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Communication and awareness about dying in the 1990s
1Centre for Cancer and Palliative Care Studies, Royal Marsden NHS Trust, London, UK. dfield@icr.ac.uk
Palliative Medicine
|March 15, 2000
Summary
Doctors increasingly disclose terminal prognoses to patients. However, healthcare professionals often use conditional disclosure, not full openness, creating a communication paradox in end-of-life care discussions.
Area of Science:
- Medical Sociology
- Thanatology
- Communication Studies
Background:
- Debates on end-of-life communication and patient awareness of terminal prognoses have persisted since the 1960s.
- Literature highlights the need for improved health professional communication strategies with terminally ill patients.
- Societal shifts in Western societies have influenced medical practices regarding disclosure of terminal prognoses.
Purpose of the Study:
- To examine the paradox between the trend towards open disclosure of terminal prognoses and the observed use of conditional disclosure by healthcare professionals.
- To analyze the complexities and conflicts inherent in communication surrounding patient awareness of impending death.
- To discuss existing literature on communication modes and patient awareness in terminal illness.
Main Methods:
- Literature review and analysis of existing studies on patient awareness and medical communication practices.
- Examination of trends in medical policies from 'withholding' to 'revealing' terminal prognoses.
- Analysis of qualitative and quantitative data on patient knowledge of their prognosis.
Main Results:
- Evidence indicates a shift in medical practice from withholding to revealing terminal prognoses in advanced industrial societies.
- An increasing percentage of patients, particularly those with chronic diseases like cancer, are aware of their terminal diagnosis.
- Recent studies suggest healthcare workers often employ 'conditional' rather than 'full open disclosure' in daily interactions with dying patients.
Conclusions:
- A perceived trend towards open disclosure of terminal illness contrasts with the reality of conditional communication strategies used by health workers.
- The practice of conditional disclosure may be employed even when patients are fully aware of their prognosis, indicating complex communication dynamics.
- Understanding these communication tensions is crucial for improving end-of-life care and patient-centered communication.