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Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer

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Abstract

Purpose

The study’s purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer.

Methods

The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer.

Results

We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making.

Conclusion

The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

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Acknowledgements

We give thanks to Sophie Domingues for the translation into English; S. Rhouni; the task force members: V. Adam et S. Dauchy (scientific coordinator), V. Block (methodologist), F. Barruel-Sinimale, S. Chevallot, M. Delanghe, R. Diab, M. Dionisio, L. Domingo, M. Dubuc, E. Duflot, A. Eberl Marty, J. C. Faivre, E. Gobert, A. Henry, S. Lafon, H. Laval, A. S. Lebihan, I. Lombard, F. Marchal, A. Marhoffer, P. Mathis, T. Montaut, L. Perrin, C. Preaubert-Sicaud, J. Raft, M. Reich, M. Rios, D. Spaeth, E. Thomas Elisabeth, N. Verotte, M. Zamith-Chavant, M. Metzger, and J. Salleron; and the members of the review group: G. Ader, E. Arbiol, E. Bansard, L. Baudin, D. Baudoin, J. M. Bergia, I. Bevilacqua, C. Bigeard, G. Bourgade, P. Brillaxis, M. C. Campergue, Y. Chait, A. Chaix, C. Chauffour-Ader, M. Chrysostome Marion, G. Chvetzoff, P. Colombat, N. Corazza, C. Corra, M. Delanghe, V. Delcroix, C. Deluca, P. Dietrich, M. L. Duhamel, L. Dupont, V. Duport, C. Gallay, E. Gilbert-Fontan, S. Guiberteau, S. Jar, M. C. Joulot, P. Kerdraon, S. Lafon, E. Lemaitre, S. Leriche, L. Lorin-Zurbuch, A. Martin, D. Mayeur, C. Merel-Vevoz, M. Montfort-Kusz, C. Morris, M. Mourceins, A. Parot-Monpetit, N. Piplard, S. Rebois, A. Riff, E. Sardou, V. Simonetti, C. Steckermans-Saez, M. Sulpice, V. Tequi, and D. Thirry.

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Authors and Affiliations

  1. Academic Department of Radiation Therapy and Brachytherapy, Lorraine Institute of Cancerology – Alexis-Vautrin CLCC [Centre de lutte contre le cancer – Cancer Center] – Unicancer, 6 avenue de Bourgogne – CS 30 519, F-54511, Vandoeuvre-lès-Nancy cedex, France

    J. C. Faivre

  2. Supportive Care in Cancer Department, Institut de Cancérologie de Lorraine, F-54500, Vandœuvre-lès-Nancy, France

    V. Adam

  3. French Association for Supportive Care in Cancer, 20 rue leblanc, F-7515, Paris, France

    V. Block

  4. Institut de Cancérologie de Lorraine, Medical Library, F-54500, Vandœuvre-lès-Nancy, France

    M. Metzger

  5. Biostatistics and Epidemiology Department, Institut de Cancérologie de Lorraine, F-54500, Vandœuvre-lès-Nancy, France

    J. Salleron

  6. Gustave Roussy, Département de Soins de Support, Université Paris-Saclay, F-94805, Villejuif, France

    S. Dauchy

  7. ES3, EA1610, Université Paris-Sud, Paris, France

    S. Dauchy

Authors
  1. J. C. Faivre
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  2. V. Adam
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  3. V. Block
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  4. M. Metzger
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  5. J. Salleron
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  6. S. Dauchy
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Contributions

Administrative support: S. Rhouni, V. Block

Editing of the manuscript: all of the authors

Final approval of the manuscript: all of the authors

Corresponding author

Correspondence to J. C. Faivre.

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All of the funding was provided by the AFSOS.

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The authors declare that they have no conflicts of interest.

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Faivre, J.C., Adam, V., Block, V. et al. Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer. Support Care Cancer 25, 3425–3435 (2017). https://doi.org/10.1007/s00520-017-3762-0

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