How do cancer patients refuse treatment? A grounded theory study

Abstract

Background All cancer patients, except for a small fraction, seek treatment after becoming aware of the disease. That small fraction do not seek any treatment due to various reasons, and this phenomenon is unknown to us. Therefore, the present study aimed to discover the reasons for treatment refusal in cancer patients. Methods This qualitative grounded theory study was conducted on 22 participants including patients, caregivers, physicians, and nurses. Purposive theoretical sampling was employed. Data were collected through in-depth interviews. All interviews were gradually transcribed and analyzed. Data analysis was carried out through the three-step method of open, axial, and selective coding and was continued until theoretical saturation. Straussian Grounded Theory was used for data analysis. Results A total of 4 themes and 20 sub-themes were extracted in this study. The core variable extracted from the interviews was “resilience” Other related themes included encounter with cancer, fighting cancer, and coping with cancer. The findings showed that in the context of fighting cancer, patients lost their resilience through various processes and refused treatment. Conclusion Cancer patients abandon the treatment in silence, oncologists and even family members being unaware of the matter. In other words, refusal of treatment is like an iceberg and the majority of the patients who have abandoned treatment are unknown to the health system. The model obtained in this study can increase the knowledge of the process that leads patients to lose their resilience against cancer and abandon treatment, which can increase the possibility of recognizing and predicting treatment refusal for oncologists.

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

“…Studies also have Qualitative studies have indicated that older patients with metastatic cancer or advanced chronic conditions forgo clinician recommendations because of diagnosis denial and fear of treatment adverse effects. [27][28][29][30] Patient-clinician communication, shared decision-making, and trust can affect patients' treatment decisions. 29,31,32 Other factors, including lack of health care access and advanced disease, also are associated with treatment declination, consistent with our observations in this study.…”

“…[27][28][29][30] Patient-clinician communication, shared decision-making, and trust can affect patients' treatment decisions. 29,31,32 Other factors, including lack of health care access and advanced disease, also are associated with treatment declination, consistent with our observations in this study. There are other reasons for forgoing treatment recommendations, and they may differ across racial and ethnic groups.…”

“…Qualitative studies have indicated that older patients with metastatic cancer or advanced chronic conditions forgo clinician recommendations because of diagnosis denial and fear of treatment adverse effects . Patient-clinician communication, shared decision-making, and trust can affect patients’ treatment decisions .…”

Medical aid in dying to avoid late‐stage dementia

“…26 There is no requirement to first exhaust all available treatment options. A patient's own choices and conduct affect whether clinicians can determine that they are terminally ill. 27,28 Similarly, whether an illness is terminal for purposes of MAID eligibility also depends on how the patient chooses to manage it. For decades, patients have qualified for MAID after declining treatments that might have reversed or cured their illnesses.…”

“…There is no requirement to first exhaust all available treatment options. A patient's own choices and conduct affect whether clinicians can determine that they are terminally ill 27,28 …”