Abstract：
BACKGROUND: Peritoneal carcinomatosis (PC) is common in patients with advanced gynecologic and gastrointestinal cancers. Frequently, patients with PC undergo palliative surgery or procedures to manage disease-related complications and side effects. However, there are limited data regarding patients\' and family caregivers\' decision-making processes about these procedures. Thus, we sought to describe the decision-making experiences of patients with PC who elect to pursue palliative surgical procedures and their family caregivers.
METHODS: We conducted a secondary analysis of qualitative data collected during a pilot randomized controlled trial of BOLSTER, a nurse-led telehealth intervention for patients with PC and their caregivers after an acute hospitalization and palliative procedure. Participants in both study arms described their experiences in semi-structured interviews. We re-analyzed coded qualitative data with a focus on understanding decision-making experiences surrounding palliative surgery and procedures using conventional content analysis.
RESULTS: Interviews from 32 participants, 23 patients and 9 caregivers, were analyzed. Participants reported their decision-making was complicated by illness uncertainty and a desire for clear, effective communication with surgical and medical oncology teams. Participants requested more information about the impact of palliative procedures on their daily life. Several also noted that, without improved understanding, a misalignment between patient and family caregiver goals and palliative procedures may inadvertently increase suffering.
CONCLUSIONS: Discussions related to patients\' goals and preferences can improve the quality of treatment decision-making in patients with PC and their caregivers. Future research should test interventions to improve advanced cancer patients\' illness understanding and decision-making surrounding palliative surgery and procedures.
METHODS: We conducted a secondary analysis of qualitative data collected during a pilot randomized controlled trial of BOLSTER, a nurse-led telehealth intervention for patients with PC and their caregivers after an acute hospitalization and palliative procedure. Participants in both study arms described their experiences in semi-structured interviews. We re-analyzed coded qualitative data with a focus on understanding decision-making experiences surrounding palliative surgery and procedures using conventional content analysis.
RESULTS: Interviews from 32 participants, 23 patients and 9 caregivers, were analyzed. Participants reported their decision-making was complicated by illness uncertainty and a desire for clear, effective communication with surgical and medical oncology teams. Participants requested more information about the impact of palliative procedures on their daily life. Several also noted that, without improved understanding, a misalignment between patient and family caregiver goals and palliative procedures may inadvertently increase suffering.
CONCLUSIONS: Discussions related to patients\' goals and preferences can improve the quality of treatment decision-making in patients with PC and their caregivers. Future research should test interventions to improve advanced cancer patients\' illness understanding and decision-making surrounding palliative surgery and procedures.
摘要：
背景：腹膜癌（PC）在晚期妇科和胃肠道癌症患者中很常见。经常,患有PC的患者接受姑息性手术或手术以控制疾病相关的并发症和副作用.然而,关于这些程序的患者和家庭护理人员决策过程的数据有限。因此，我们试图描述选择进行姑息性外科手术的PC患者及其家庭护理人员的决策经验.
方法：我们对BOLSTER试点随机对照试验中收集的定性数据进行了二次分析，对急性住院和姑息治疗后的PC患者及其护理人员进行护士主导的远程医疗干预。两个研究小组的参与者都在半结构化访谈中描述了他们的经历。我们重新分析了编码的定性数据，重点是了解使用常规内容分析围绕姑息性手术和程序的决策经验。
结果：来自32名参与者的访谈，23名患者和9名护理人员，进行了分析。参与者报告说，他们的决策因疾病的不确定性和明确的愿望而复杂化，与外科和内科肿瘤团队的有效沟通。参与者要求提供更多有关姑息治疗对其日常生活影响的信息。一些人还指出，如果没有更好的理解，患者和家庭照顾者目标与姑息治疗之间的不一致可能会无意中增加痛苦.
结论：与患者目标和偏好相关的讨论可以提高PC患者及其护理人员的治疗决策质量。未来的研究应该测试干预措施，以改善晚期癌症患者对姑息性手术和手术的了解和决策。
方法：我们对BOLSTER试点随机对照试验中收集的定性数据进行了二次分析，对急性住院和姑息治疗后的PC患者及其护理人员进行护士主导的远程医疗干预。两个研究小组的参与者都在半结构化访谈中描述了他们的经历。我们重新分析了编码的定性数据，重点是了解使用常规内容分析围绕姑息性手术和程序的决策经验。
结果：来自32名参与者的访谈，23名患者和9名护理人员，进行了分析。参与者报告说，他们的决策因疾病的不确定性和明确的愿望而复杂化，与外科和内科肿瘤团队的有效沟通。参与者要求提供更多有关姑息治疗对其日常生活影响的信息。一些人还指出，如果没有更好的理解，患者和家庭照顾者目标与姑息治疗之间的不一致可能会无意中增加痛苦.
结论：与患者目标和偏好相关的讨论可以提高PC患者及其护理人员的治疗决策质量。未来的研究应该测试干预措施，以改善晚期癌症患者对姑息性手术和手术的了解和决策。
