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Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases

Supportive Care in Cancer volume 14, pages 1055–1063 (2006)Cite this article

Abstract

Goals of work

To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers.

Patients and methods

Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns.

Results

Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice.

Conclusions

Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.

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Acknowledgement

This study was generously supported by the Allan Kerbel Fund in Symptom Control.

Author information

Affiliations

  1. Princess Margaret Hospital, University of Toronto, 5th Floor, 610 University Avenue, M5G 2M9, Toronto, Ontario, Canada

    Jacqueline Sze & Stephen Marisette

  2. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 5th Floor, 610 University Avenue, M5G 2M9, Toronto, Ontario, Canada

    Diane Williams, Joyce Nyhof-Young, Andrea Bezjak & Rebecca K. S. Wong

  3. Centre for Nursing, Hospital for Sick Children, Level 4, 555 University Avenue, M5G 1X8, Toronto, Ontario, Canada

    Dauna Crooks

  4. The Temmy Latner Centre for Palliative Care (TLCPC), 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada

    Amna Husain

Authors
  1. Jacqueline Sze
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  2. Stephen Marisette
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  3. Diane Williams
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  4. Joyce Nyhof-Young
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  5. Dauna Crooks
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  6. Amna Husain
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  7. Andrea Bezjak
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  8. Rebecca K. S. Wong
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Corresponding author

Correspondence to Rebecca K. S. Wong.

Additional information

The content of this manuscript has been presented in part at the 16th International Symposium Multinational Association of Supportive Care in Cancer.

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Sze, J., Marisette, S., Williams, D. et al. Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases. Support Care Cancer 14, 1055–1063 (2006). https://doi.org/10.1007/s00520-006-0032-y

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  • DOI: https://doi.org/10.1007/s00520-006-0032-y

Keywords

  • Decision making
  • Radiation oncology
  • Brain neoplasms
  • Caregivers
  • Hope