{"entity":{"id":"idea-moon-treatment-refusal-pathway","kind":"idea","name":"A structured pathway for patients declining proven treatment","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Misinformation and unproven therapies): Johnson et al., Cancer misinformation and harmful information on Facebook and other social media (JNCI 2022)","url":"https://doi.org/10.1093/jnci/djab141"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-misinformation","b-patient-voice"],"keyPapers":["paper-johnson-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":2},"route":"/ideas/idea-moon-treatment-refusal-pathway/","neighbours":{"bottleneck":[{"id":"b-misinformation","kind":"bottleneck","name":"Misinformation and unproven therapies","route":"/bottlenecks/b-misinformation/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"}],"paper":[{"id":"paper-johnson-j-natl-cancer-inst","kind":"paper","name":"Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report","route":"/key-papers/paper-johnson-j-natl-cancer-inst/"}]}}