br We used a semistructured interview
We used a semistructured interview guide, con-structed by the two authors, in face-to-face interviews according to a qualitative study design. The guide gave a general structure to the interview, but the inter-viewer was free to use follow-up questions whenever needed for validation and further exploration of the answers. The 30- to 46-minute long interviews were ta-perecorded and transcribed verbatim before they Protease Inhibitor Cocktail were analyzed by the two authors. We used a qualitative con-ventional content analysis, as described by Hsieh et al.,15 based on coding categories derived directly from the text. In brief, the two authors reread the in-terviews several times to identify meaning units, text segments, or words of potential interest with reference to the research question, i.e., how the patients perceived and preferred the information in relation to continuation of palliative chemotherapy. For example, statements explicitly stressed or repeated several times were selected. Preliminary codes were then chosen for the texts or words identified as mean-ing units. Next step was to group similar preliminary codes into preliminary categories. The content of
Categories and Subcategories From the Face-to-Face Interviews With Women on Their Second to Eighth Line of Palliative Chemotherapy for Treatment of Metastatic Breast Cancer
Communication Partial/selective truths
Patients’ will to please Hope Patient-doctor communication
Patient-family interaction The doctor The expert
each category was to be limited, without too wide var-iations and without obvious overlapping between the categories, and we tried to find possible relationships or hierarchies between them. The Stockholm Ethical Committee approved the study.
The informants described that their need for infor-mation changed over time and became more selective for positive news, not necessary the ‘‘whole’’ truth. Other common themes in the interviews were descrip-tions of how the patients experienced their doctors as experts, exemplified with good and bad characteris-tics. The women expressed they wanted to please the doctors and hoped for cure. A summary of categories and subcategories is displayed in Table 2.
The informants expressed different needs in how much or little details they thought were accurate, which sometimes changed over time.
Partial/Selective Truths. Some of the informants said they looked for positive information only, and when they found such information, they did not ask for more, afraid of getting bad news. However, the need for information and the way the patients wanted to communicate with their doctors changed over time. At the beginning of their palliative treatment, some of them had asked about their prognosis, and detailed information about the tumor size, but now they asked for less and less information as time went by and the disease progressed.
‘‘She (the doctor) often says that hyphae looks like every-thing is under control, not changing much, and then I settle with that’’ and later on the same woman says ‘‘I am easily satisfied (laughing)!’’
A sixty-three-year-old woman with metastases since four years, on her second line of palliative chemotherapy.
To begin with you asked about it (the prognosis), but now I have stopped.
A sixty-three-year-old woman with metastases since four years, and on her second line of palliative chemotherapy.
Instead of asking their doctor and getting an answer about their specific condition, they sometimes googled on the Internet. They found these data not necessarily applicable to their own situation and, therefore, less frightening. Some informants said they preferred to read about isolated symptoms rather than about the disease and prognosis. If they found in-formation about their symptoms linked to bad prog-nosis by accident, they often referred to it as old or not relevant information.
Sometimes you can end up on a webpage telling you that survival with skeletal metastases is maximum 2 years. Then you look at the date and see that it was published in 2002, and feel relieved. Because such information gives you the hiccups, so I try to avoid such obscure information.
A fifty-nine-year-old woman with metastases since one year ago, on her second line of palliative chemotherapy.
Patients’ Will to Please the Doctor. The women ex-pressed a wish to make things easier for their doctors and said they focused on symptoms and treatment but left their feelings and inner thoughts out of the consultation. The informants felt guilty for their long notes with questions and said they did their best to hide frustration and anger when the health care system failed them in terms of late appointments, another new doctor, and so on. They even excused their doctor when he or she had provided too optimistic information.