The medical practice of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective

Kleffens, Titia van; Baarsen, Berna van; Leeuwen, Evert van

doi:10.1016/j.socscimed.2003.08.027

Cited by 55 publications

(53 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, the majority of physicians respect patients' autonomy and their decisions and requires the consent of relatives when the patient is not capable of reaching a decision (27). However there are still many physicians who have a paternalistic attitude toward their patients, as demonstrated by our finding that 83% of physicians thought that patients would consent to the method recommended by the physician (28).…”

Section: Discussionmentioning

confidence: 93%

Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

et al. 2009

View full text Add to dashboard Cite

Aim To assess physicians' knowledge and practices for obtaining patients' informed consent to medical procedures.Methods An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery.Results Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P = 0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P = 0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P < 0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P < 0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P ≥ 0.05 for all questions). ConclusionPhysicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process. PUBLIC HEALTH doi: 10.3325/cmj.2009.50.567 PUBLIC HEALTH 568 Croat Med J. 2009 50: 567-74 www.cmj.hrInformed consent is a professional ethics issue emanating from the fiduciary responsibility of the physician to the patient. It is an integral component of the physician's fiduciary responsibility. In many countries informed consent for medical procedures is a standard procedure (1-9) for providing the patients with the information on diagnostic and treatment procedures, risks, complications, and alternative treatment options in non-emergency cases (5,9,10), thereby considerably improving the communication between physician and patient. A signed form is the evidence that their conversation led to a mutual understanding. However, the implementation of the informed consent process differs among countries because informing the patient and requiring the consent are still not regarded as a legal obligation of the physician (6).In the clinical setting, the term "informed consent" was developed in the USA in 1957. It was further developed in the Declaration of Helsinki in 1964, which established worldwide ethical principles for medical research involving human participants. In its current, 2008 version (11), the article 24 states: "In medical research involving competent human subjects, each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, insti...

show abstract

Section: Discussionmentioning

confidence: 93%

Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Such a refusal should take into consideration improved survival and quality of life weighed against the much-dreaded side effects of treatment, given that most patients are distinctly influenced by what they have witnessed in other cancer patients, which will undoubtedly cloud the notion of cancer treatments 31,32 .…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

et al. 2017

View full text Add to dashboard Cite

Purpose Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions. MethodsWe retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined.Results During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; p < 0.001).Conclusions Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer.

show abstract

“…Patient autonomy is conceptualized because the patient's right to create informed selections regarding their own care while not undue influence or manipulation from others. Van Kleffens et al (2004) 35,36 in their qualitative study revealed that patient autonomy was a comprehensive thought with elaborations on making decisions and defining life choices as sub-concepts of patient autonomy. In contrast to what's usually believed, decisions of patients relating to refusing a medicine treatment don't so much rely on the medical information about disease and treatment options, but are rather inspired by patients' own experiences or those of close others.…”

Section: Table Twomentioning

confidence: 99%

Psychological Well-Being of Elderly Women Who Early Survive Breast Cancer and its Associated Factors

Alam

Boughdady

El‐Gilany

2017

IJND

View full text Add to dashboard Cite

Background: Diagnosis and treatment of breast cancer (BC) adversely affect the psychological well-being (PWB) of elderly patients. Aim of the study: This study aims to describe the PWB of elderly women-survivors of (BC) and its associated factors. Subjects: A convenient sample of 163 old women undertaken treatment of BC was enclosed within the study. Setting: This study was carried out at Mansoura University hospital (oncology center) in the outpatient clinics. Tools: Data collected included: Socio demographic and clinical data structured interview schedule. Psychological well-being was measured by the Arabic version of Ryff's Psychological Well-Being (RPWB) Scale. Religious activities were measured by the brief Arab religious coping Scale (BARCS). Results: Older women with breast cancer showed highly low mean scores (ranging from 21.7 to 25.6) within the six subscales of PWB. The mean scores of environmental mastery, personal growth, positive relations and purpose in life vary significantly consistent with age groups of the participants, educational level. The mean scores of autonomy, positive relations and self-acceptance showed vital variation consistent with variety of work before retirement. The mean scores of autonomy, environmental mastery, personal growth, life purpose, and self-acceptance vary consistent with income level. On the other hand the mean scores of personal growth, positive relations, and self-acceptance subscales vary significantly consistent with presence or absence of co-morbidities. Religious-coping-activities have vital inverse, weak correlation with autonomy and vital positive, moderate correlations with environmental mastery, positive relations, and self-acceptance. Conclusion: This study concluded that the women with breast cancer have low PWB scores. Several factors are related to variation in PWB. Religious coping improves PWB of elderly women extant breast cancer in posttreatment phase. There is a space for improvement. Recommendations: Special attention should be paid to elderly women with impaired PWB during follow-up visits.

show abstract

The medical practice of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective

Cited by 55 publications

References 23 publications

Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

Psychological Well-Being of Elderly Women Who Early Survive Breast Cancer and its Associated Factors

Contact Info

Product

Resources

About