Palliative Lung Cancer

I was to see a patient who was diagnosed with a 4th stage lung cancer (under palliative care) for chest physio review. Just to outline a little bit of the patient’s background: he was notified by his radiologist a few years back that he was suspected of having bronchogenic carcinoma. He was told that he would be referred to a hospital for further investigation. However, he waited for an appointment with the hospital that never came. He was recently admitted to the hospital by a ?neighbour when they saw his current condition.

The patient was on oxygen therapy via Venturi mask, and looked frail and exhausted. He was initially compliant with my subjective questioning, but became slightly agitated when I asked for permission to perform auscultation. He refused any form of physiotherapy intervention, and blamed the hospital system for not following up with him during his initial stage. I attempted twice to persuade him for physio, but was unsuccessful.

In such situations, I felt that any form of persuasion or intervention rationale became inappropriate as the patient had already decided that he would benefit from nothing at his current state. After consulting other physiotherapists in the hospital, I learned that although PT Rx could aid in the management of his respiratory condition, it was best not to push the patient since he refused even after several attempts. After all, PT intervention cannot be indicated without the patient’s consent. However, the approach should differ if the patient's recovery was more promising. In this instance, I could perhaps consider consulting the doctor or referring him to a clinical psychologist?