?Do not tell?: what factors affect relatives? attitudes to honest disclosure of diagnosis to cancer patients?

Abstract

Disclosure of the diagnosis of cancer to patients is a difficult task for physicians in developing countries. Family members often oppose truth telling. The aim of this study was to evaluate the incidence of the "do not tell" attitude in a general population of cancer patients and to explore the factors affecting the attitude of cancer patients' relatives about honest disclosure. Using a questionnaire, relatives of 150 patients with recently diagnosed cancer were interviewed. Of the relatives, 66% did not want the diagnosis to be disclosed. Male gender of the patient, a diagnosis of a non-breast cancer malignancy, the presence of stage IV disease, no previous request for disclosure by the patient, insufficient knowledge of the relative about cancer in general, and stronger religious belief of the relative were associated with greater likelihood of the relative having a "do not tell" attitude in univariate analyses ( P=0.032, P=0.000, P=0.051, P=0.021, P=0.128, and P=0.058, respectively). In a multivariate analysis, the diagnosis of a non-breast cancer malignancy, and insufficient knowledge of the relative about cancer in general retained their significance (exp(B)=14.77, P=0.000; exp(B)=3.04, P=0.01, respectively). Differences among different countries and cultures are discussed.

Akciğer kanserli hastaya tanısı söylenmeli mi?

“…Ancak geçmişte insiyatif kullanarak kanser tanısını söylemeyen hekimlerin oranı günümüzde giderek azalmaktadır (11,12). Ancak Balkan ve Doğu toplumlarında biz de olduğu gibi bilgilendirme konusunda sorunlar devam etmektedir (7,(13)(14)(15). Çalışmamız sonucunda da katılımcıların %89.6'sı akciğer kanseri tanısı almaları halinde tanılarını bilmek isteyeceklerini, %88.3'ünün iste hastalık hakkında detaylı bir bilgilendirme isteyeceklerini bildirmişlerdir.…”

“…Bu yaklaşım tedavide hekim ile hastanın birlikte karar vermesi ve tedavi başarısının artmasını sağlamaktadır (5,6). Ancak hastalığın kötü gidişinin toplum içinde yarattığı olumsuz algı, farklı demografik özellikleri olan hastaların farklı düşünebilmeleri ve hasta yakınlarının bu konuda engelleyici tutum takınmaları tanının hastaya söylenmesi konusunda sorun yaşanmasına neden olmaktadır (7). Bu araştırmada, akciğer kanseri olmayan hasta veya sağlıklı bir kişinin olası akciğer kanseri tanısı alması durumunda, kendisine ya da yakın akrabalarına tanının ne olduğunun ve hastalığın seyrinin açıklanmasını isteyip istemediği sorgulanmış, ayrıca kanser tedavisi gören kişilerin bu konudaki bakış açıları değerlendirilmiştir.…”

Opinions of the Turkish population on cancer and being informed of the diagnosis of cancer

“…In Eastern countries, there is a perception that an individual belongs to a family, and the power and liability for decision-making processes are a family issue. Among the factors that urge people to hide the diagnosis are being male, the cancer being at an advanced stage, the cancer being of a type that makes the lifespan shorter or impairs the quality of life, having a lack of information about cancer, and having strong religious beliefs (15)(16)(17)(18). In another study, elderly, female, and poorly educated or unemployed people preferred not to inform the patient (19).…”

Communication preferences and needs of cancer patients: the importance of content

“…We have read that words do not have the same meaning and resonance in all cultures, that uttering a "bad word" is considered to negatively affect patients in certain cultures, and that in other cultures, words such as "cancer " or "depression" do not even exist [6,15]. We have become acquainted not only with different communication styles but also with different views of the roles that family and physicians assume in different cultures with respect to cancer patients [1,8,12,17]. We have learned that in specific clinical circumstances, we can use euphemisms, and that we can't always ignore families' requests to withhold or to mitigate the truth about a cancer diagnosis or prognosis [1].…”