Advertisement

Truth Telling and Palliative Care

  • Lidia Schapira
  • David P. Steensma
Chapter

Abstract

The primary mission of palliative care is to assist and guide patients through all phases of treatment and crucial to this work is maintaining the patient’s integrity and dignity. To accomplish this, patients need to understand their prognosis and be guided to take an active role in crafting a treatment plan that conforms to individual values and goals of care. Information needs change over time and may differ among members of a single family. We propose that truth is not just an item traded between doctors and patients but, instead, a concept that is larger than a set of facts and scientific constructs. Clinicians struggle with protective instincts and their own discomfort when faced with the duty to inform and this can lead to avoidance. We review the data that supports honest and compassionate disclosure and frame this exchange as an important step in a model based on individual resilience and healthy coping.

Keywords

Palliative Care Truth Telling Emotional Coaching Incurable Illness Cultural Humility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Baile, W. F., Buckman, R., Lenzi, R., et al. (2000). SPIKES – A six step protocol for delivering bad news: Application to the patient with cancer. The Oncologist, 5(4), 302–311.PubMedCrossRefGoogle Scholar
  2. Baile, W. F., Kudelka, A. P., & Beale, E. A. (1999). Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer, 86(5), 887–897.PubMedCrossRefGoogle Scholar
  3. Blackhall, L. J., Murphy, S. T., & Frank, G. (1995). Ethnicity and attitudes toward patient autonomy. The Journal of the American Medical Association, 274, 820–825.CrossRefGoogle Scholar
  4. Bruera, E., Neumann, C. M., Mazzocato, C., et al. (2000). Attitudes and beliefs of palliative care physicians regarding communication with terminally ill patients. Palliative Medicine, 14(4), 287–298.PubMedCrossRefGoogle Scholar
  5. Butow, P. N., Tattersall, M. H., & Goldstein, D. (1997). Communication with cancer patients in culturally diverse societies. Annals of the New York Academy of Sciences, 809, 317–329.PubMedCrossRefGoogle Scholar
  6. Dahlstrand, H., Hauksdottir, A., Valdimarsdottir, U., et al. (2008). Disclosure of incurable illness to spouses: Do they want to know? A Swedish population-based follow-up study. Journal of Clinical Oncology, 26(20), 3372–3379.PubMedCrossRefGoogle Scholar
  7. Fallowfield, L. (1997). Truth sometimes hurts but deceit hurts more. Annals of the New York Academy of Sciences, 809, 525–536.PubMedCrossRefGoogle Scholar
  8. Furst, L. (1998). Between doctors and patients: The changing balance of power. Charlottesville, VA: The University Press of Virginia.Google Scholar
  9. Greene, J. D. (2003). From neural “is” to moral “ought”: What are the moral implications of neuroscientific moral psychology? Nature Reviews. Neuroscience, 4, 847–850.CrossRefGoogle Scholar
  10. Greene, J. D., Cushman, F. A., Stewart, L. E., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2009). Pushing moral buttons: The interaction between personal force and intention in moral judgment. Cognition, 111(3), 364–371.PubMedCrossRefGoogle Scholar
  11. Greene, J., & Haidt, J. (2002). How (and where) does moral judgment work? Trends in Cognitive Sciences, 6(12), 517–523.PubMedCrossRefGoogle Scholar
  12. Greene, J. D., Morelli, S. A., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2008). Cognitive load selectively interferes with utilitarian moral judgment. Cognition, 107, 1144–1154.PubMedCrossRefGoogle Scholar
  13. Hebert, R. S., & Schulz, R. (2006). Journal of Palliative Medicine, 9(5), 1164–1171.PubMedCrossRefGoogle Scholar
  14. Jotkowitz, A., Glick, S., & Gezundheit, B. (2006). Truth-telling in a culturally diverse world. Cancer Investigation, 24(8), 786–789.PubMedCrossRefGoogle Scholar
  15. Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: “You got to go where he lives”. The Journal of the American Medical Association, 286(23), 2993–3001.CrossRefGoogle Scholar
