Beyond denial: A case report illustrating the complexity of disengagement in advanced cancer care.
Julie Haslam, Anne-Sophie Morissette-Gravel, Laury Chamelian et al.
✦ AI-curated · Sources linked
Case in brief
A woman in her forties from Africa with advanced metastatic gastric cancer declined prognostic discussions, did not want her family informed, and avoided opioid analgesia. Although these behaviors were initially interpreted by her treating team as denial, she explicitly acknowledged her diagnosis and its severity. Psycho-oncology consultation reframed her choices as coherent with her values, maternal role, and cultural background rather than evidence of impaired insight or maladaptive coping. On the final day of her life, she accepted palliative care and agreed to family notification, illustrating that her apparent disengagement changed over time.
What made this case unusual
Behaviors resembling denial coexisted with explicit acknowledgment of the cancer’s severity; consultation linked her choices to personal values and cultural context rather than impaired insight.
Diagnostic / clinical pearl
Do not equate declining discussions or treatment with lack of insight. Assess the patient’s understanding, values, cultural context, and possible psychiatric or neurocognitive factors before interpreting disengagement as maladaptive denial.
Why it matters
Offering individualized, empathic care while respecting autonomy may allow patients to engage differently over time, without pathologizing their initial choices.