Factors related to treatment refusal in Taiwanese cancer patients.
BACKGROUND
Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system.


METHODS
This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI).


RESULTS
A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (≥10times) (p=0.016).


CONCLUSIONS
Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.
Department of Nursing, Chang Gung Medical Foundation at Linkou Branch, Linkou, Taiwan E-mail : tingyu@cgmh.org.tw.
Ting-Yu
TY
Chiang
Chao-Hui
CH
Wang
Yu-Fen
YF
Lin
Shu-Lan
SL
Chou
Ching-Ting
CT
Wang
Hsiao-Ting
HT
Juang
Yung-Chang
YC
Lin
Mei-Hsiang
MH
Lin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D004493:Education; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D011379:Prognosis; D012067:Religion; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D016312:Treatment Refusal