Influence of truth disclosure on quality of life in cancer patients

The impact on quality of life from informing diagnosis in patients with cancer: a systematic review and meta-analysis

Background

The aim of this study was to assess the impact on quality of life from informing patients with cancer of their diagnosis and disease status.

Method

We searched the follow databases, PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO, WEB OF SCIENCE, Embase, CBM (Chinese Biomedical Literature database), WANFANG database (Chinese Medicine Premier), and CNKI (China National Knowledge Infrastructure), using the following terms: neoplasm, cancer, tumor, tumor, carcinoma, disclosure, truth telling, breaking bad news, knowledge, knowing, awareness, quality of life, QOL. Pairs of reviewers independently screened documents and extracted the data, and the meta-analysis was performed using Revman 5.0 software.

Results

Eleven thousand seven hundred forty records retrieved from the databases and 23 studies were included in the final analysis. A meta-analysis revealed that there were no differences in either the general quality of life and symptoms of fatigue, pain, dyspnea, insomnia, appetite loss, and diarrhea, between informed and uniformed cancer patients (P > 0.05). There were also no differences found between the patient groups in physical function, role function, cognitive activity, and emotional function (P > 0.05). In terms of vitality, patients who were completely informed about their diagnosis showed higher vitality than uniformed patients. Uninformed patients seemed to have lower social function scores. Between partly informed and uninformed cancer patients, no differences were found in their general quality of life, function domains, and disease-related symptoms (P > 0.05).

Conclusion

Informing cancer patients of their diagnosis may not have a detrimental effect on their quality of life.

Trial registration

CRD42017060073.

The impact of informing diagnosis on quality of life in patients with cancer: A protocol of systematic review and meta-analysis

BACKGROUND

Cancer is the second leading cause of death globally. More millions new cancer cases are diagnosed, and millions persons died due to cancer each year. There are different attitudes on disclosure of diagnosis to the patients with cancer. The current systematic reviews are qualitative, and indicate that there is limited evidence on the association between awareness of diagnosis and quality of life in patients with cancer. In this study, we aim to evaluate the effect of awareness of diagnosis on quality of life in patients with cancer by conducting a systematic review and meta-analysis.

METHODS

We will perform a comprehensive electronic search in the databases below: MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, WEB OF SCIENCE, Chinese Biomedical Literature database, WANFANG database, and China National Knowledge Infrastructure. The cohort studies focusing on the association between awareness of diagnosis and quality of life in patients with cancer will be included. The risk of bias for the included studies will be appraised using the Newcastle-Ottawa Scale tool for cohort study. We will pool the effect estimates from the included studies to quantitatively present the strength of the association of interest.

RESULTS

This study will present pooled effect estimates regarding the impact of informing diagnosis on quality of life in patients with cancer.

CONCLUSION

This is the first quantitative systematic review which tends to provide modest evidence on the association between informing diagnosis and quality of life in patients with cacner.

PROSPERO REGISTRATION NUMBER

CRD42017060073.

Disclosing a Dementia Diagnosis: A Review of Opinion and Practice, and a Proposed Research Agenda

PURPOSE

The ethical and practical issues in disclosing a dementia diagnosis remain subjects of some debate. In this review of the literature we document previous opinion and practice in the area of diagnostic disclosure.

DESIGN AND METHODS

We identified sources for this review with a MEDLINE and PsycINFO database search, followed by collection of additional articles from reference lists.

RESULTS

Across sources we were able to identify a broad list of arguments both for and against diagnostic disclosure. We briefly discuss some of the ethical principles that undergird those reasons.

IMPLICATIONS

Practice guidelines and professional opinion regarding disclosure appear to depart from the actual experience reported by clinicians, patients, and family members. At a more detailed level, process issues in disclosure, such as who is told, how and what they are told, and the impact of disclosure, are poorly understood. Sensitivity to individual differences may promote an optimal approach to disclosure. Research in this area is sparse and often contradictory, and throughout the review we propose research questions that, when answered, could clarify issues in disclosure that are essential to sound dementia care.

Japanese nurses' perceptions about disclosure of information at the patients' end of life

Information disclosure at the end of life is one of the most debated ethical issues in Japan. This paper, using data from a larger questionnaire survey in which 147 Japanese nurses participated, describes nurses' perceptions about this issue. The nurses perceived that non-disclosure of impending death information to patients was the norm in Japan due to its traditional values. This non-disclosure of information has various impacts on clinical nurses. Tension was evident between the Japanese traditional concepts supported by some nurses and the shift toward Western cultural and ethical values supported by other nurses. The nurses confronted uninformed patients who became suspicious, isolated, angry, or died unprepared for their life's ending. The nurses were placed in the middle between the patient and the family, as nurses became keepers of family secrets, or between nurses' ethical obligations to the patient and those of the institution. The nurses had the belief that at the patient's end of life, it is important to change health professionals' attitude from curing to caring.