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Doctor, Why Should I do this? The Role of Meaningfulness in Oncological Decision-Making

Frank Gieseler, Valerie Schaefer and Werner Theobald

In this essay, the aspect of meaningfulness in treatment decisions of older cancer patients is elucidated. The significance of meaningfulness as a central concept of solving problems, especially under life-threatening conditions such as being ill with cancer, became obvious to us in our daily oncological practice and through interviews with older cancer patients. Meaningmaking can be seen as an on-going process of composing and recomposing one's life story through sharable values. One of the major differences between young and elderly cancer patients is that older people are able to look back on their life stories. Meaningfulness as a guiding structure for making decisions about treatment is closely rooted in the highly personal life history of the individuals involved. The doctor must aid and invite patients to tell their life stories in the context of the disturbing element, namely the cancer diagnosis and fears about treatment side effects and assist them to integrate their treatment decision into that story. Empathic witnessing of the existential experience of suffering is a basic part of the concept of "guideddecision making" (GDM), where the doctor guides the patient to the right decision on the grounds of evidence-based medical guidelines and individual factors.