Patients who decide to forgo Breast Cancer Treatment: Perspectives and Experiences of Cancer Professionals.

Background: Breast cancer is highly treatable if caught early, yet there are increasing numbers of women who decline treatment entirely, or in favour of alternative therapies. Previous research has demonstrated that such decisions can be troubling for health professionals, creating an ethical dilemma in which the bioethical mandate to respect patient autonomy must be offset against duties to act in the patient’s best interest. Previous research has indicated that health professionals may find it difficult to accept and understand such decisions; however, this research has predominantly focused on the experiences of different health professionals in isolation.

Method: Qualitative, semi-structured interviews were carried out with eight oncology health professionals (Three oncologists, two breast surgeons and three clinical nurse specialists) to explore how health professionals understood and responded to these decisions. A critical realist epistemology was adopted and interviews were analysed using thematic analysis.

Results: Four overarching themes were identified including ‘Head-Heart Lag’, ‘Tug of War’ ‘You Can’t Win Them All’ and ‘The Power and Privilege of Unbiased Expertise’. Themes yielded insights into how professionals navigate their responsibilities towards patients who decline treatment and the values, frameworks and resources that influence this process.

Conclusion: Results indicated that health professionals’ responses were grounded in a commitment to evidence based practice, and that time and experience are important factors in professionals learning to accept a decision to decline breast cancer treatment. Findings are considered in the broader social context of contemporary healthcare and in relation to professional and patient needs. Recommendations are made for a more reflexive medical practice which transcends the constraints of the evidence-based paradigm and liberates health professionals to engage with the existential, as well as the medical within the clinical encounter.