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Table 2 Description of the themes emerged through the coding process and their sub-categories

From: Ethical issues in oncology practice: a qualitative study of stakeholders’ experiences and expectations

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