Comparative Perspectives on the Social Perceptions and Decision-Making Processes of Patients, Physicians, and Caregivers Regarding the Care of Patients with Unresectable Metastatic Colon and Lung Cancer

In France, the question of whether to continue, limit, or discontinue palliative care for patients with unresectable metastatic cancer is the subject of intense debate. Several international studies have estimated that between 10% and 20% of cancer patients received chemotherapy in the last month of their lives (Benson, 2001; Nieder et al., 2014; Earle, Landrum, Souza, Neville, Weeks & Avanian, 2008; Ho, Barbera, Saskin, Lu, Neville & Earle, 2011). One reason for prescribing treatments at a very advanced stage of the disease is that physicians often overestimate their patients’ life expectancy (Nieder et al., 2014; Christakis & Lamont, 2000). However, these treatments are not without side effects and can accelerate the decline in patients’ quality of life (Rajagopal, Nipp & Selvaggi, 2014).

The question raised concerns the psychological processes (attitudes and social representations) that underlie individuals’ behavioral intentions and actual behaviors, which guide decision-making. From this perspective, the focus is on the cognitions mobilized by individuals (doctors, patients, caregivers) to make a decision and subsequently to consolidate the choice made.

These cognitions are organized within a representation that is termed social (Deschamps & Moliner 2012) because it is collectively shared within a group (e.g., patients, doctors, support network), because it involves significant issues (e.g., illness, therapeutic treatments), because it is situated within a social reality (Moliner & Guimelli, 2015), and because it is influenced by other groups (Doise, Spini & Clémence, 1999; Cannone, Dany, Dudoit et al. 2004).

The study of social representations focuses on cognitions—that is, the contents of thought—and more specifically on common-sense knowledge that coexists with scientific thought (Moscovici, 1961; Jodelet, 1989), including among healthcare professionals (Salès-Wuillemin Morlot, Fontaine et al., 2011).

The objective of the EOLE project is to identify and compare, using two complementary approaches (economic and psychosocial), the personal factors and treatment characteristics that influence the decisions of patients, caregivers, and prescribing physicians to choose one type of medical care over another in cases of unresectable metastatic lung or colon cancer.