From the Guidelines
When a patient refuses medical treatment, healthcare providers should first ensure the patient has decision-making capacity and respect their autonomy while thoroughly documenting their refusal and discussions. This approach is supported by the most recent and highest quality study, which emphasizes the importance of shared decision-making and respecting patient autonomy 1.
Key Steps to Take
- Assess the patient's decision-making capacity by evaluating their ability to understand information, appreciate consequences, reason about options, and communicate choices.
- Respect the patient's autonomy and thoroughly document their refusal and discussions.
- Attempt to understand the patient's concerns through open-ended questions and address specific fears or misconceptions.
- Offer alternative treatments or modified approaches that might be more acceptable to the patient.
- Clearly explain the potential consequences of refusal using plain language, and consider involving family members or trusted individuals with the patient's permission.
Importance of Documentation and Follow-Up
- Thoroughly document the patient's refusal and discussions in their medical record.
- Schedule follow-up appointments and periodically reassess the patient's decision as their condition or perspectives may change.
- Maintain a therapeutic relationship without abandoning the patient, even if they refuse treatment.
Emergency Situations
- In emergency situations where the patient lacks capacity and no advance directive exists, treatment may proceed under implied consent or emergency exception principles to prevent imminent harm, as supported by guidelines from various medical societies 1.
However, the most recent and highest quality study 1 provides the best guidance on this issue, emphasizing the importance of shared decision-making and respecting patient autonomy.
From the Research
Steps to Take When a Patient Refuses Medical Treatment
- Respect the patient's autonomy and decision-making capacity, as emphasized in the study 2
- Ensure the patient has clear, evidence-based medical information to make informed decisions about their care, as highlighted in 2 and 3
- Explore the reasons behind the patient's refusal, including any unconscious motivations or concerns, as suggested in 2
- Discuss advance care planning with the patient, as mentioned in 2, to ensure their wishes are respected and documented
- Collaborate with the patient and their family (if applicable) to develop an alternative care plan that aligns with their values and goals, as implied in 2
Considerations for Specific Conditions
- For patients with hypertension, lifestyle modifications such as weight loss, healthy dietary patterns, and physical activity can be effective in lowering blood pressure, as discussed in 4, 5, and 6
- Pharmacological therapy may be necessary for some patients, with first-line medications including thiazide diuretics, angiotensin-converting enzyme inhibitors, and calcium channel blockers, as outlined in 4, 5, and 6
- Accurate diagnosis and optimal treatment of hypertension can reduce adverse cardiovascular events and risk of death, as emphasized in 6