# Multisystem Disease With Suspected Malignancy: Clinical Management Following Diagnostic Refusal

## TL;DR

This paper discusses the ethical and clinical management of an elderly patient who refused further cancer testing, emphasizing personalized care and patient autonomy.

## Contribution

The paper highlights a practical approach to managing diagnostic uncertainty and respecting patient autonomy in primary care.

## Key findings

- The patient's refusal of further testing led to a shift in care toward palliative support and continuous follow-up.
- The case demonstrates how ethical principles guide clinical decisions in the absence of a definitive diagnosis.
- Primary care physicians can maintain quality care through trust and individualized strategies in complex cases.

## Abstract

Follow‑up of older adults in primary care often entails clinical challenges that go beyond diagnosis. Comorbidities, functional limitations, and social vulnerabilities require a holistic, person‑centred approach grounded in a continuous and trusting doctor-patient relationship. We present a case of an 88-year-old man followed in Family Medicine consultations, who presented with cervical and abdominal skin lesions evolving over three months. Imaging findings were highly suggestive of disseminated oncologic disease. Two biopsies were performed, but no definitive diagnosis was reached. After a clear clinical explanation regarding diagnostic hypotheses and likely disease progression, the patient refused further aetiological investigations. Respecting the principle of autonomy, the clinical management strategy shifted towards continuous follow‑up, adaptation of the therapeutic plan, and a referral to palliative care was proposed. This case underlines the importance of individualised care and adherence to ethical principles, particularly patient autonomy, when diagnostic investigation is declined. It illustrates how primary care physicians can maintain clinical oversight and deliver quality care when faced with diagnostic uncertainty.