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Shaulov A, Baddarni K, Cherny N, Shaham D, Shvartzman P, Tellem R, Clarfield AM. "Death is inevitable - a bad death is not" report from an international workshop. Isr J Health Policy Res 2019; 8:79. [PMID: 31718701 PMCID: PMC6852941 DOI: 10.1186/s13584-019-0348-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Palliative care is an approach meant to improve the quality of life of patients facing life-threatening illness and to support their families. An international workshop on palliative care took place in Caesarea, Israel under the auspices of the National Institute for Health Policy Research on July 4-5th, 2018, with the goal of discussing challenges to the development and integration of palliative care services in Israel. At the workshop, both national and international figures in the field of palliative care and health policy addressed several issues, including truth telling, religious approaches to end of life care, palliative care in the community, pediatric palliative care, Israel’s Dying Patient Act, the Ministry of Health’s National Plan for palliative care, and challenges in using advance directives. We summarize the topics addressed, challenges highlighted, and directions for further advancement of palliative care in the future, emphasizing the critical role of the Ministry of Health in providing a framework for development of palliative care.
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Affiliation(s)
- Adir Shaulov
- Department of Hematology, Hadassah-Hebrew University Medical center, Jerusalem, Israel.
| | | | - Nathan Cherny
- Department of Palliative care, Shaarei Zedek Medical Center, Jerusalem, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah-Hebrew University Medical center, Jerusalem, Israel
| | - Pesach Shvartzman
- Department of Family Medicine and Palliative Care Unit, Clalit Health Services and Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rotem Tellem
- Palliative Care Service, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Mark Clarfield
- Department of Geriatrics, Soroka Medical center, Beer Sheva and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Zhang LQ, Chen PN, Wang HL, Sun L, Zhao XK, Song X, Wu MJ, Zhang TJ, Ji LF, Han WL, Fan ZM, Yuan Y, Yang HJ, Wang JP, Zhou FY, Qi YJ, Wang LD. Truth telling for patients with esophageal squamous cell carcinoma in Henan, China. Cancer Biol Med 2017; 14:83-89. [PMID: 28443207 PMCID: PMC5365178 DOI: 10.20892/j.issn.2095-3941.2016.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE : This study aims to investigate the truth-telling status and the relevant factors of esophageal squamous cell carcinoma (ESCC) patients in Henan, China. METHODS : A cross-sectional study from April to June 2015 using questionnaires was given to 301 family members of hospitalized ESCC patients based in three affiliated hospitals of Zhengzhou University (i.e., The First Hospital, The Second Hospital, and Tumor Hospital) and Anyang Tumor Hospital. RESULTS : Among the 41.9% (126/301) hospitalized ESCC patients who knew of their true diagnoses, only 4.0% patients were informed by their corresponding responsible doctors, 39.7% by their family members, and 56.3% by themselves. Univariate analyses showed that disclosure of confirmed ESCC diagnosis to patients was correlated with gender, family history of cancer (FHC), education level, vocation, hospital administrative level, and attitudes of family members (P < 0.05). Furthermore, multivariate analysis indicated that attitude of family members was the most important and an independent factor for diagnosis disclosure. Those patients with a negative FHC, under-education, manual occupation, advanced stages, and hospitalized in municipal hospitals exhibited a low rate of truth telling. CONCLUSIONS : Truth telling for ESCC patients in Henan is not prevalent and may be improved through consultation with family members, particularly for patients with a negative FHC, poor education, manual occupation, and advanced stages.
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Affiliation(s)
- Lian-Qun Zhang
- Anyang Tumor Hospital, Anyang 455000, China.,Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Pei-Nan Chen
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Hai-Ling Wang
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Li Sun
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Xue-Ke Zhao
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Xin Song
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Min-Jie Wu
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Tang-Juan Zhang
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Ling-Fen Ji
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Wei-Li Han
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Zong-Min Fan
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Yuan Yuan
- Anyang Tumor Hospital, Anyang 455000, China
| | | | | | | | - Yi-Jun Qi
- Key Laboratory of Cellular and Molecular Immunology, College of Medicine, Henan University, Kaifeng 475004, China
| | - Li-Dong Wang
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
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Tremblay I, Van Vliet G, Gonthier M, Janvier A. Partnering with parents to disclose Klinefelter syndrome to their child. Acta Paediatr 2016; 105:456-61. [PMID: 26683842 DOI: 10.1111/apa.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED In paediatrics, a diagnosis of Klinefelter syndrome can occur after prenatal testing or because of symptoms such as learning difficulties or incomplete puberty. After the diagnosis, parents have to decide when and how to speak about this condition to their child. Parents and healthcare professionals (HCPs) may have different perceptions related to disclosure of this diagnosis. Due to the absence of clear guidelines, parents and HCPs may feel uncomfortable discussing the condition and may hide the truth in a prolonged fashion. CONCLUSION For patients with a prenatal diagnosis, we recommend a gradual and personalised disclosure process starting between the ages of 5 and 13 years. For older patients, a personalised approach should also be the goal. Various communication strategies and recommendations regarding disclosure of Klinefelter syndrome are proposed.
