A 74-Year-Old Man Comes to the Hospital Due to Weight

question 483

Multiple Choice

A 74-year-old man comes to the hospital due to weight loss, fatigue, and blood in the stools.  Review of systems is positive for a change in bowel habits.  Further evaluation reveals localized colon carcinoma.  The patient is told the diagnosis and is educated about his prognosis and treatment options, including surgery; he listens carefully and asks no questions.  He is a high school graduate and worked in an automotive factory until retirement; he and his wife have been active in his retirement community.  The patient appears to comprehend the information without difficulty.  He says, "I've lived long enough, and I do not want surgery or treatment of any kind."  The patient is accompanied by his wife, who agrees with the physician's recommendation for surgery.  Which of the following is the most appropriate next step in addressing this situation?

• A)Ask the patient's wife to convince him to receive treatment
• B)Ask the patient to explain why not receiving treatment is preferable to curative treatment
• C)Discharge the patient home against medical advice and tell him you are available if he changes his mind
• D)Discharge the patient home against medical advice but schedule outpatient follow-up in 1 week
• E)Perform a Montreal Cognitive Assessment