Theis Susanne, Senyigit Jülide, Büchler Britta, Kolck Gesa, Moehler Markus, Hasenburg Annette, Paul Norbert
Department of Obstetrics and Gynegology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany.
Institute of History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany.
Front Oncol. 2025 Jul 8;15:1588721. doi: 10.3389/fonc.2025.1588721. eCollection 2025.
Being diagnosed with cancer is a life-altering event that profoundly reshapes an indivdual's biography, especially in terms of temporality and physicality. Modern treatment approaches, such as maintenance therapy or therapeutic abstinence, often conflict with patients' desire for a radical fight against the disease. Decision-making about therapeutic goals is shaped by the tension between medical-scientific expertise and personal values and experiences, making it particularly challenging to align diverse preferences and norms. This study aims to analyse values in the context of the challenging human experience of cancer. We hypothesise that conventional quantitative measures, including patient-reported outcome measures (PROMs) may be insufficient to fully capture patients' perspective on therapeutic success. To address this, we will conduct semi-structured interviews with individuals diagnosed with gynecological or colorectal cancer. Using a mixed methods approach, we aim to identify patients' values, treatment goals, and expectations. The study's key outcomes include: 1) an ethical analysis of values in the context of cancer experiences 2) a reconstruction of values that shape individual treatment goals and expectations and 3) a comparison between ethical concepts of successful life, patients' situational values, and evidence-based medical preferences. Building on these insights, the study pursues three secondary objectives: 1) developing a strategy for patient-centred adaptation of clinical evaluations of treatment approaches, including escalation, maintenance and abstinence, 2) designing a well-defined clinical framework for therapeutic goal setting, and 3) integrating this framework into medical education, addressing clinical, oncological, ethical and communication competencies.
被诊断出患有癌症是一件改变人生的大事，它会深刻重塑一个人的人生轨迹，尤其是在时间性和身体方面。现代治疗方法，如维持治疗或治疗性节制，往往与患者彻底对抗疾病的愿望相冲突。关于治疗目标的决策受到医学科学专业知识与个人价值观和经历之间张力的影响，这使得协调不同的偏好和规范极具挑战性。本研究旨在分析癌症这一具有挑战性的人类经历背景下的价值观。我们假设，包括患者报告结局测量（PROMs）在内的传统定量测量方法可能不足以充分捕捉患者对治疗成功的看法。为解决这一问题，我们将对被诊断患有妇科或结直肠癌的个体进行半结构化访谈。采用混合方法，我们旨在确定患者的价值观、治疗目标和期望。该研究的主要成果包括：1）对癌症经历背景下的价值观进行伦理分析；2）重构塑造个体治疗目标和期望的价值观；3）比较成功人生的伦理概念、患者的情境价值观和循证医学偏好。基于这些见解，该研究追求三个次要目标：1）制定以患者为中心的治疗方法临床评估调整策略，包括强化、维持和节制；2）设计一个明确的治疗目标设定临床框架；3）将该框架纳入医学教育，涉及临床、肿瘤学、伦理和沟通能力。
