title: [Challenging conversation with a patient about the change in treatment strategy from a curative to a palliative setting].
abstract: Palliative care is fortunately gaining importance in the treatment of endstage oncological patients. Patient information regarding therapeutic strategies, especially when treatments are suggested to alleviate symptoms and are not curing the disease can be the most challenging part. Our case of a 49 year old female presenting with a colorectal adenocarcinoma and vertebral body metastasis required spinal stabilization surgery to prevent paralysis. However, she did not consent to the necessary treatment, completely refusing to recognize the seriousness of her disease. In spite of many attempts to enlighten her, the disease was allowed to progress, and it was only when thrombosis caused massive edema of the right leg that the patient finally started to ask about prognosis and potential treatment. An interdisciplinary approach to provide medical and psychosocial help could be established. This case shows the typical problems of a physician-patient relationship in an oncologic clinic and emphasizes the importance of integrating medical with psychosocial care.
authors.affiliation: Interne Abteilung mit Palliativstation, Krankenhaus Oberwart, Osterreich. ghkiss@aon.at
authors.forename: Heinrich
authors.initials: H
authors.lastname: Kiss
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D001005:Anus Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006701:Home Nursing / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000523:psychology / Q000628:therapy; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012004:Rectal Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D014342:Truth Disclosure