South Middlesex Times

Guilt and obligation, rather than hope for recovery, are significant factors driving terminally ill cancer patients to pursue minimally beneficial treatments in their final days, according to a study by Rutgers researchers.

"In the United States, advanced illness care is enveloped in a set of moralized social attitudes around 'fighting' and 'not giving up,' where death is seen as the enemy, to be fought off at all costs," stated Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research. George, who is also a research member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, is the lead author of the study featured in the journal Health Psychology.

"This creates a dilemma for patients, who can feel like they are falling short of some moral code and disappointing others if they consider discontinuation of treatments," George explained. "Ours is among the first studies to quantify these sentiments."

To evaluate the decision-making processes at the end of life for terminally ill patients, George and his team recruited 116 participants from the Rutgers Cancer Institute and other clinical sites, focusing on individuals with a median life expectancy of less than 12 months in advanced stages of various cancers, including pancreatic, lung, colorectal, or breast cancer.

Participants were interviewed, with questions probing whether guilt and duty led them to persist with nonbeneficial treatments. Responses revealed up to 88% of patients continued treatments out of moral obligation or concern for loved ones. 19% of those surveyed indicated, "a little," when asked if stopping treatment felt like forsaking their family; 19% answered "somewhat," 15.5% responded "quite a bit," and 11.2% said "a great deal."

Furthermore, 86% admitted to attempting to appear healthier for their loved ones’ sake. This behavior extended to interactions with their oncologists, with over 41% stating they presented themselves as more optimistic and healthier in medical settings, correlating with increased patient distress.

George noted that previous studies had examined feelings of guilt tied to caregiving burdens, emphasizing this study's novel exploration of guilt linked to not meeting societal expectations of fighting cancer. He highlighted the necessity for nuanced discussions in treatment planning. "In an ideal world, a decision about stopping or continuing treatment would be guided by deliberation and intention and reflection on the part of patients, including open dialogue with others," he said.

The findings urge families, loved ones, and healthcare providers to consider what influences patient choices, allowing patients the option to cease non-beneficial treatments without feeling obligated by social expectations.

"Typically, doctors present people with information about treatment options and ask them what they want to do," George continued. "These results suggest we need to go a step further and discuss moral sentiments. Helping people articulate their feelings related to needing to continue treatments out of social expectations, or for the sake of others, could produce outcomes that are more in line with a patient's actual wishes."