Thursday, 26 June 2008

Truth-telling at the end of life

Truth-telling at the end of life: a pilot study on the perspective of patients and professional caregivers.
Patient education and counseling Apr 2008 (epub: 03 Jan 2008), vol. 71, no. 1, p. 52-6
Deschepper-Reginald, Bernheim-Jan-L, Vander-Stichele-Robert et al
OBJECTIVE: To describe the attitudes towards truth-telling of both terminal patients and professional caregivers, and to determine their perceived barriers to full information exchange. METHODS: In-depth interviews with 17 terminal patients selected through GPs and staff members of Flemish palliative care centres, and 3 focus groups with different professional caregivers. Analysis was based on grounded theory. RESULTS: There was considerable variability in the preferences of patients regarding when and how they wanted to be informed of their diagnosis, prognosis, expected disease course and end-of-life decisions. Major ambivalence was observed regarding the degree to which patients wanted to hear 'the whole truth'. Patients and caregivers agreed that truth-telling should be a 'dosed and gradual' process. Several barriers to more complete and timely truth- telling were identified. CONCLUSION: The preferences of both patients and caregivers for step-by-step--and hence slow and limited-- information prevents terminal patients from reaching the level of information needed for informed end-of-life decision-making. PRACTICE IMPLICATIONS: The preference of patients and caregivers to 'dose' the truth may entail some risks, such as a 'Catch 22' situation in which both patients and caregivers wait for a signal from each other before starting a dialogue about impending death.

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