A qualitative study to assess collusion and psychological distress in cancer patients

Abstract

Introduction:Collusion is frequently encountered but least studied entity in palliative care services in India. Impact of collusion is manifold and identifying it requires good communication skills. Once identified, it gives an indication for existing healthy versus developing unhealthy collusion to be dealt within families.Objective:The objective of this study was to identify the prevalence of collusion and its clinical and psychological correlates among patients and caregivers in a palliative cancer care.Materials and Methods:We describe systematic identification and unraveling of collusion across multiple levels in a palliative cancer care eventually drafting an algorithm to unravel the collusion. Patients and families were recruited from in-patient palliative care services after obtaining written informed consent. Qualitative interviews were conducted using collusion questionnaire, EQ5D, Visual Analog Scale, and NIMHANS psychiatric morbidity screen.Results:Among 62 cancer families interviewed, we identified that 71% collusion exists between doctor and patient, 61.3% between doctor and caregiver, and 75.83% between patient and caregiver. Around 50% collusions were unraveled systematically. Collusion was more prevalent in patients with rapid progression of illness (<6 months), patients with poor coping skills, and preference of being interviewed alone.Conclusion:This statistics suggests that collusion goes unnoticed in terminal illnesses and communication skills play a major role in identifying and dealing with collusion. This also unearths need to formulate interview techniques and structured assessment tools or questionnaire in palliative cancer care which are sparse.

Prevalence of collusion in cancer communications: A meta‐analysis

“…A total of 27 studies fulfilled eligibility criteria and were thus eligible for inclusion in this systematic review and meta-analysis. 2,3, Table 1 shows the characteristics of included studies with the prevalence of collusion. The pooled prevalence of diagnostic and prognostic collusion among patients and caregivers was obtained.…”

“…Full texts of 126 articles were screened. A total of 27 studies fulfilled eligibility criteria and were thus eligible for inclusion in this systematic review and meta‐analysis 2,3,8‐32 . Table 1 shows the characteristics of included studies with the prevalence of collusion.…”

“…Understanding the collusion more effectively and develop uniform unraveling techniques is a challenging task in the light of mentioned factors. However, from our meta‐analysis, we expect the development of fluid but uniform standardized interview techniques such as FRIENDS protocol (Find‐Feelings, Reason‐Reason out‐Reassure, Identify‐Intention, Effect of Escaping, Now or Never, Discuss‐Deterioration‐Damage and Stabilize) 2 to meet the clinical and research demand in this area. Further, the act of balancing an ethical conflict between ‘patient autonomy and ‘family decision‐making could appear a challenging task and efforts could be channelized towards giving a meaningful understanding of the prevalence of such collusion in cancer care.…”

“…The collusion can exist during the process of making a diagnostic disclosure of prognostic disclosure with patients and caregivers. The prevalence of diagnostic and prognostic collusion varies from 30% to 70% depending on cultural context 1,2 . Literature on the prevalence of collusion is varied due to different geographical and socio‐cultural practices including the methods of unraveling the collusion 3 .…”

“…The prevalence of diagnostic and prognostic collusion varies from 30% to 70% depending on cultural context. 1,2 Literature on the prevalence of collusion is varied due to different geographical and socio-cultural practices including the methods of unraveling the collusion. 3 In this context, a systematic review was conducted to identify the pooled prevalence of diagnostic and prognostic collusion (disclosure and non-disclosure of information) among studies involving health care workers (HCW), cancer patients, and caregivers.…”