Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study

Abstract

Purpose The curative oesophageal cancer continuum—diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients’ and relatives’ experiences with the process of decision-making through the EC illness and treatment trajectory. Methods Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley. Results Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals. Conclusion The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.

Keywords

• esophageal cancer
• decision-making
• qualitative research
• patients’ experiences
• relatives’ experiences
• participant observations