The role of the family in treatment decision making by patients with cancer.

PURPOSE/OBJECTIVES: To examine family disagreements about treatment decisions for patients with advanced lung cancer. RESEARCH APPROACH: Descriptive, qualitative study. SETTING: A large comprehensive cancer center in Cleveland, OH. PARTICIPANTS: 37 patients with stage III or IV lung cancer and 40 caregivers (24 primary and 16 secondary) from 26 families were interviewed. METHODOLOGIC APPROACH: Open-ended audiotaped interviews were transcribed verbatim. NUD*IST (non-numerical unstructured data indexing, searching, and theorizing) computer software (QSR International, Melbourne, Australia) was used to perform content analysis. MAIN RESEARCH VARIABLES: Vast differences in opinions between patients and family caregivers about treatment decisions and care. FINDINGS: Sixty-five percent of families reported various family disagreements that mainly concerned routine treatment decisions, discontinuation of therapeutic treatment, and use of hospice care. CONCLUSIONS: Family disagreements about treatment decisions for patients with advanced lung cancer are common and include a wide range of issues. Family members play an important role in the selection of patients' doctors, hospitals, treatment options, and provisions of care. INTERPRETATION: The findings suggest that nurses need to be aware of differences of opinion between patients with advanced cancer and their caregivers. Knowledge of family disagreements about treatment decisions can help nurses' efforts to integrate families into decision-making processes in clinical settings to facilitate family communications and improve patients' and caregivers' satisfaction with treatment decisions.