Possibly impossible patients: management of difficult behavior in oncology outpatients.

Angry, threatening, or otherwise disruptive behavior by patients can interfere with necessary oncologic treatment, sometimes to the point of rendering continued care impossible. We offer oncology clinicians guidance in dealing with difficult outpatients by discussing the differential diagnosis and multidisciplinary management of treatment-disrupting behavior in the ambulatory oncology setting.We review the existing literature on dealing with difficult patients and present clinical experience at a comprehensive cancer center where a formalized, institutional process for responding to disruptive outpatients has been developed.A structured, multidisciplinary approach to deal with difficult behavior in oncology outpatients can improve care and staff morale. Staff using this approach can identify causes of treatment-disrupting behavior, develop and implement appropriate behavior plans, facilitate communication, address mental health issues, and ensure that decisions to terminate a relationship with a patient are ethical, clinically justified, and supported by due process.In the future, clinical recommendations and institutional guidelines for dealing with difficult patients should be evaluated with more structured, quantitative research.