Why Do Cancer Patients Decide to Withdraw Their Treatment? A Systematic Review and Meta-Synthesis

Discontinuation of treatment by cancer patients is a complex decision driven by many factors that are not yet fully understood. Using a qualitative approach is the best way to explore this complexity in greater depth. Therefore, this study aimed to explore and synthesize the factors that influence the decision-making of cancer patients regarding withdrawal from treatment.

This is a qualitative systematic review and meta-synthesis, conducted using the six-step meta-synthesis method developed by Sandelowski and Barroso in 2007. Initially, a comprehensive systematic search was conducted in PubMed, Web of Science, Scopus, and CINAHL to identify relevant studies published between 2000 and 2024 according to our inclusion criteria. Subsequently, conventional content analysis was used to analyze the data extracted from qualitative studies. Initially, 348 studies were retrieved, and after screening, 18 studies were included in the meta-synthesis.

From 177 primary codes, one main theme, two categories (endogenous and exogenous factors), and eight sub-categories were extracted through the meta-synthesis process. The factors affecting withdrawal from treatment were: "financial and insurance challenges," "the communication role of the healthcare team," "cultural and social factors," "spiritual and religious beliefs," "family functioning," "personal attributes," "the role of emotions," and "medication side effects."

The decision to withdraw from treatment is a multifaceted process influenced by personal values, clinical considerations, and social dynamics. A deeper understanding of these factors enables healthcare providers, especially nurses, to design better support programs.