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PubMed1996

[Truth disclosure to patients diagnosed with cancer].

OBJECTIVE: To find the sort of information given to cancer patients in PC and the factors which affect the disclosure of the diagnosis. DESIGN: A descriptive crossover study, carried out through a personal interview. SETTING: A county hospital with no oncology service. PATIENTS: All those patients with cancer (histologically confirmed) admitted to the hospital during April and May 1993. MEASUREMENTS AND MAIN RESULTS: Each patient was asked what illness he/she had, who told him/her and where, along with his/her sociodemographic details. Later the date of diagnosis and the site and spread of the tumour were taken from the medical records. Out of 108 patients under study, 8 knew they had cancer, 1 said he/she had a tumour and 11 believed they had "something bad". 7 patients had no information about their illness and 81 gave alternative diagnoses (inflammation, cyst...). Disclosure was more common in the cases of breast cancer, haematological cancer and those diagnosed over 6 months previously. No significant differences regarding the spread of the tumour or the sociodemographic variables were found. CONCLUSIONS: The disclosure of a diagnosis of cancer is the exception, not the rule. Concealment is only abandoned in the case of potentially curable tumours and those which offer a longer life expectancy.

Aged↗
PubMed2004

Truth-telling in clinical practice and the arguments for and against: a review of the literature.

In general, most, but not necessarily all, patients want truthfulness about their health. Available evidence indicates that truth-telling practices and preferences are, to an extent, a cultural artefact. It is the case that practices among nurses and doctors have moved towards more honest and truthful disclosure to their patients. It is interesting that arguments both for and against truth-telling are established in terms of autonomy and physical and psychological harm. In the literature reviewed here, there is also the view that truth-telling is essential because it is an intrinsic good, while it is argued against on the grounds of the uncertainty principle. Based on this review, it is recommended that practitioners ought to ask patients and patients' families what informational requirements are preferred, and research should continue into truth-telling in clinical practice, particularly to discover its very nature as a cultural artefact, and the other conditions and contexts in which truth-telling may not be preferred.

Attitude of Health Personnel↗
PubMed2001

Ethical decision-making on communication in palliative cancer care: a personalist approach.

Perhaps one of the main ethical dilemmas physicians face in cancer medicine is the question of truthfulness with terminally ill cancer patients. Reluctance to share the truth with the patient about his or her diagnosis and/or prognosis is frequently associated with cultural pressures. Based on two cases, the authors illustrate how ethical analysis can help in solving dilemmas related to truth disclosure to terminally ill cancer patients and their families. A personalist approach reveals that the often-adduced conflict between nonmaleficence/beneficence and autonomy with regard to truth telling originates from a narrow understanding of the concept of autonomy. This confrontation is, therefore, more apparent than real. A brief review of the main ethical systems and the results of their application to clinical decision-making follow the discussion of the cases.

Aged↗
PubMedDate not supplied

Cross-cultural issues in the disclosure of cancer.

PURPOSE: To increase awareness of cultural differences in the disclosure of a cancer diagnosis or prognosis, the author reviews several surveys of patients and physicians from around the world. OVERVIEW: The Western medical community is increasingly emphasizing full truthful disclosure of cancer diagnoses or prognoses and respect for autonomy as necessary prerequisites to ethical practice. However, surveys of European, Japanese, Native American, and various ethnic American (including Korean, Chinese, Mexican, Hispanic, African, and European American) cancer patients and physicians reveal that many cultures consider complete and accurate disclosure of cancer undesirable. Cultural differences in the rates of disclosure of a cancer diagnosis or prognosis; the physician's use of euphemisms to give a true or false diagnosis; as well as considerations of how to disclose a cancer diagnosis are described. CLINICAL IMPLICATIONS: Developing an awareness about cross-cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. To this end, all healthcare professionals should be informed about how the patient would like to be informed of a diagnosis and how involved he or she would like family members to be. In addition, an awareness of the use of nonverbal communication in some cultures and the psychosocial impact of certain terms, such as "cancer," is essential. Often, phrases such as "malignant tumor" or "growth" are less inflammatory and are more readily accepted. In ascertaining a knowledge of various cultural preferences and developing a sensitivity to these preferences, clinicians are better able to provide effective care to individuals from a variety of cultural and individual backgrounds.

