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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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References

Abdul-Razzak, A, You, J, Sherifali, D, et al. (2014) ‘Conditional candour’ and ‘knowing me’: An interpretive description study on patient preferences for physician behaviours during end-of-life communication. BMJ Open 4, e005653. doi:10.1136/bmjopen-2014-005653CrossRefGoogle Scholar
Anderson, WG, Kools, S and Lyndon, A (2013) Dancing around death: Hospitalist–patient communication about serious illness. Qualitative Health Research 23, 3–13. doi:10.1177/1049732312461728CrossRefGoogle ScholarPubMed
Becker, G, Jors, K and Block, S (2015) Discovering the truth beyond the truth. Journal of Pain and Symptom Management 49, 646. doi:10.1016/j.jpainsymman.2014.10.016CrossRefGoogle ScholarPubMed
Bergqvist, J and Strang, P (2019) Breast cancer patients’ preferences for truth versus hope are dynamic and change during late lines of palliative chemotherapy. Journal of Pain and Symptom Management 57, 746–752. doi:10.1016/j.jpainsymman.2018.12.336CrossRefGoogle ScholarPubMed
Berkey, FJ, Wiedemer, JP and Vithalani, ND (2018) Delivering bad or life-altering news. American Family Physician 98, 99–104.Google ScholarPubMed
Beste, J (2005) Instilling hope and respecting patient autonomy: Reconciling apparently conflicting duties. Bioethics 19, 215–231. doi:10.1111/j.1467-8519.2005.00438.xCrossRefGoogle ScholarPubMed
Bousquet, G, Orri, M, Winterman, S, et al. (2015) Breaking bad news in oncology: A metasynthesis. Journal of Clinical Oncology 33, 2437–2442. doi:10.1200/jco.2014.59.6759CrossRefGoogle ScholarPubMed
Britten, N, Campbell, R, Pope, C, et al. (2002) Using meta ethnography to synthesise qualitative research: A worked example. Journal of Health Services Research & Policy 7, 209–215.CrossRefGoogle ScholarPubMed
Buckman, R (2005) Breaking bad news: The S-P-I-K-E-S strategy. Community Oncology 2, 138–142.CrossRefGoogle Scholar
Clayton, JM, Hancock, K, Parker, S, et al. (2008) Sustaining hope when communicating with terminally ill patients and their families: A systematic review. Psycho-Oncology 17, 641–659. doi:10.1002/pon.1288CrossRefGoogle ScholarPubMed
Critical Appraisal Skills Program (CASP) UK (2020). CASP Checklists. Available at: https://casp-uk.net/casp-tools-checklists/.Google Scholar
Dixon-Woods, M, Shaw, RL, Agarwal, S, et al. (2004) The problem of appraising qualitative research. Quality & Safety in Health Care 13, 223–225. doi:10.1136/qshc.2003.008714CrossRefGoogle ScholarPubMed
Duke, S and Bailey, C (2008) Communication: Patient and Family. In Payne, S, Seymour, J and Ingleton, C (eds), Palliative care nursing: Principles and evidence for practice, 2nd ed. Maidenhead, England: Open University Press, pp. 121–144.Google Scholar
Enzinger, AC, Zhang, B, Schrag, D, et al. (2015) Outcomes of prognostic disclosure: Associations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer. Journal of Clinical Oncology 33. doi:10.1200/JCO.2015.61.9239CrossRefGoogle ScholarPubMed
Fallowfield, LJ, Jenkins, VA and Beveridge, HA (2002) Truth may hurt but deceit hurts more: Communication in palliative care. Palliative Medicine 16, 297–303. doi:10.1191/0269216302pm575oaCrossRefGoogle ScholarPubMed
Fried, TR, Bradley, EH and O’ Leary, J (2003) Prognosis communication in serious illness: Perceptions of older patients, caregivers, and clinicians. Journal of the American Geriatrics Society 51, 1398–1403. doi:10.1046/j.1532-5415.2003.51457.xCrossRefGoogle Scholar
Gaston, CM and Mitchell, G (2005) Information giving and decision-making in patients with advanced cancer: A systematic review. Social Science & Medicine 61, 2252–2264. doi:10.1016/j.socscimed.2005.04.015CrossRefGoogle ScholarPubMed
Glaser, B and Strauss, A (1965). Awareness of dying. Aldine.Google Scholar
Goldberg, RJ (1984) Disclosure of information to adult cancer patients: Issues and update. Journal of Clinical Oncology 2, 948–955. doi:10.1200/jco.1984.2.8.948CrossRefGoogle ScholarPubMed
Hagerty, RG, Butow, PN, Ellis, PM, et al. (2005) Communicating with realism and hope: Incurable cancer patients’ views on the disclosure of prognosis. Journal of Clinical Oncology 23, 1278–1288. doi:10.1200/jco.2005.11.138CrossRefGoogle ScholarPubMed
Hancock, K, Clayton, JM, Parker, SM, et al. (2007) Truth-telling in discussing prognosis in advanced life-limiting illnesses: A systematic review. Palliative Medicine 21, 507–517. doi:10.1177/0269216307080823CrossRefGoogle ScholarPubMed
Henselmans, I, Smets, EMA, Han, PKJ, et al. (2017) How long do I have? Observational study on communication about life expectancy with advanced cancer patients. Patient Education and Counseling 100, 1820–1827. doi:10.1016/j.pec.2017.05.012CrossRefGoogle Scholar
