title: Truth-telling to patients' terminal illness: what makes oncology nurses act individually?
abstract: OBJECTIVE
  Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions.
  
  
  METHODS
  A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored.
  
  
  RESULTS
  Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%).
  
  
  CONCLUSIONS
  Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.
authors.affiliation: School of Nursing, National Yang Ming University, Taipei, Taiwan; Department of Nursing, National Yang-Ming University Hospital, Taipei, Taiwan. Electronic address: shhuang@ym.edu.tw.
authors.forename: Shu-He
authors.initials: SH
authors.lastname: Huang
authors.affiliation: School of Nursing, National Yang Ming University, Taipei, Taiwan. Electronic address: fitang@ym.edu.tw.
authors.forename: Fu-In
authors.initials: FI
authors.lastname: Tang
authors.affiliation: Oncology Unit of O'Connor Hospital, San Jose, CA, USA. Electronic address: alanis0731@gmail.com.
authors.forename: Chang-Yi
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: mbchen@vghtpe.gov.tw.
authors.forename: Mei-Bih
authors.initials: MB
authors.lastname: Chen
authors.affiliation: Department of Statistics of Information Science, Center for Statistical Consultation, Fu Jen Catholic University, Taipei, Taiwan. Electronic address: stat1013@mail.fju.edu.tw.
authors.forename: Te-Hsin
authors.initials: TH
authors.lastname: Liang
authors.affiliation: School of Nursing, National Yang Ming University, Taipei, Taiwan. Electronic address: sjsheu@ym.edu.tw.
authors.forename: Shuh-Jen
authors.initials: SJ
authors.lastname: Sheu
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009859:Oncology Nursing / Q000379:methods*; D010865:Pilot Projects; D017009:Professional Autonomy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure
keywords: Attitude; Experience; Oncology nurse; Terminal cancer; Truth telling