If Mrs. Zhang is depressed, she may refuse treatment because she has lost interest in living. You could ask Mrs. Zhang about how she's been feeling emotionally and also inquire about her energy level, her sleeping and eating patterns, and her interest in usual activities to learn about her mood. It may be important to acknowledge how difficult it can be to learn you have cancer and explain that it's normal to experience feelings of sadness or hopelessness.

Tension between Mrs. Zhan and Meiling may be affecting Mrs. Zhang's health or ability to get the type of care she wants. You could acknowledge their difference in perspective and ask Mrs. Zhang how she feels about this conflict and whether she and her daughter have talked about it. You might consider asking Meiling to leave the room so you can speak with Mrs. Zhang alone, if you think she might speak more freely.

If Mrs. Zhang prefers not to consult an oncologist and Meiling remains concerned about forgoing conventional care, this conflict may interfere with their relationship, the care Mrs. Zhang receives, and their end-of-life experience. You could suggest that with Mrs. Zhang's permission, Meiling could meet with an oncologist to discuss her mother's diagnosis, prognosis, and treatment options.

If Mrs. Zhang and Meiling do speak with an oncologist, that physician may mention hospice. The same is true with the TCM provider. You could ask whether they are familiar with hospice, provide basic details about this option, and give them contact information so they can learn more.