Journal of Preventive Medicine and Public Health

Original Article

Exploring Factors Influencing Decisions to Withdraw Treatment in Iranian Patients With Metastatic Cancer: A Qualitative Content Analysis Study: Faezeh Abadi, Mostafa Bijani, Esmat Nouhi, Camelia Rohani; J Prev Med Public Health. 2026;59(3):267-277. Published online April 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.872

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Objectives
The decision to withdraw treatment in patients with metastatic cancer is a complex and emotionally charged process influenced by multiple interrelated factors. Despite its significant clinical and ethical implications, this phenomenon remains insufficiently explored through qualitative inquiry. This study aimed to explore the factors influencing decisions to withdraw treatment among patients with metastatic cancer.
Methods
A qualitative study using conventional content analysis was conducted. Fourteen patients with metastatic cancer were purposively selected. Data were collected through in-depth, semi-structured interviews and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. Data organization was facilitated using MAXQDA software.
Results
The analysis yielded 1 main theme (“Finding the meaning of life, and freedom from cycles of suffering”), 4 categories, and 15 subcategories. The overarching theme suggests that understanding life’s meaning enables patients to situate their illness within a broader existential purpose, thereby affirming life’s intrinsic value beyond mere physical survival. The 4 categories were social and family influences, physical health factors, psychological determinants, and divine and spiritual beliefs.
Conclusions
This study outlines a multilevel approach to improving end-of-life care. At the clinical level, holistic nursing assessments are needed to guide transitions to palliative care. At the institutional level, implementing structured protocols with multidisciplinary support and financial counselling is essential. At the national level, policies should ensure universal health coverage and promote cultural acceptance of dignified treatment withdrawal. These findings provide actionable insights for healthcare administrators and policymakers and offer a foundation for strategies aimed at reducing barriers and improving access to supportive care services.

Summary

Key Message
This qualitative study with the conventional content analysis method explored the factors influencing treatment withdrawal decisions in 14 Iranian patients with metastatic cancer. The results revealed one overarching theme: “Finding the meaning of life and freedom from the cycles of suffering,” along with 15 subcategories and four main categories: “social and family influences,” “physical health factors,” “psychological determinants,” and “divine and spiritual beliefs.” These findings provide practical insights for healthcare administrators and policymakers to develop strategies for mitigating barriers and enhancing access to supportive care services for this vulnerable population.

Citations

Citations to this article as recorded by

Why Do Cancer Patients Decide to Withdraw Their Treatment? A Systematic Review and Meta‐Synthesis
Faezeh Abadi, Esmat Nouhi, Mostafa Bijani, Camelia Rohani
Cancer Medicine.2026;[Epub] CrossRef

Reviews

Qualitative Research in Healthcare: Data Analysis: Dasom Im, Jeehye Pyo, Haneul Lee, Hyeran Jung, Minsu Ock; J Prev Med Public Health. 2023;56(2):100-110. Published online February 15, 2023; DOI: https://doi.org/10.3961/jpmph.22.471

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2,072 Download
108 Web of Science
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Abstract Summary PDF

Qualitative research methodology has been applied with increasing frequency in various fields, including in healthcare research, where quantitative research methodology has traditionally dominated, with an empirically driven approach involving statistical analysis. Drawing upon artifacts and verbal data collected from in-depth interviews or participatory observations, qualitative research examines the comprehensive experiences of research participants who have experienced salient yet unappreciated phenomena. In this study, we review 6 representative qualitative research methodologies in terms of their characteristics and analysis methods: consensual qualitative research, phenomenological research, qualitative case study, grounded theory, photovoice, and content analysis. We mainly focus on specific aspects of data analysis and the description of results, while also providing a brief overview of each methodology’s philosophical background. Furthermore, since quantitative researchers have criticized qualitative research methodology for its perceived lack of validity, we examine various validation methods of qualitative research. This review article intends to assist researchers in employing an ideal qualitative research methodology and in reviewing and evaluating qualitative research with proper standards and criteria.

Summary

Korean summary
질적연구 방법론은 보건의료 연구에서 연구 참여자가 경험하는 주요 현상을 잘 포착할 수 있도록 해 준다. 이 논문에서는 합의적 질적연구, 현상학적 연구, 질적 사례 연구, 근거이론, 포토보이스, 내용 분석 등 6가지의 대표적인 질적 연구 방법론에 대한 간략한 철학적 배경과 구체적인 데이터 분석 및 해석 방법을 소개한다.

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Qualitative Research in Healthcare: Necessity and Characteristics: Jeehee Pyo, Won Lee, Eun Young Choi, Seung Gyeong Jang, Minsu Ock; J Prev Med Public Health. 2023;56(1):12-20. Published online January 10, 2023; DOI: https://doi.org/10.3961/jpmph.22.451

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Abstract Summary PDF

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Summary

Korean summary
이 원고는 질적연구 방법론의 필요성 및 특징과 함께 보건의료 분야에서 질적연구 방법론이 활용된 선행 연구들을 정리하였다. 이는 보건의료 분야의 사회과학적 특성을 더 잘 드러내는 질적연구 방법론의 적용 및 확대에 도움이 될 것이다.

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Special Article

Perceptions of the General Public About Health-related Quality of Life and the EQ-5D Questionnaire: A Qualitative Study in Korea: Minsu Ock, Jeehee Pyo, Min-Woo Jo, Michael Herdman, Nan Luo; J Prev Med Public Health. 2022;55(3):213-225. Published online May 31, 2022; DOI: https://doi.org/10.3961/jpmph.22.151

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Abstract Summary PDF

Objectives
The aim of this qualitative study was to investigate how members of the general public in Korea interpret the concept of health, and which dimensions of health are most important to them. We also explored their perceptions of the EuroQoL 5-Dimension (EQ-5D), including the EuroQoL visual analogue scale (EQ-VAS).
Methods
We conducted face-to-face, in-depth interviews with 20 individuals from the general population, using a semi-structured interview guide. Content analysis was performed with verbatim transcripts and field notes to identify codes and categorize them according to their similarities and associations.
Results
In total, 734 different codes were derived and classified into 4 categories. Participants cited the importance of both the mental and physical aspects of health, although they emphasized that the physical aspects appeared to play a larger role in their conceptualization of health. Participants noted that the EQ-5D has the advantage of being composed of 5 dimensions that are simple and contain both physical and mental areas necessary to describe health. However, some of them mentioned the need to add more dimensions of mental health and social health. Participants showed great satisfaction with the visually well-presented EQ-VAS. However, participants opined that the EQ-VAS scores might not be comparable across respondents because of different ways of responding to the scale.
Conclusions
While physical health is a fundamental aspect of health, mental and social aspects are also important to Koreans. The content of the EQ-5D broadly matched the attributes of health considered important by Koreans.

Summary

Korean summary
이번 연구에서는 질적 연구 방법론을 활용하여 한국인이 건강을 이해하고 개념화하는 방법과 건강의 어떤 차원을 중요하게 여기는지 살펴보면서 EQ-5D에 대한 인식을 살펴보았다. 이번 연구를 통하여 EQ-5D와 EQ VAS가 전반적으로 한국인의 건강 관련 삶의 질을 잘 측정할 수 있지만, 정신적 및 사회적 측면에 대한 항목을 추가하면 한국인의 건강 관련 삶의 질을 더 잘 반영할 수 있음을 확인하였다.

Citations

Citations to this article as recorded by

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