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What do you do if a patient and their family are resistant to treatment options?

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When faced with a patient and their family who are resistant to treatment options, healthcare professionals encounter a delicate situation that requires empathy, clear communication, and a thorough understanding of the patient's perspective. Resistance can stem from fear, mistrust, cultural beliefs, or misinformation. It's crucial to approach such scenarios with the intent to listen and provide support, rather than to coerce or confront. By fostering an environment where patients feel heard and respected, you can begin to address their concerns and work collaboratively towards a solution that aligns with their values and medical needs.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023

1 Understand Concerns

Begin by actively listening to the patient and their family to understand the root of their resistance. This involves not only hearing their words but also acknowledging their emotions and perspectives. Empathy is key here; showing that you genuinely care about their wellbeing can help build trust. Ask open-ended questions to encourage them to express their fears or doubts, and be patient as they share their thoughts. Understanding their concerns is the first step in addressing them and finding a mutually agreeable path forward.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023
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As a breast surgeon, I attend to many women with self-detected breast lumps or a screen-detected breast abnormality. Often, they need a biopsy for diagnosis. Once cancer is diagnosed, the treatments include surgery, chemotherapy, radiation treatment. I have seen a wide range of concerns + fears. Rejecting a mammogram because of radiation, rejecting a biopsy because they have googled that it makes the lump change into cancer, or that it makes it spread; or rejecting chemotherapy because it is poison. First step is to have this open conversation and hear them out, and figure out what their concerns are, where they got that information, or that impression.

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2 Educate Patient

Once you understand their concerns, provide clear and concise information about the proposed treatments. Use layman's terms to explain the benefits, risks, and the rationale behind each option. Ensure that the patient and their family have a good grasp of the situation by asking them to repeat back what they've understood. This can help clarify any misconceptions and reinforce their comprehension. Education empowers patients and families, potentially reducing resistance as they become more informed about their choices.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023
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Once I hear out the patient's concerns on their fears of mammograms/biopsies/chemotherapy, this is where education comes in. To share facts, up to date articles and information for them to process and reassess. A few actually have that fear deeply rooted in a childhood trauma or bad healthcare experience. This takes longer to unravel, and I administer some basic counseling, and advise them to seek psychological help.

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3 Explore Alternatives

If resistance persists, explore alternative treatment options together. There may be different methods or approaches that are more acceptable to the patient and their family while still effectively addressing the medical issue. Discuss the pros and cons of these alternatives and how they compare with the original treatment plan. The goal is to reach a compromise without compromising the quality of care. Involving the patient in decision-making can lead to better adherence to the treatment plan.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023
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In Singapore, many of our cancer patients would like to try traditional chinese medicine. As far as I can, I encourage them to see a licensed practitioner, so that we can give complementary treatments, rather than "alternative".

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4 Support Autonomy

Respect for patient autonomy is fundamental in healthcare. It's important to support the patient's right to make decisions about their own body, even if you disagree with their choice. Ensure that they are making informed decisions by reiterating the potential consequences of refusing treatment. However, if they fully understand and still choose not to proceed, respect their decision, and continue to offer support and care within the scope of their choices.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023
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For patients fearful of mammograms, biopsies or chemotherapy, the one most powerful thing I tell them is: You are in control, you have the choice. No one will force you to do something you don't want to. We doctors have a duty of care, to present options, and all I ask is for you to hear me out- and understand why I'm proposing a certain treatment plan. Feel free to ask any questions, and let me know how much I can help you get better. There are always alternatives and options.

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5 Collaborate Closely

Collaboration with other healthcare professionals can provide additional perspectives and resources when dealing with resistant patients. A multidisciplinary approach may include social workers, psychologists, or religious leaders who can address specific concerns. This collaborative effort can lead to more comprehensive care plans that respect the patient's values and beliefs while also striving for the best medical outcomes.

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陈艺旋

乳房外科医生，专于乳癌，乳房发炎。正确诊断，活检，手术－帮助病人。新加坡医药协会会长；官委议员2021-2023
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Many of my breast cancer patients have pre-existing anxious personality, and even more so after a cancer diagnosis. Being able to teach them about how to better manage uncertainty helps them cope better during the treatment journey. For some women, I encourage them to see a psychologist, or a cancer coach. A few need to see a psychiatrist for medications as their anxiety was interfering with their cancer treatments.

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6 Follow Up Regularly

Regular follow-up is essential to maintain open lines of communication and monitor the patient's condition. These check-ins allow you to reassess the patient's stance on treatment and provide ongoing education and support. They also serve as opportunities to build a stronger rapport with the patient and their family, which can be instrumental in overcoming resistance over time. Consistent follow-up demonstrates your commitment to their health and well-being, fostering a relationship based on trust and mutual respect.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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What do you do if a patient and their family are resistant to treatment options?

1

2

3

4

5

6

7

1 Understand Concerns

2 Educate Patient

3 Explore Alternatives

4 Support Autonomy

5 Collaborate Closely

6 Follow Up Regularly

7 Here’s what else to consider

Healthcare

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What do you do if a patient and their family are resistant to treatment options?

1

2

3

4

5

6

7

1 Understand Concerns

2 Educate Patient

3 Explore Alternatives

4 Support Autonomy

5 Collaborate Closely

6 Follow Up Regularly

7 Here’s what else to consider

Healthcare

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