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Table 3 HCPs’ reflections on main theme 1: Handling incurable cancer

From: Living and dying with incurable cancer: a qualitative study on older patients’ life values and healthcare professionals’ responsivity

Subtheme

Clinical practice

1.1 Anticipatory outlook ona reduced life”

The HCPs participating in the group interviews recognized the desire of older patients to continue normal life as long as possible. To respect this desire or “protect” patients, HCPs could propose not to continue with chemotherapy. In such cases, “supportive care” aiming at symptom control could be explained and presented as being the best option. Whether patients accept this focus on supportive care, largely depends on how they think curative treatment is going to contribute to better quality of life now and in the future. The material of the group interviews, furthermore, showed that HCPs attach great importance to older patients’ social systems, with special attention to the relationships between parents and children. These long-standing relationships usually influence the balancing act between “normal life” and treatment through implicit and explicit expectations that shape care-giving and care asking. For example, HCPs experienced that they were often awarded the power of decision-making by their older patients so that they could protect them from their more cure-oriented children.

1.2 Hope

According to HCPs, patients usually hope for action by HCPs. The latter thus have a responsibility to explore a patient’s hope. Another goal for HCPs, as they stated, is to keep the hopes of patients realistic, incorporating information, scenarios, and “the insecurity of not knowing exactly” into their conversations with patients. Realism entails understanding that the body is quickly deteriorating while the mind can still be sharp. If this is the case, HCPs stated that palliative care should be presented as the appropriate action. This might, at first sight, diverge with patients focusing on life extension primarily.

1.3 Coping with an unpredictable disease

HCPs discussed that cancer might be experienced by patients as an abstract, unobservable phenomenon that requires optimal medical imaging combined with HCPs’ advanced communicative skills to be at all understandable. HCPs feel they have a responsibility in this matter, in line with the preferences of their patients.