ and no point in continuing ongoing treatment and accept their patients’ possible feelings of anxiety.
    Second and third, doctors should exemplify what can be done now and focus on the future life.
    In conclusion, hope gives MitomycinC in end of life when, in fact, energy is scarce. Both the doctor and the treatment serve as factors increasing patients hope. Oncologists must bear in mind that important decisions regarding continuous treatment with late lines of palliative chemotherapy are seldom autonomous, but affected by family and doctors.
    Disclosures and Acknowledgments
    The authors thank all the women who participated in the interviews. The two authors have had no special funding for the research work.
    Ethical approval: The Stockholm Ethical Committee approved the study, and all patients received oral and written information before informed consent was obtained.
    References
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    4. Finlayson CS, Chen YT, Fu MR. The impact of patients’ awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer: a Focus formation sys-tematic review from 1997-2014. J Palliat Med 2015;18: 176e186.
    6. Shin DW, Cho J, Kim SY, et al. Patients’ and family care-givers’ understanding of the cancer stage, treatment goal, and chance of cure: a study with patient-caregiver-physician triad. Psychooncology 2018;27:106e113. 
    7. Mackillop WJ, Stewart WE, Ginsburg AD, Stewart SS. Cancer patients’ perceptions of their disease and its treatment. Br J Cancer 1988;58:355e358.
    8. Burns CM, Broom DH, Smith WT, Dear K, Craft PS. Fluc-tuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process. Support Care Cancer 2007;15:187e196.
    9. Jenkins V, Fallowfield L, Saul J. Information needs of pa-tients with cancer: results from a large study in UK cancer centres. Br J Cancer 2001;84:48e51.
    10. El-Jawahri A, Traeger L, Park ER, et al. Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer 2014;120: 278 e285.
    11. Hagerty RG, Butow PN, Ellis PA, et al. Cancer patient preferences for communication of prognosis in the metastatic setting. J Clin Oncol 2004;22:1721e1730.
    12. Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med 2005;61:2252e2264.
    13. Enzinger AC, Zhang B, Schrag D, Prigerson HG. Out-comes of prognostic disclosure: associations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer. J Clin Oncol 2015; 33:3809e3816.
    14. Tanco K, Rhondali W, Perez-Cruz P, et al. Patient percep-tion of physician compassion after a more optimistic vs a less optimistic message: a randomized clinical trial. JAMA Oncol 2015;1:176e183.
    16. Clayton JM, Hancock K, Parker S, et al. Sustaining hope when communicating with terminally ill patients and their families: a systematic review. Psychooncology 2008;17: