Document Type: Original Article

Authors

1 Department of Medical Ethics and Philosophy of Health, Shiraz University of Medical Sciences, Shiraz, Iran

2 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Department of Hematology and Medical oncology, Shiraz University of Medical Sciences, Shiraz, Iran

4 Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: This study sought to provide a comprehensive understanding of cancer treatment refusal based on the experiences of patients, caregivers, and health care providers.
Methods: In this qualitative research study, we enrolled 21 cancer patients, their caregivers, and health care providers. We conducted in-depth interviews of the participants to obtain the necessary data about treatment refusal. The data were coded, and data analysis was performed via the inductive analysis method.
Results: There were three main categories in this study: “coexistence of hope and denial”, “treatment complexity and repeated complications”, and “treatment is in vain”. The first main category had five subcategories: ‘lack of symptoms, a way to denial’; ‘misconception’; ‘hope’; ‘hiding the disease’; and ‘insistence on maintaining one’s lifestyle’. Subcategories of the second main category included: ‘fear: shared experience’; ‘sign and symptom exacerbation; end of denial’; ‘duality in life quality’; ‘side-effects: a barrier to treatment’; ‘side-effect reliever’; and ‘tendency for alternative medicine’. Subcategories of the third category included: ‘degenerative course of cancer’; ‘acceptance of death’; and ‘remorsefulness: the shared experience’.
Conclusion: In this study, participants provided different explanations for forgoing or avoiding treatment. During the initial cancer stages, denial was an effective factor for patients to not seriously consider the appropriate diagnostic and therapeutic interventions. As the disease advanced, alternative treatments and complications were the main factors for treatment refusal. Identification of the main motives for treatment refusal during the course of the disease would be effective for cancer management.

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