Treatment Refusal by Cancer Patients: A Qualitative Study of Oncology Health Professionals’ Views and Experiences in Australia

Abstract

In some cases, against medical advice, a person with cancer decides not to undergo any conventional, evidence-based cancer treatments including chemotherapy, radiotherapy hormone therapy and others. Estimates for treatment refusal range from 2.6% to 14.55%. Refusing evidence-based conventional cancer treatments is linked to rapid deterioration, poor prognosis and a higher risk of premature death. This study aimed to explore oncology health professionals’ experiences and views on why patients refuse standard cancer treatments. We employed an in-depth qualitative research design, adopting a social constructionist framework. Fourteen health professionals in Western Australia (WA) with experience working in oncology were interviewed. Four themes were identified: ‘They want to do it their way’; ‘Keeping the door open’; ‘It can be draining’; and ‘Where to from here?’. We found that treatment refusal had a disproportionate impact on individuals, families, health professionals and the health system, including time spent engaging with patients contemplating refusing treatment. The issue is complex and multifaceted, with several motivations for treatment refusal. Statistics on 5-year survival rates need to be presented in a number of ways so that people understand what these statistics mean. General information on cancer regarding incidence, treatments and survival rates could be presented via social media so that we reach more people. Supports for oncology health professionals are needed including training to prevent compassion fatigue and burnout.