Exploring behavioural motivations of treatment refusal in cancer: a Q-methodological approach

Background: Cancer treatment refusal is known to lower survival rates and increase cancer symptoms in individuals with cancer. Behavioural motivations of treatment refusal need to be elucidated for better cancer care. Using Q-methodology, a mixed methods research approach, we explored behavioural motivations of treatment refusal in individuals diagnosed with cancer. Method: Thirty-nine individuals (n = 39; age = 49.2 ± 12.2 years) were recruited from Australia, the UK, and the USA, who had refused cancer treatment within the past decade. Participants completed an online demographic questionnaire and a Q-sort activity which required the organisation and ranking of 44 statements on potential treatment refusal motivations. Q-sort data were analysed with an inverted factor analysis. Compositive Q-sorts, distinguishing statements, and demographic data facilitated interpretation of the resulting factors. Results: Eight factors, accounting for 66% of total variance, were identified and interpreted. The eight factors were as follows: (1) I was not motivated by my health status, (2) Treatment was too risky for how unwell I was, (3) I was motivated by my age, (4) I did not distrust the medical system and practitioners, (5) Religious and spiritual practices would heal me, (6) I was influenced by my religious and spiritual beliefs, (7) My prognosis was not good enough, and (8) I wanted to heal naturally. Conclusion: Diverse motivations for cancer treatment refusal were found, which could help practitioners understand an individual’s considerations regarding treatment decisions. Future research should investigate motivations underpinning cancer treatment refusal and establish person-centred strategies to address concerns when promoting evidence-based cancer treatment.