title: Reasoning about truth-telling in end-of-life care of patients with acute stroke.
abstract: BACKGROUND
  Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care.
  
  
  OBJECTIVE
  The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke.
  
  
  METHODS
  Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden.
  
  
  RESULTS
  The main findings were the team members' dynamic movement between the categories 'Truth above all' and 'Hide truth to protect'. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others.
  
  
  CONCLUSIONS
  The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient's best interest first.
  
  
  CONCLUSIONS
  The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.
authors.affiliation: Skaraborg Hospital Skövde, Sweden; University West, Trollhättan, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Rejnö
authors.forename: Gunilla
authors.initials: G
authors.lastname: Silfverberg
authors.affiliation: Ersta Sköndal University College, Stockholm, Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ternestedt
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000150:complications / Q000209:etiology; D004993:Ethics, Nursing; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010820:Physicians / Q000941:ethics / Q000523:psychology; D036301:Qualitative Research; D020521:Stroke / Q000150:complications / Q000523:psychology*; D013548:Sweden; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology; D014342:Truth Disclosure / Q000941:ethics*
keywords: Content analysis; ethical problems; stroke team members; truth; withholding truth