Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study

Figures & data

Table 1 Doctor background

ID	Age	Years of experience	Sex	Specialist^a	Palliative care^b	Hospital function^c
1	40’s	15	M	Spec.	PCT/PCU	Cancer
2	40’s	19	M	Spec./Onco	PCT	University
3	30’s	9	M	Cert.	PCT/PCU	Cancer
4	40’s	24	M	Spec.	No	General
5	40’s	17	M	Spec.	PCT/PCU	Cancer
6	50’s	27	F	Spec.	PCT	General
7	50’s	27	M	Spec.	PCT	General
8	50’s	30	F	Spec.	PCT	General
9	40’s	22	M	Spec.	PCT	University
10	50’s	30	F	Spec.	PCT	University
11	40’s	23	M	Spec.	PCT	General
12	40’s	20	F	Spec.	PCT	General
13	30’s	11	M	Cert.	PCT	Cancer center
14	30’s	13	M	Spec.	PCT	University
15	40’s	16	M	Spec./Onco	PCT/PCU	Cancer center
16	50’s	22	F	Spec.	PCT	Cancer center
17	40’s	20	M	Spec.	PCT	General
18	50’s	30	M	Spec.	PCT/PCU	Cancer center
19	50’s	30	M	Spec.	PCT	General
20	50’s	24	F	Spec.	PCT	University
21	30’s	13	M	Spec.	PCT	General

Notes:^aAcquisition of breast specialization: Cert. (Board Certified member of The Japanese Breast Cancer Society), Spec. (Specialist of The Japanese Breast Cancer Society), Onco (Diplomate, Subspecialty Board of Medical Oncology, JSMO), ^bHospital Palliative Care Resource: PCT (Palliative Care Team), ^cHospital: Cancer (Designated cancer hospital), University (University hospital), General (General hospital), Cancer center (National cancer center)

Abbreviation: PCU, Palliative Care Unit.

Box 1 Set of interview questions

#1 Story of how you became a breast surgeon.

#2 Process from initiating to concluding treatment of patients with recurrent/metastatic breast cancer.

#3 What is discussed before treatment begins?

#4 As a surgeon, how do you feel when cancer recurs (in a patient you operated on)?

#5 Your evaluation of the guidelines (what do you think about second and third line treatment)?

#6 How do you view the response rate in clinical trials and drugs covered by insurance?

#7 When and how do you convey the future outlook or that a cure will be difficult?

#8 Do you explain the option of non-treatment? (Why?)

#9 How do you talk about the termination of treatment? (Specifically)

#10 Methods of confirming patient intent, methods of communication

#11 In what sort of communication about prognosis do you engage?

#12 How do you consult with patients regarding early and terminal palliative care, etc.?

#13 How do you feel about the fact that patients will inevitably die?

#14 Resistance to dealing with death in the course of providing care, and past experiences with it

#15 Is there anything you want to add? Is there anything that you want to say more about?

Figure 1 The process based on two beliefs.

Table 2 Clues as to which belief the doctors themselves hold when they approach treatment beliefs

Acceptance group	・Often discusses not just treatment but bad news, outlook ・Makes an effort to prepare to talk about bad news ・Has experienced being told by patients that they want to discuss bad news early ・Has experienced sharing bad news with patients who were able to accept a good death ・Good collaboration with palliative medicine, palliative care team
Non-acceptance group	・Discussing bad news will worsen relationship with patients, or has worsened it ・Patients are happier if they can make it to the end of life without considering death ・Often end treatment by saying, “let’s take a little break from treatment” ・Thinks palliative medicine alone will not prolong patient life ・Feels guilty about postoperative recurrence