Table 2 Description of the themes emerged through the coding process and their sub-categories
Themes | Description | Examples of potential issues |
|---|---|---|
Communication issues | It includes all the issues related to the content of communication as well as to the process of communication | Communicate the worsening of the prognosis |
Lack of empathy | ||
Transparency and completeness of information | ||
Unreliable or non-filtered information | ||
Incomprehension among colleagues | ||
Presence of potential barriers [language, low health literacy] | ||
End-of-life | It includes all those controversial issues related to treatment in the terminal phase of oncological disease, mainly from a moral but also legal and regulatory standpoint | Assisted suicide |
Advance Directives | ||
Palliative deep sedation | ||
Withholding/withdrawing treatment | ||
Transition from active therapies to palliative care | ||
Feeling of abandonment of terminally ills | ||
Resource allocation | It refers to obstacles to a fair distribution of healthcare resources; in this study, resources are intended primarily as clinical and surgical time, availability of drugs and treatments, and accessibility to updated therapies | Economic discrimination [high cost of branded drugs, new drugs available only for purchase] |
Territorial differences in therapies availability | ||
Age-based restriction of therapeutic proposals (Ageism) | ||
Genetic mutations: testing and counselling | It refers to innovative genetic testing techniques open up a wide range of scenarios, all of which raise ethical issues. This category is at the crossroads between the issues of decision-making, informed consent, privacy and patient autonomy | Communication of the result of the genetic test to relatives |
Understanding the meaning of genetic testing | ||
Awareness on therapeutic choices | ||
Prognosis reliability | ||
Informed consent | It refers to problems related to the principle of self-determination and the right to information, such as patients failing to understand clinical information, due to the lack of health literacy, awareness of treatment options, due to their diminished autonomy (i.e. minors and adults with significant cognitive impairment) | Informed Consent in paediatrics |
Right to information | ||
Patient manipulation towards selected therapeutic choices | ||
Medical Culture | It refers to cultural aspects of medical practice with potential ethically relevant impacts on the former. It includes the contemporary tendency to conceive the medical act as a procedural activity and physicians as mere technicians | “Acting” medicine vs “thinking” medicine |
Concept of death and mortality | ||
Terminal illness as failure | ||
Cancer as taboo word | ||
Medical Decision Making | It includes all borderline cases in which standard therapeutic guidelines and protocols cannot simply be top down applied, or conflict with the patient’s values (i. e. in the absence of sufficient scientific evidence to support a specific therapeutic choice or in cases of uncertain prognosis) | Uncertainty of prognosis in rare cancers |
Newly diagnosed cancer in the elderly | ||
Cancer during pregnancy | ||
Jehovah witnesses and surgery | ||
Practical problems | It includes issues that are neither purely clinical nor purely ethical, but which are perceived as ethically worthy since they affect the quality of care, albeit indirectly | Obsolescence of office supplies |
Limited medical time |