Truth Disclosure Practices of Physicians in Jordan

Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates

BACKGROUND

Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure.

OBJECTIVE

To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE).

METHODS

Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care.

RESULTS

Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines.

CONCLUSION

Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress.

Attitudes of Physicians in Jordan Towards Non-Disclosure of Health Information

Objectives

This report aims to investigate the attitudes of physicians in Jordan towards non-disclosure of health information among physicians, with a focus on those who are 'always truthful' and those who are not.

Methods

The report is based on the second subset of data from a cross-sectional study-conducted between January and August 2016-of the truth disclosure practices among and attitudes of physicians in Jordan. The sample consisted of 240 physicians selected from four major hospitals by stratified random sampling and invited to complete a self-administered questionnaire regarding truth disclosure attitudes. The attitudes of physicians who were 'always truthful' were compared with those who were not.

Results

A total of 164 physicians (response rate: 68%) completed the questionnaire. Of these, 17 (10%) were 'always truthful', while the remaining 144 (90%) were not. Physicians who were 'always truthful' were more likely to indicate that non-disclosure is 'unethical' (77% versus 39%; P = 0.009). Moreover, physicians who were 'always truthful' were more likely to disagree that non-disclosure is beneficial for the physical and psychological health of patients (82% versus 55%; P = 0.03). Most of the surveyed physicians agreed that all patients have the right to know their diagnosis, most patients prefer to know their diagnosis and the introduction of legislation to enforce disclosure would positively affect medical practice in Jordan.

Conclusion

The differential attitudes of physicians who were 'always truthful' and those who were 'not always truthful' suggests a rationale behind independent non-disclosure; namely, that non-disclosure is ethically justifiable and beneficial for the physical and psychological health of patients.