Experiences of truth disclosure in terminally ill cancer patients in palliative home care.
OBJECTIVE
The aim of this study was to explore the experiences and preferences of terminally ill cancer patients regarding truth telling in the communication of poor prognoses.


METHODS
We recorded and transcribed interviews with 45 patients who knew their cancer was terminal, and analyzed their responses hermeneutically.


RESULTS
Patients identified three different modes of truth: (1) the absolute objective truth that they are dying; (2) the partial truth about their condition including some facts but not all of the details; and (3) the desired truth, originating in the patient's own beliefs about a healthy or better life. Coping strategies were related to patients' preferred mode of truth: (1) facing the truth in order to take action; (2) facing some parts of the truth in order to maintain hope; and (3) hovering between facing and avoiding the truth. In their struggle for existential survival, patients used different coping strategies, changing from one to another depending upon the circumstances.


CONCLUSIONS
Varying use of different coping strategies impacts on patient preferences concerning communication about bad news with their doctors. Truth-telling entails more than merely providing information related to the forthcoming death. It also concerns how physicians or other healthcare staff can support the patient's existential survival by fine-tuning the communication of "truth" according to the individuals' preferences.
Palliative Education and Research Center, The County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden.
Maria
M
Friedrichsen
Research and Development Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.
Ann
A
Lindholm
Department of Social & Welfare Studies, Linköping University, Linköping, Sweden.
Anna
A
Milberg
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003142:Communication; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D010817:Physician-Patient Relations; D011379:Prognosis; D036301:Qualitative Research; D013548:Sweden; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure