Physicians’ evaluations of patients’ decisions to refuse oncological treatment

Abstract

Objective:To gain insight into the standards of rationality that physicians use when evaluating patients’ treatment refusals.Design of the study:Qualitative design with indepth interviews.Participants:The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment.Results:Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients’ treatment refusals. From a medical perspective, a patient’s treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient’s refusal of these treatments. Thus, an important factor in the physician’s evaluation of a treatment refusal is whether the treatment refused is curative or non-curative.Conclusion:Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient’s decision being understood and accepted by the physician. The physician’s acceptance is crucial to his or her attitude towards the patient. It contributes to the patient’s feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship.

Discharge against medical advice: Ethical considerations and professional obligations

“…[29][30][31] Regardless of the setting for nonadherence, the variance between recommended and accepted treatments often stems from the fact that patients tend to make decisions based on values and broader interests whereas physicians tend to emphasize more circumscribed medical goals. 32,33 Informed and Voluntary Refusal of Treatment A patient's intention to leave AMA may trigger physicians and other hospital staff to question the patient's decision-making capacity. 34 One's capacity to make decisions is specific to the decision at hand.…”

Traditional Chinese Medicine as a Basis for Treating Psychiatric Disorders: A Review of Theory with Illustrative Cases

“…11,12 Reasons for noncompliance with pharmacologic interventions are diverse and include adverse reactions, a fear of long-term effects, the desire for more ''natural'' treatments, and the idea that taking medication is a tacit admission of a diagnosis with which the patient does not agree. 13,14 Americans are seeking complementary and alternative medicine (CAM) treatments for a wide variety conditions, including mental illness. The National Health Interview Survey (NHIS) of 2007 revealed that 38.3% of U.S. adults and 11.8% of children reported using some type of CAM treatment.…”

Genetics in the medical and psychosocial practice: on the role of value hierarchies in counselling

“…Patients mainly refused treatment for reasons of personal values and experiences, something that was difficult to accept for physicians who generally used goal-oriented rationality. Only in the case of noncurativeness did physicians place more emphasis on value-oriented rationality, leading to a better patientphysician relationship (Van Kleffens and Van Leeuwen 2005). Treatment decisions were also the focus in a study of Schildmann et al (2013).…”

“…Not value conflicts per se, but values explicitly being a basis for decisions are found to play a role in the physician-patient relationship. Van Kleffens and van Leeuwen (2005) interviewed patients and physicians to gain insight into the rationalities of both groups, especially in regard to the patient's refusal of oncological treatment. Patients mainly refused treatment for reasons of personal values and experiences, something that was difficult to accept for physicians who generally used goal-oriented rationality.…”