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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.
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