How patients with advanced gynecological cancer perceive clinicians' attention to their values, wishes, and needs: a qualitative study.
Abstract
Objectives
Understanding patients' values, wishes, and needs (VWN) is essential to guiding appropriate palliative care in home and hospital settings, thereby optimizing quality of life. This study aims to gain insight into the expectations and experiences of patients with advanced gynecological cancer in the palliative phase regarding clinicians' attention to their VWN throughout the illness trajectory.
Methods
A qualitative study grounded in an interpretivist-constructivist approach was conducted from March 2024 to October 2024. Patients with advanced gynecological cancer were recruited from outpatient clinics at two hospitals in the Netherlands, using purposive sampling to achieve variation in age, diagnosis, and time since diagnosis. Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis.
Results
Twenty-one patients (aged 39-86) participated; most were diagnosed with ovarian cancer (N = 17). Three key needs shaped patients' ability to express and discuss their VWN: 1) feeling recognized as a person, 2) being involved in the decision-making process in accordance with their preferences, and 3) receiving help and guidance in navigating the complex healthcare system. Participants hesitated to share non-physical issues, perceiving communication as primarily focused on the illness and medical treatment.
Conclusion
The findings highlight the importance of dialogues that create space for patients to express and discuss their VWN related to both the illness and broader aspects of living with advanced cancer, tailored to their individual preferences and need for support in navigating care. The way clinicians time and structure conversations is among the important factors shaping these opportunities. PRACTICE IMPLICATIONS A systematic approach can support continuous attention to VWN throughout the illness trajectory, thereby guiding appropriate palliative care and optimizing quality of life. This approach requires explicit agreements on which clinician explores and monitors VWN, when this should occur, and how this is documented and transferred between settings.