title: [Silence pact from the perspective of caretakers of palliative care patients].
abstract: OBJECTIVE
  To determine why terminally-ill patients, family caregivers and health care providers make a pact of silence about the terminal status of the patient, and to identify the attitudes, experiences and opinions of family caregivers concerning the conspiracy of silence in palliative care.
  
  
  METHODS
  A qualitative phenomenological study based on an interpretive analysis, conducted in Primary Health Care, Seville, Spain. Study dimensions: knowledge of the diagnosis and prognosis of the condition; disclosure of information; reaction to information received, feelings and approach to death; information disclosed to the patient and reasons behind partial disclosure; communication between patients, families, and health care providers.
  
  
  METHODS
  Family caregivers of patients on palliative care suspicious about a pact of silence.
  
  
  RESULTS
  Family caregivers hamper professional-patient communication; use of deceit to conceal the truth; suspicion that the patient knows the truth; the clinician conceals the truth; paternalist attitudes; feelings of sadness, grief, resignation, acceptance of the disease.
  
  
  CONCLUSIONS
  The pact of silence has negative effects on coping with death, quality of life in the last days of life, and mourning. Communication between patients, health care providers, and families should be improved to prevent the pact of silence, and help patients cope with death.
authors.affiliation: Centro de Salud Bellavista y Los Bermejales, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, España. Electronic address: angelacjl@gmail.com.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Cejudo López
authors.affiliation: Centro de Salud San Pablo, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, España.
authors.forename: Begoña
authors.initials: B
authors.lastname: López López
authors.affiliation: Centro de Salud El Cachorro, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Duarte Rodríguez
authors.affiliation: Centro de Salud Pino Montano B y San Jerónimo, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, España.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Crespo Serván
authors.affiliation: Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: Coronado Illescas
authors.affiliation: Unidad de Gestión clínica Quirófanos, Hospital de Jerez, Cádiz, España.
authors.forename: Carlota
authors.initials: C
authors.lastname: de la Fuente Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D003142:Communication; D008192:Deception; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D057566:Self Report; D014342:Truth Disclosure
keywords: Actitud frente a la muerte; Attitude to death; Caregivers; Communication; Comunicación; Cuidadores; Cuidados paliativos; Hospice care; Pact of silence; Pacto de silencio