Johnston, FM and Beckman, M (2019) Navigating difficult conversations. Journal of Surgical Oncology 120, 23–29. doi:10.1002/jso.25472CrossRefGoogle ScholarPubMed
Kiely, BE, Soon, YY, Tattersall, MH, et al. (2011) How long have I got? Estimating typical, best-case, and worst-case scenarios for patients starting first-line chemotherapy for metastatic breast cancer: A systematic review of recent randomized trials. Journal of Clinical Oncology 29, 456–463. doi:10.1200/JCO.2010.30.2174CrossRefGoogle Scholar
Kogan, AC, Enguidanos, S and Penido, M (2013) Does disclosure of terminal prognoses mean losing hope? Patient perspectives on palliative care consultations (S717). Journal of Pain and Symptom Management 45, 426–427. doi:10.1016/j.jpainsymman.2012.10.134CrossRefGoogle Scholar
Liberati, A, Altman, DG, Tetzlaff, J, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 339, b2700. doi:10.1136/bmj.b2700CrossRefGoogle ScholarPubMed
Maciejewski, PK and Prigerson, HG (2013) Emotional numbness modifies the effect of end-of-life discussions on end-of-life care. Journal of Pain and Symptom Management 45, 841–847. doi:10.1016/j.jpainsymman.2012.04.003CrossRefGoogle ScholarPubMed
McLennon, MS, Uhrich, RM, Lasiter, RS, et al. (2013) Oncology nurses’ narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients. Cancer Nursing 36, 114–121. doi:10.1097/NCC.0b013e31825f4dc8CrossRefGoogle ScholarPubMed
Millar, C, Reid, J and Porter, S (2013) Refractory cachexia and truth-telling about terminal prognosis: A qualitative study. European Journal of Cancer Care 22, 326–333. doi:10.1111/ecc.12032CrossRefGoogle ScholarPubMed
Mishelmovich, N, Arber, A and Odelius, A (2016) Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care. European Journal of Oncology Nursing 21, 153–159. doi:10.1016/j.ejon.2015.09.006CrossRefGoogle ScholarPubMed
Mostafazadeh-Bora, M and Zarghami, A (2017) Breaking and sharing bad news in end of life: The religious and culture matters. Journal of Religion and Health 56, 1655–1657. doi:10.1007/s10943-016-0249-0CrossRefGoogle ScholarPubMed
Noblit, GW and Hare, RD (1988) Meta-ethnography Synthesizing Qualitative Studies. Thousand Oaks, CA: Sage.Google Scholar
Pontin, D and Jordan, N (2013) Issues in prognostication for hospital specialist palliative care doctors and nurses: A qualitative inquiry. Palliative Medicine 27, 165–171. doi:10.1177/0269216311432898CrossRefGoogle ScholarPubMed
Ptacek, JT and Eberhardt, TL (1996) Breaking bad news: A review of the literature. The Journal of the American Medical Association 27, 496–502. doi:10.1001/jama.276.6.496CrossRefGoogle Scholar
Rejnö, Å, Silfverberg, G and Ternestedt, B-M (2017) Reasoning about truth-telling in end-of-life care of patients with acute stroke. Nursing Ethics 24, 100–110. doi:10.1177/0969733016664974CrossRefGoogle ScholarPubMed
Sarafis, P, Tsounis, A, Malliarou, M, et al. (2014) Disclosing the truth: A dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Global Journal of Health Science 6, 128–137. doi:10.5539/gjhs.v6n2p128Google Scholar
Selman, LE, Brighton, LJ, Hawkins, A, et al. (2017) The effect of communication skills training for generalist palliative care providers on patient-reported outcomes and clinician behaviors: A systematic review and meta-analysis. Journal of Pain and Symptom Management 54(3), 404–416.e5. http://dx.doi.org/10.1016/j.jpainsymman.2017.04.007.CrossRefGoogle ScholarPubMed
Thomas, J and Harden, A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology 8, 45. doi:10.1186/1471-2288-8-45CrossRefGoogle ScholarPubMed
Thorne, S, Jensen, L, Kearney, MH, et al. (2004) Qualitative metasynthesis: Reflections on methodological orientation and ideological agenda. Qualitative Health Research 13, 1–24. doi:10.1177/1049732304269888Google Scholar
Tong, A, Sainsbury, P and Craig, J (2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19, 349–357. doi:10.1093/intqhc/mzm042CrossRefGoogle ScholarPubMed
van Vliet, LM, van der Wall, E, Plum, NE, et al. (2013) Explicit prognostic information and reassurance about nonabandonment when entering palliative breast cancer care: Findings from a scripted video-vignette study. Journal of Clinical Oncology 31, 3242–3249.CrossRefGoogle ScholarPubMed
Wilson, F, Ingleton, C, Gott, M, et al. (2014) Autonomy and choice in palliative care: Time for a new model? Journal of Advanced Nursing 70, 1020–1029. doi:10.1111/jan.12267CrossRefGoogle ScholarPubMed
Xafis, V and Wilkinson, D (2019) Commentary: Treating ambiguity in the clinical context: Is what you hear the doctor say what the doctor means? Cambridge Quarterly of Healthcare Ethics 28, 422–432. doi:10.1017/S0963180119000343CrossRefGoogle ScholarPubMed
Zhang, B, Wright, A, Huskamp, H, et al. (2009) Health care costs in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine 169, 480–488. doi:10.1001/archinternmed.2008.587CrossRefGoogle ScholarPubMed