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The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis

Published online by Cambridge University Press:  25 August 2021

Elizabeth M. Miller Open the ORCID record for Elizabeth M. Miller [Opens in a new window] ,
Joanne E. Porter Open the ORCID record for Joanne E. Porter [Opens in a new window]  and
Michael S. Barbagallo Open the ORCID record for Michael S. Barbagallo [Opens in a new window]
Elizabeth M. Miller*
Affiliation:
School of Health, Federation University Australia, Churchill, Victoria, Australia
Joanne E. Porter
Affiliation:
School of Health, Federation University Australia, Churchill, Victoria, Australia
Michael S. Barbagallo
Affiliation:
School of Health, Federation University Australia, Churchill, Victoria, Australia
*
Author for correspondence: Elizabeth M. Miller, School of Health, Federation University Australia, Northways Road, Churchill, Victoria 3842, Australia. E-mail: [email protected]
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Abstract

Objective

Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting.

Methods

A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms (“truth disclosure”) AND (“palliative care or end-of-life care or terminal care or dying”) were used. The search was repeated using (“bad news”) AND (“palliative care or end-of-life care or terminal care or dying”) terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers.

Results

Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: “Enablers in breaking bad news” and “Truth avoidance/disclosure.” Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis.

Significance of results

The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.

Keywords

AutonomyBad newsCommunicationPalliativeTruth disclosure
Type
Review Article
Information
Palliative & Supportive Care , Volume 20 , Issue 3 , June 2022 , pp. 433 - 444
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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