Ethical challenges in confidential conversations with patients in palliative care

BackgroundConfidential conversations between nurses and patients are considered important in person-centred palliative care, as they provide opportunities for patients to share matters of personal significance within a trusting relationship. Yet, less is known about the ethical challenges nurses encounter when receiving and responding to what patients disclose in these conversations.Research question/aim/objectivesTo deepen the understanding of the ethical challenges nurses encounter in confidential conversations with patients in palliative care.Research designAn interpretive qualitative design was used. The study comprised a secondary analysis of an existing dataset. Data were analysed using reflexive thematic analysis.Participants and research contextThe dataset comprised five focus groups with 22 registered nurses working in specialised palliative care in Northern Sweden.Ethical considerationsThe original study received ethical approval from the appropriate review board. All participants provided informed consent. Participation was voluntary and could be withdrawn at any time.Findings/resultsThe analysis generated an overarching theme: Confidential conversations expose ethical challenges where professional intervention reaches its limits. Three interpretive themes were identified: Creating possibilities while accepting the uncertainty of not knowing; Remaining present with patients whose suffering cannot be relieved; and Maintaining professional responsibility while being affected. The findings suggest that responsibility persists despite limited control over disclosure, the possibility of alleviating suffering, and nurses' emotional responses to patients' experiences. Responsibility was exercised within uncertainty rather than through control or intervention.ConclusionConfidential conversations with patients in palliative care involve ethical challenges that persist when professional control is limited. Patients retain authority over what they disclose, while nurses remain responsible for how disclosures are received and responded to. Sustaining this form of ethical practice requires organisational conditions that support nurses in remaining present, responsive, and professionally responsible when intervention cannot provide a clear solution.