  16. Katz, J. (1986). The silent world of doctor and patient. New York, NY: The Free Press.Google Scholar
  17. Langer, S. L., Brown, J. D., & Syrjala, K. L. (2009). Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer, 115(18 Suppl), 4311–4325.PubMedCrossRefGoogle Scholar
  18. Li, S., & Chou, J. L. (1997). Communication with the cancer patient in China. Annals of the New York Academy of Sciences, 809, 243–248.PubMedCrossRefGoogle Scholar
  19. Linder, J. F., & Meyers, F. J. (2007). Palliative care for prison inmates: “Don’t let me die in prison”. The Journal of the American Medical Association, 298(8), 894–901.CrossRefGoogle Scholar
  20. Mack, J. W., Wolfe, J., Cok, E. F., et al. (2007). Hope and prognostic disclosure. Journal of Clinical Oncology, 25(35), 5636–5642.PubMedCrossRefGoogle Scholar
  21. Maynard, D. (2003). Bad news, good news: Conversational order in everyday talk and clinical settings. Chicago, IL: University of Chicago Press.Google Scholar
  22. McCabe, M. S., Wood, W. A., & Goldberg, R. M. (2010). When the family requests withholding the diagnosis: Who owns the truth? Journal of Oncology Practice, 6(2), 94–96.PubMedCrossRefGoogle Scholar
  23. Mitchison, D., Butow, P., Sze, M., Aldridge, L., Hui, R., Vardy, J., Eisenbruch, M., & Iedema, R. (2011). Goldstein D. Psychooncology Feb: Prognostic Communication preferences of migrant workers and their relatives.Google Scholar
  24. Parker, P. A., Baile, W. F., de Moor, C., et al. (2001). Breaking bad news about cancer: Patients’ preferences for communication. Journal of Clinical Oncology, 19(7), 2049–2056.PubMedGoogle Scholar
  25. Parkes, C. M. (1978). Psychological aspects. In C. M. Saunders (Ed.), The management of terminal disease (pp. 44–64). London: Edward Arnold.Google Scholar
  26. Renz, M., Koeberle, D., Cerny, T., et al. (2009). Between utter despair and essential hope. Journal of Clinical Oncology, 27(1), 146–149.PubMedCrossRefGoogle Scholar
  27. Schneider, C. (1998). The practice of autonomy: patients, doctors, and medical decisions. NY: Oxford University Press.Google Scholar
  28. Simpson, M. A. (1982). Therapeutic uses of truth. In E. Wilkes (Ed.), The dying patient. Lancaster: MYP Press.Google Scholar
  29. Smith, T. J., Dow, L. A., Virago, E., et al. (2010). Giving honest information to patients with advanced cancer maintains hope. Oncology ( Williston Park)., 24(6), 521–525.PubMedGoogle Scholar
  30. Spiegel, D. (1999). A 43-year-old woman coping with cancer. The Journal of the American Medical Association, 282(4), 371–378.CrossRefGoogle Scholar
  31. Surbone, A. (2000). Truth telling. Annals of the New York Academy of Sciences, 913, 52–62.PubMedCrossRefGoogle Scholar
  32. Surbone, A. (2006). Telling the truth to patients with cancer: What is the truth? The Lancet Oncology, 7(11), 944–950.PubMedCrossRefGoogle Scholar
  33. Surbone, A., Ritossa, C., & Spagnolo, A. G. (2004). Evolution of truth-telling attitudes and practices in Italy. Critical Reviews in Oncology/Hematology, 52(3), 165–172.PubMedCrossRefGoogle Scholar
  34. The, A. M., Hak, T., Koeter, G., et al. (2000). Collusion in doctor-patient communication about imminent death: An ethnographic study. BMJ, 321(7273), 1376–1381.PubMedCrossRefGoogle Scholar
  35. Uchitomi, Y., & Ymawaki, S. (1997). Truth telling practice in cancer care in Japan. Annals of the New York Academy of Sciences, 809, 290–299.PubMedCrossRefGoogle Scholar
  36. Wright, A. A., Zhang, B., Ray, A., et al. (2008). Associations between end-of-life discussions, patient metnal health, medical care near death, and caregiver bereave adjustment. The Journal of the American Medical Association, 300(14), 1665–1673.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  1. 1.Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Dana-Farber Cancer InstituteBostonUSA
  4. 4.Department of MedicineBrigham and Women’s HospitalBostonUSA

Personalised recommendations