From the Guidelines
The patient's decision to refuse a potentially beneficial treatment due to concerns about its neurological side effects should be respected, as there is no evidence of current depression affecting their decision-making capacity. When a patient with cancer expresses a preference for comfort-focused care over more aggressive treatment, healthcare providers should respect this decision if the patient demonstrates capacity 1. In this scenario, although the patient had depression three years ago, there's no evidence of current depression affecting their decision-making. Depression in the past alone is not sufficient reason to question capacity, as stated in the ASCO guideline adaptation for screening, assessment, and care of anxiety and depressive symptoms in adults with cancer 1. The patient shows understanding of their situation by acknowledging the treatment benefits and side effects, and they're making a values-based decision prioritizing quality of life.
Some key points to consider in this decision include:
- The importance of respecting patient autonomy in medical decision-making, particularly in end-of-life care decisions when the patient demonstrates understanding of their options 1
- The need for regular screening and assessment of depressive symptoms in patients with cancer, as recommended by the ASCO guideline adaptation 1
- The use of valid and reliable measures, such as the Personal Health Questionnaire (PHQ-9), to assess for depressive symptoms and determine the associated sociodemographic, psychiatric or health comorbidities, or social impairments 1
- The consideration of the patient's values and priorities in making treatment decisions, as emphasized in the ASCO guideline adaptation 1
Overall, the patient's decision should be respected, and their autonomy in making medical decisions should be prioritized, as long as they demonstrate capacity and understanding of their options 1.
From the Research
Patient Autonomy and Treatment Refusal
- Patients with a history of depression, currently being treated for cancer, have the right to refuse treatment due to concerns about neurological side effects, considering their past diagnosis of depression and current absence of depressive symptoms 2, 3.
- The decision to refuse treatment should be made after careful consideration of the potential benefits and risks, and patients should be fully informed about the treatment options and their potential side effects 4, 5.
Consideration of Past Diagnosis of Depression
- A past diagnosis of depression does not necessarily mean that the patient is currently experiencing depressive symptoms, and treatment decisions should be based on the patient's current mental health status 2, 6.
- However, a history of depression can increase the risk of developing depression again, and patients with a history of depression may be more vulnerable to the psychological effects of cancer treatment 3, 4.
Patient Involvement in Treatment Decisions
- Patients with cancer and a history of depression should be involved in treatment decisions and should be encouraged to express their concerns and preferences 4, 5.
- Healthcare providers should provide patients with clear and accurate information about treatment options and their potential side effects, and should support patients in making informed decisions about their care 2, 6.
Importance of Multidisciplinary Care
- The management of depression in patients with cancer requires a multidisciplinary approach, involving oncologists, mental health professionals, and other healthcare providers 5, 6.
- A collaborative care model that incorporates a stepped care approach can be effective in managing depression in patients with cancer, and can help to ensure that patients receive comprehensive and coordinated care 5.