Attitude to Health↗
PubMed2001

Alzheimer's disease. To tell or not to tell.

OBJECTIVE: To evaluate reasons for telling or not telling patients about a diagnosis of Alzheimer's disease and to assess the effect of such a decision on patients, families, physicians, and the health care system. QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 1999 using the key words "Alzheimer's disease" or "dementia" and "truth disclosure" or "attitude to health." There were no randomized controlled trials (level I evidence) in the literature. Articles identified provided level II evidence (case-controlled and cross-sectional studies) or level III evidence (expert opinion). All articles identified were chosen for this study. MAIN MESSAGE: In attempting to determine whether or not to communicate a diagnosis of Alzheimer's disease, physicians face a predicament: the desire to communicate honestly and directly with a patient is sometimes at variance with the equally compelling desire to concur with the patient's family's reluctance to disclose the diagnosis. Most Alzheimer's patients should be told of their diagnosis, but the timing of the discussion and the way it occurs are crucial to a good outcome. Most patients accept the information without a catastrophic response. Physicians must gain support from patients' families because it could take time for them to accept disclosure of what is perceived as a "hopeless" diagnosis. CONCLUSION: We must continue to support Alzheimer's patients and promote hope.

Aged↗
PubMed1992

Breaking bad news.

OBJECTIVE: To investigate the importance of a sympathetic approach to breaking bad news in the doctor-patient relationship. DATA SOURCES: Worldwide surveys of views on truth disclosure by health care professionals, the public, and patients with cancer and other diseases. STUDY SELECTION: Surveys using a Medline Computer Search were identified. DATA EXTRACTION: Twenty-two questionnaire studies. DATA SYNTHESIS: The data obtained demonstrate trends of an increasing wish since 1950 on the part of patients, the public and doctors for more openness. CONCLUSIONS: The skills necessary for breaking bad news well can be acquired through organised undergraduate and postgraduate education which emphasises a good working doctor-patient relationship.

Australia↗
PubMedDate not supplied

Without parental consent: conducting research with homeless adolescents.

ISSUES AND PURPOSE: To identify the ethical and legal implications of conducting research with homeless adolescents and to discuss guidelines for conducting research without parental consent. CONCLUSIONS: Ethical principles of capacity, risk, postponement, and truthful disclosure within the context of the rights of minors to consent to healthcare treatment form the basis of the argument for allowing adolescents to consent to participate in research without parental consent when there is minimal risk or when such consent could place them at increased risk for harm. PRACTICE IMPLICATIONS: Adolescents who are the target population for clinical research or who are intended recipients of nursing care should be involved in setting priorities, purposes, and protocols. Parents and other adults from their communities should be included in developing strategies to protect their confidentiality and privacy while helping them achieve autonomy in making informed health-related decisions.

Adolescent↗
PubMed2001

The value of taking an 'ethics history'.

OBJECTIVES: To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement. DESIGN: Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds. SETTING: A large district general hospital in the United Kingdom. MAIN MEASURES: To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives. RESULTS: Twenty-four (43%) were inadequately informed of their illness. Forty-six (82%) said they would want to know were something serious to be found. Twenty-eight (50%) wanted to make their own decision if requiring risky treatment and 11 (20%) wanted family members involved. Thirty-one (55%) wanted to make a cardiopulmonary resuscitation (CPR) decision and five of these decisions differed from those made by the doctors. Twenty-five (45%) preferred the doctors to decide. Eleven (20%) of the patients had heard of living wills but only one had executed such a will. Seven (13%) of the patients wished to provide advance directives. Three (5%) did not find the history taking helpful but none were discomforted. CONCLUSION: Taking an ethics history is a simple means of obtaining useful information about patients' preferences.

Advance Care Planning↗
PubMed1982

Subjecting hospitals to truth in lending disclosure requirements: Bright V. Ball Memorial Hospital.

