Treatment planning and decision-making support through the multidisciplinary collaboration for a cancer patient with severe depression : Practice of multidisciplinary conferences utilizing Johnsen’s quadrants

Abstract

  We reported a case in which a multidisciplinary conference utilizing Johnsen’s quadrants was held for the treatment of a cancer patient with severe depression, and the patient’s quality of life (QOL) was improved through the planning and execution of a step-by-step treatment plan. The dialogue using Johnsen’s quadrants was useful for sharing information and identifying problems in both psychiatry and physical medicine. This provided an opportunity to review medical restrictions in the treatment of psychiatric and physical complications, and for discussing a treatment plan that emphasizes the patient’s intention and QOL. Since the ability of patients with psychiatric disorders to consent to treatment can change or recover with psychiatric treatment, it is desirable to determine whether the condition is reversible and if it is, to first conduct psychiatric treatment to recover the ability to consent. However, in this case, the patient’s decisional capacity to treatment did not fully recover even after treatment for severe depression, and issues remain regarding decision-making support in cases where the ability to consent does not recover with psychiatric treatment.