Denial of Terminal Patients with Advanced Cancer Tatsuya MORITA 1 , Satoshi INOUE 1 , Satoshi CHIHARA 1 1Hospice, Seirei Mikatabara Hospital Keyword: Denial , Anxiety , Defense mechanism , Palliative care , Advanced cancer pp.173-180
Published Date 1997/2/15
DOI https://doi.org/10.11477/mf.1405904272
  • Abstract
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 We reviewed 27 denial patients with far advanced cancer receiving palliative care, and reported 3 cases. Seven patients showed manic or hypomanic episode (DSM-IV) as manic defense.In 25 cases, denial was developed against implications of the disease, not against the existence of the disease itself. Examples of behavior style influenced by denial were refusal of medical interventions, eager participation in alternative therapy or new religions, unrealistic requests to physicians, and inappropriate idealization of physicians. Contributing factors to the defense included the anxiety of their family members, the patients' character, and lack of social support. Problems for care givers were conflicts concerning medications, involvement in family discord, excessive requests to carers. Prognoses of denial were eventual acceptance or matured defense in 52%, anxiety or depression in 26%, and continuing denial in 22%. We discussed desirable palliative care for denial terminal cancer patients and stressed the importance of holding conferences to get better communication among staff members, and making efforts to cultivate awareness of these phenomena in advanced cancer patients.

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