Precision patients: Selection practices and moral pathfinding in experimental oncology.

Area of Science:

• Oncology
• Precision Medicine
• Clinical Trials

Background:

• Precision medicine aims to match patients with targeted therapies.
• Early phase oncology trials focus on selecting suitable patients for available treatments.

Purpose of the Study:

• To investigate the experiences and responses of oncologists to moral challenges in patient selection for phase 1 oncology trials.
• To explore the implications of transparency regarding inclusion criteria in precision medicine.

Main Methods:

• Qualitative investigation of selection practices in a Danish phase 1 oncology unit.
• Analysis of oncologists' interactions and decision-making processes regarding patient inclusion.

Main Results:

• Patient selection in phase 1 oncology is patient-oriented, focusing on clinical and genetic fitness for protocols.
• Lack of transparency in inclusion criteria, while potentially problematic, can respect patient agency.
• Waiting lists for 'unfit' patients serve as a mechanism to navigate scientific and moral uncertainties.

Conclusions:

• Non-transparency and waiting lists are integral to managing ethical complexities in phase 1 oncology patient selection.
• These practices support oncologists in navigating uncertainties and respecting patient moral agency.