Declining treatment in the context of cancer: The experiences of individuals and cancer care staff

Abstract

This thesis qualitatively explores the experiences of individuals with cancer and cancer care staff when treatment is declined. Chapter one is a systematic review of reasons why individuals with breast or gynaecological cancer decline treatment. A total of 15 studies were included in the review. The extracted data was thematically synthesised through which four themes were generated: ‘Power and Influence’, ‘Cost and Reward’, ‘Feeling Alone’ and ‘Altered State of Being: Not Me’ – within one overarching theme, ‘Self-Preservation’. The findings indicate the complex and multifaceted reasons why individuals decline treatment and the need for systemic support and collaboration to facilitate meaningful change. Chapter two is an empirical paper exploring the experiences of cancer care staff when a patient declines treatment. Interpretative phenomenological analysis was used to analyse interview data from which six closely interconnected themes were generated: ‘Consultation is the foundation’, ‘Ethical dilemma: Autonomy vs. preserving life’, ‘Professionals are not immune’, ‘Team cohesiveness as a strength’, ‘Learning and growth through reflections’ and ‘The system adds a layer of complexity’ within one overarching theme, ‘Collaborative shared decision-making’. The experiences have implications for individuals and the external systems, and recommendations are outlined for future research and clinical practice to support cancer care staff and patients, and facilitate change. Chapter three considers the contributions from chapters one and two to theory and practice, alongside future research recommendations. To conclude, a reflective commentary on the research process is provided.

Date of Award	8 Sept 2025
Original language	English
Awarding Institution	Bangor University
Supervisor	Samantha Owen (Supervisor), Lucy Piggin (Supervisor) & Lisa Heaton-Brown (Supervisor)