Information to cancer patients: ready for new challenges?

Abstract

The article by Bracci et al. on information to cancer patients in three different geographic areas in Italy, published in this issue of our journal, provides empirical evidence that attitudes and practices of disclosure to cancer patients have evolved in Italy [3]. A shift toward truth telling began in Italy and in many other countries in the late 1980s-early 1990s [26,32]. Under the influence of many intertwined medical, legal, and societal changes, patients' information and involvement in decision making regarding their cancer care has been steadily increasing. In Italy, major changes occurred both in legislation and in the code of professional medical ethics, which now require physicians to provide full information to their patients and obtain their written consent for all medical and surgical procedures [30, 31]. Cultural transformations, however, are not the same as regulatory ones and do not proceed at the same pace. Empirical studies performed in Italy and other countries, in fact, persistently revealed that partial and non disclosure were still supported and practiced by physicians and that the actual rate of disclosure remained low even among those who claimed to favor patients' right to information and participation. Patient surveys also continued to show that many cancer patients were unaware of the severity and curability of their illness [12,13,18,35,36]. Important variations were observed in patient and physician attitudes and practices toward disclosure in association with age, geographic location (including residence in urban versus rural communities and in northern versus southern areas of different countries), and type of treating institution.By contrast, the study by Bracci et al. suggests that today's Italian cancer patients understand the benefits of learning the truth about their diagnosis and treatment options from their doctors and know how to express their level of satisfaction with the information provided and how to articulate the areas in which communication failed or was insufficient [3]. The study also examined different patient-doctor relationship styles, which are also evolving in countries where paternalism had traditionally been dominant in clinical medicine, and explored their link with their patients' information preferences and satisfaction [3,29]. Additional studies recently performed in Italy outside the field of oncology also indicate that open communication of diagnosis and treatment options is now common in other chronic, severe, often life-threatening illnesses [10].Patients in Bracci's study were treated in different geographic areas of Italy at three large teaching hospitals [3]. Within the context of teaching hospitals or specialized oncologic units, cancer patients are naturally exposed to more information than those who are treated at small local hospitals or in general wards or outpatient clinics. Nevertheless, differences emerged among patients within the study [3]. The authors' finding of persisting differences between Northern and Southern Italian patients speak...

Is therapeutic non-disclosure still possible? A study on the awareness of cancer diagnosis in China

“…This is similar to the findings of a recent Iranian study, which revealed a correlation between illiteracy and being unaware of the true diagnosis [25]. As new technologies become more accessible, patients increasingly seek, and obtain medical information outside clinical encounters, generally through mass media or the Internet [26]. This is especially true for those of younger age and higher education [27].…”

Patients’ understanding of treatment goals and disease course and their relationship with optimism, hope, and quality of life: a preliminary study among advanced breast cancer outpatients before receiving palliative treatment

“…This finding is in accordance with the study undertaken by Brokalaki et al [43], which reported that the patients who were high school and university graduates showed significantly superior levels of comprehension when compared to the patients who were graduates of elementary schools. Because technologies have become more accessible, patients with cancer increasingly seek and obtain information about their disease and treatment generally using the mass media or the Internet [45]. Considering that our patients were outpatients and one-third of them had a college or higher education level, it might have been easier for them to access the information of prognostic awareness.…”

Measuring Moral Distress Among Critical Care Clinicians: Validation and Psychometric Properties of the Italian Moral Distress Scale-Revised*

“…This factor may be considered by some theorists as the core of moral distress, since it more explicitly refers to an ethical realm (7,38,39). Deceptive or misleading communication, such as giving "false hopes" or not discussing death with a dying patient, may not be a rare occurrence in clinical practice especially in the field of critical care and oncology where truth-telling may be perceived as difficult and painful for both clinicians and patients (40,41). Although in the From a practical perspective, the multidimensionality of the Italian MDS-R will allow a more accurate assessment of moral distress and the implementation of tailored interventions addressing the components of moral distress that will be found out to be more critical for a specific ICU or for a specific professional category.…”