Medica Jadertina, Vol. 45 No. 3-4, 2015.
Professional paper
Patient with advanced prostate cancer: What to do when a patient refuses the recommended therapy?
Danijela Daus-Šebeđak
orcid.org/0000-0003-3300-4502
; Specijalistička ordinacija obiteljske medicine "Dr. Danijela Daus-Šebeđak", Podvinje
Mladenka Vrcić Keglević
; Zaklada za razvoj obiteljske medicine, Zagreb
Abstract
This article describes the case of a patient with metastatic prostate cancer who refused recommended active oncologic treatment. The patient was a 77-year-old man, with advanced local cancer status, very high PSA level and bone metastases, to whom castration and antiadrogen therapy were recommended. In spite of the intention of his family doctor to accept the recommendations, the patient and his family remained persistent. He only accepted a palliative home care. Taking care for this patient was not an easy task for his family doctor because many dilemmas arose; to accept or not his decision, or if the medical decisions were evidence-based , have I done enough for this patient? But, from the rational point of view, family doctors should accept their patients’ decisions, because they are in accordance to the Croatian Law on Patient’s Rights and in accordance to the Doctor's Ethical Code. Moreover, the patient's decision seemed rational from the medical point of view. There is a lot of evidence based (EBM) literature questioning the effectiveness of chemotherapy near the end of life. But, something irrational in family doctor's thoughts and feelings still remains bringing him a certain sort of stress. This was solved through discussion in peer-groups, because other methods do not exist in practice. In conclusion, it could be said that this situation is very common in health care and that further resources, human and material, should be invested in helping the health care professional to deal with the possibility of the burn-out syndrome.
Keywords
refusal recommended therapy; prostate cancer; work stress; family medicine
Hrčak ID:
152275
URI
Publication date:
29.1.2016.
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