Treatment Decisions and the Therapeutic Process

Abstract

This chapter considers the challenges of treatment decision-making for patients with incurable disease and the benefits of having a neutral space for reflection. Though respect for patients’ autonomy, shared decision-making, and informed consent are considered to be central to modern healthcare, adherence to these principles may seem illusory when patients are desperate and when the risks and benefits of treatment are ambiguous. The potential challenges to patient autonomy and informed consent are explored in this chapter, with particular reference to the context of phase one trials. In this setting, the intent of the treatment may easily be misconstrued by patients (therapeutic misconception) and the chances of benefits versus risks incorrectly estimated by them (therapeutic misestimation). This chapter explores the value of Managing Cancer and Living Meaningfully (CALM) in providing a neutral space for reflection and in allowing patients to explore their preferences regarding treatment while also considering the views of their healthcare providers and family members.