The federal Truth in Lending Act requires creditors to comply with complex disclosure requirements whenever they engage in consumer credit transactions. In light of procedures adopted by hospitals and health care professionals which permit payment for services over time, there is some question as to whether these groups may be considered creditors within the meaning of the Act and therefore subject to the Act's disclosure requirements. In Bright v. Ball Memorial Hospital, the Court of Appeals for the Seventh Circuit concluded that a hospital can be a creditor with respect to certain hospital-patient transactions. However, the court found that the defendant had not consummated consumer credit transactions with the plaintiffs and consequently had not violated the Act by failing to make disclosures. This Case Comment contends that although the court correctly determined that a hospital, in certain circumstances, may be subject to the Act, it incorrectly held that Ball Memorial failed to consummate consumer credit transactions with the plaintiffs. This Case Comment also discusses the circumstances under which a hospital should be considered a creditor for purposes of the Truth in Lending Act and recommends that hospitals offering installment payment plans routinely comply with disclosure requirements of the Act.

Accounting↗
PubMed1982

The validity of self-reports in alcoholism research.

It is often assumed that many alcoholics underreport their drinking and behavioral problems. Nonetheless, previous studies using official records and collateral reports suggest that self-reports of concrete drinking problems are not biased, and that overreports equal or exceed underreports. New data are presented, based on collateral reports and blood alcohol measures for 632 alcoholics interviewed four years after treatment. Results indicate that the subjects accurately reported abstention and major alcohol-related events, such as jail terms and hospitalization. Compared with estimates from blood alcohol measures, 35% of recent drinkers underreported their consumption during the 24 hours before the interview, and 24% underreported their consumption during the previous month. However, an overall outcome classification based on a combination of consumption and other measures was not substantially affected by errors in consumption reports. These findings indicate that most types of self-reports are valid, and that broadly based outcome measures are not likely to be significantly biased by underreporting errors.

Alcohol Drinking↗
PubMed2005

Debunking the 'only 50%' myth: prevalence of established risk factors in New Zealanders with self-reported ischaemic heart disease.

OBJECTIVE: To estimate the prevalence of established risk factors for ischaemic heart disease (IHD) in New Zealand adults and compare the prevalence in adults with and without this disease. DESIGN: Data were obtained from the 2002/03 New Zealand Health Survey. Risk factor prevalence was determined by: self-reported doctor diagnosis of high blood pressure, high cholesterol and diabetes; self-report of smoking and physical inactivity; and measurement of obesity. Presence of IHD was based on self-report of heart disease (doctor diagnosed at age 25 years or over) together with current medical or past surgical treatment for this disease. Multiple logistic regression was used to determine prevalence rate ratios (PRRs) for males and females separately, adjusting for age, ethnicity and deprivation. RESULTS: The overall prevalence of IHD was 8%. Overall risk factor prevalences were in the range of 20-25% for each of high blood pressure, high cholesterol, smoking, obesity and physical inactivity, and approximately 5% for diabetes. Overall, 94-97% of adults with IHD had at least one risk factor (depending on how smoking was defined). The PRRs of IHD were highest for cholesterol (about 4.5), followed by blood pressure (about 2.3), with all other risk factors around 1.5. PAF estimates indicate that 80-85% of IHD was attributable to the presence of at least one risk factor for all age, gender and ethnic groups. CONCLUSIONS: Established risk factors account for 80-85% of the non-fatal burden of IHD in New Zealand. Limited research resources would be better used to evaluate which interventions are effective and efficient at reducing exposure of all population groups to known risk factors, rather than on identification of additional risk factors.

Adult↗
PubMed1988

On self-boundary: a study of the development of the concept of secrecy.

The child's developing concept of a 'boundary' between an inner world of 'self' and an outer world 'non-self' is central to a number of systems of psychodynamic theory. The notion of boundary is also essential to Piaget. Despite the evident importance of the subject, there have been few attempts to discover the age at which this concept emerges. This study of 40 urban Australian children uses the development of the concept of secrecy as a marker. Most children attained this concept during the fifth year of life.

Australia↗