# A structured pathway for patients declining proven treatment

Source: https://onco.cc/ideas/idea-moon-treatment-refusal-pathway/  
OnCo record `idea-moon-treatment-refusal-pathway` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When someone refuses recommended treatment, do not just record it. Offer a second conversation, address the beliefs behind it, keep the door open and track what happens.

## Summary

Refusal of standard therapy is associated with markedly worse survival in observational studies, and many refusals reflect misinformation, fear of toxicity or distrust rather than settled values. The proposal is a standard pathway: a documented exploration of reasons, a second consultation with a different clinician or navigator, targeted information addressing the specific belief, an explicit offer to revisit at defined intervals, and registry tracking of refusals and outcomes.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: The pathway converts a meaningful share of initial refusals into informed acceptance or safer alternatives and improves survival among initial refusers compared with historical controls.
- Rationale: Refusal is often a moment of fear rather than a fixed decision; systems currently treat it as final.
- Proposed test: Implement in three centres; compare rates of eventual treatment acceptance and 2-year survival among initial refusers against matched historical cohorts.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Misinformation and unproven therapies): Johnson et al., Cancer misinformation and harmful information on Facebook and other social media (JNCI 2022): https://doi.org/10.1093/jnci/djab141

## Connected records

- bottlenecks: [Misinformation and unproven therapies](https://onco.cc/bottlenecks/b-misinformation/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)
- key papers: [Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report](https://onco.cc/key-papers/paper-johnson-j-natl-cancer-inst/)

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