Dilemmas in the (un)veiling of the diagnosis of Alzheimer's disease: walking an ethical and professional tight rope.
OBJECTIVE
To enhance the understanding and effect of physician's difficulties, attitudes and communication styles on the disclosure of the diagnosis of AD in practice.


METHODS
Qualitative, phenomenological study, combining pre-encounter interviews with physicians, observations of actual encounters of diagnosis disclosure of AD, and post-encounter interviews.


RESULTS
There were various ways or tactics to (un)veil the bad news that may be perceived as different ways of dulling the impact and avoiding full and therefore problematic statements. In the actual encounters this was accomplished by keeping encounters short, avoiding elaboration, confirmation of comprehension and explicit terminology and using fractured sentences.


CONCLUSIONS
The present study's findings highlight the difficulties encountered in breaking the news about AD, in the way it is actually done, and the problems that may arise from this way of un/veiling the news. The main problem is that the reluctance to make a candid disclosure of the diagnosis as was demonstrated in this study may violate basic moral and legal rights and may also deprive patients and caregivers of some of the benefits of early disclosure of diagnosis.


CONCLUSIONS
There is a need for assisting physicians to cope with their personal difficulties, problems and pitfalls in breaking the news.
Karnieli-Miller
Orit
O
Center for the Excellence for Patient-Professional Relationship in Health Care Studies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel. OritKM@gmail.com
Werner
Perla
P
Aharon-Peretz
Judith
J
Eidelman
Shmuel
S
D000223:Adaptation, Psychological; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003220:Conflict, Psychological; D003657:Decision Making; D005190:Family / Q000523:psychology; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel; D008297:Male; D009341:Negativism; D028701:Patient Rights; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D011361:Professional Competence; D011368:Professional-Family Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014342:Truth Disclosure / Q000941:ethics*