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People with anorexia nervosa struggle with questions of authenticity. More attention should be paid this concept—both how patients think about it, and how clinicians should think about it. INSET: The Study. [ABSTRACT FROM AUTHOR]

Background: Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment., Methods: Qualitative in-depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed., Results: Physicians reported that a number of nonmedical factors influence professional decisions about the offering or limiting of cancer treatment in advanced cancer in addition to medical criteria. Physicians' individual judgments about the benefit of treatment, as well as the amount of their clinical experience, were cited as such factors. In addition, the physicians' perceptions of the patient's age and life circumstances were reported to influence their treatment decisions. Multiprofessional team discussions and the systematic collection of relevant clinical data regarding the outcomes of different treatment approaches in advanced cancer were suggested as strategies to improve the quality of treatment decisions., Conclusion: The findings of this study provide explanations for the variation in treatment in advanced cancer. Making value judgments explicit and gathering more appropriate clinical data on the outcomes of treatment near the end of life are prerequisites for improved ethical and evidence-based treatment decisions in advanced cancer.

Background: Costs for medical care and strategies to handle limited resources in health care are discussed in many European countries. Few empirical studies explore the oncologists' perceptions and views regarding economical aspects in clinical practice., Research Participants and Methods: Semi-structured interviews with physicians working in oncology in Germany and England. For this paper, parts of the transcripts in which interviewees discuss economical aspects of clinical practice were analysed exploratively and according to principles of content analysis., Results: 17 (Germany) and 12 (England) research interviews were analysed. German physicians described different forms of implicit rationing. The effects of economic considerations are judged as predominantly negative. Physicians working in England named concrete situations in which interventions are not performed because of cost considerations. The rationing of medical care was viewed as necessary in light of limited resources. The assignment of allocation decisions on the macro-level was favoured because of the resulting relief for the physician-patient relationship., Conclusions: The narratives of interviewees in both countries differ regarding the perceptions and views on economical aspects in clinical practice. The specific approaches of each health care system towards the allocation of limited resources offer one basis for explanations of these differences., (Copyright © 2011 S. Karger AG, Basel.)