The ethical decisions UK doctors make regarding advanced cancer patients at the end of life - the perceived (in) appropriateness of anticoagulation for venous thromboembolism: A qualitative study

BMC Medical Ethics

Research Article

Anthony Maraveyas¹  Simon Noble²  Hayley Prout³  Ian Watt⁴  Miriam Johnson⁵  Dawn Dowding⁶  Laura Sheard⁷ 

[1] Department of Academic Oncology, Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull, England;Department of Palliative Medicine, Cardiff University, Cardiff, Wales;Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales;Health Sciences, University of York, York, England;Hull York Medical School, University of Hull, Hull, England;School of Healthcare, University of Leeds, Leeds, England;University of York, Area 2, Health Sciences, Seebohm Rowntree Building, YO10 5DD, York, England;

关键词: Venous thromboembolism;    Heparin;    Low-molecular-weight;    Palliative care;    Qualitative research;    Ethics;    Medical;   

DOI  :  10.1186/1472-6939-13-22

 received in 2012-02-20, accepted in 2012-08-27,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundCancer patients are at risk of developing blood clots in their veins - venous thromboembolism (VTE) - which often takes the form of a pulmonary embolism or deep vein thrombosis. The risk increases with advanced disease. Evidence based treatment is low molecular weight heparin (LMWH) by daily subcutaneous injection. The aim of this research is to explore the barriers for doctors in the UK when diagnosing and treating advanced cancer patients with VTE.MethodQualitative, in-depth interview study with 45 doctors (30 across Yorkshire, England and 15 across South Wales). Doctors were from three specialties: oncology, palliative medicine and general practice, with a mixture of senior and junior staff. Framework analysis was used.ResultsDoctors opinions as to whether LMWH treatment was ethically appropriate for patients who were symptomatic from VTE but at end of life existed on a shifting continuum, largely influenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of a daily injection had influenced some doctors not to prescribe LMWH. The point at which LMWH injections should be stopped in patients at the end of life was ambiguous. Some perceived ‘overcaution’ in their own and other clinicians’ treatment of patients. Viewpoints were divergent on whether dying of a PE was considered a “good way to go”. The interventionalism and ethos of palliative medicine was discussed.ConclusionsDecisions are difficult for doctors to make regarding LMWH treatment for advanced cancer patients with VTE. Treatment for this patient group is bounded to the doctors own moral and ethical frameworks.

【 授权许可】

CC BY   
© Sheard et al.; licensee BioMed Central Ltd. 2012