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Affiliation(s)
- Isabelle Tremblay
- Department of Psychology; Sainte-Justine Hospital; Quebec Canada
- Research Center; Sainte-Justine Hospital; Quebec Canada
| | - Guy Van Vliet
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Endocrinology Service; Sainte-Justine Hospital; Quebec Canada
| | - Monique Gonthier
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Department of Pediatrics; University of Montreal; Quebec Canada
| | - Annie Janvier
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Department of Pediatrics; University of Montreal; Quebec Canada
- Bureau de l’Éthique Clinique; University of Montreal; Quebec Canada
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Abstract
Objective: In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. Materials and Methods: 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Results: Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease. Conclusions: There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.
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Affiliation(s)
| | - Triada Exiara
- Department of Internal Medicine, General Hospital of Komotini, Komotini, Greece
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Fu G, Heyman GD, Chen G, Liu P, Lee K. Children trust people who lie to benefit others. J Exp Child Psychol 2014; 129:127-39. [PMID: 25443139 DOI: 10.1016/j.jecp.2014.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022]
Abstract
The current research examined whether children consider who benefits from lies when judging the trustworthiness of liars. Across two studies (total N=214), 6- to 11-year-olds trusted individuals who lied to promote the interests of others, but not those who lied to promote their own interests. In contrast, children trusted individuals who told the truth regardless of who benefited. Trust in individuals who lied to promote the interests of others was evident even in the absence of moral approval for their actions. These results demonstrate that children take into account both the truth value of a speaker's statements and who benefits when assessing trustworthiness and that moral approval is not a prerequisite for trust.
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Affiliation(s)
- Genyue Fu
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang Province 321004, China
| | - Gail D Heyman
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang Province 321004, China; Department of Psychology, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Guowei Chen
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang Province 321004, China
| | - Peilong Liu
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang Province 321004, China
| | - Kang Lee
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang Province 321004, China; Erick Jackman Institute of Child Study, University of Toronto, Toronto, Ontario M5S 1V6, Canada
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Huang SH, Tang FI, Liu CY, Chen MB, Liang TH, Sheu SJ. Truth-telling to patients' terminal illness: what makes oncology nurses act individually? Eur J Oncol Nurs 2014; 18:492-8. [PMID: 24907230 DOI: 10.1016/j.ejon.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions. METHODS A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored. RESULTS Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%). CONCLUSIONS Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.
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Affiliation(s)
- Shu-He Huang
- School of Nursing, National Yang Ming University, Taipei, Taiwan; Department of Nursing, National Yang-Ming University Hospital, Taipei, Taiwan.
| | - Fu-In Tang
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
| | - Chang-Yi Liu
- Oncology Unit of O'Connor Hospital, San Jose, CA, USA.
| | - Mei-Bih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Te-Hsin Liang
- Department of Statistics of Information Science, Center for Statistical Consultation, Fu Jen Catholic University, Taipei, Taiwan.
| | - Shuh-Jen Sheu
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
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Abstract
The high incidence of fatal diseases, inequitable access to health care, and socioeconomic disparities in India generate plentiful clinical bad news including diagnosis of a life-limiting disease, poor prognosis, treatment failure, and impending death. These contexts compel health care professionals to become the messengers of bad news to patients and their families. In global literature on breaking bad news, there is very little about such complex clinical interactions occurring in India or guiding health care providers to do it well. The purpose of this article is to identify the issues for future research that would contribute to the volume, comprehensiveness, and quality of empirical literature on breaking bad news in clinical settings across India. Towards this end, we have synthesized the studies done across the globe on breaking bad news, under four themes: (a) deciding the amount of bad news to deliver; (b) attending to cultural and ethical issues; (c) managing psychological distress; and (d) producing competent messengers of bad news. We believe that robust research is inevitable to build an indigenous knowledge base, enhance communicative competence among health care professionals, and thereby to improve the quality of clinical interactions in India.
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Affiliation(s)
- Lawrence Martis
- Social Aetiology of Mental Illness - CIHR Postdoctoral Fellow, Centre for Addiction and Mental Health, 455 Spadina Avenue, Toronto, Ontario, M5S 2G8, Canada
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Abstract
Children and youth (referred to as 'children' in the present statement), whether actual patients or volunteers, frequently participate in medical education. The present position statement discusses the numerous ethical challenges that may arise including respect for persons, truth telling and confidentiality. The statement provides guidelines that may be helpful to educators from a wide variety of disciplines.
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Zahedi F. The challenge of truth telling across cultures: a case study. J Med Ethics Hist Med 2011; 4:11. [PMID: 23908753 PMCID: PMC3713926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022] Open
Abstract
Accompanied with various opinions across cultures, truth telling is a major debate in bioethics. Many studies have focused on attitudes toward truth disclosure. We intend to review several relevant research studies, and discuss the issue through a clinical case consultation. It seems that while "the right to know" is emphasized in bioethics, in some cultural contexts, health professionals fear communicating bad news. The patients may not receive information directly, because it is believed that the truth may make the patient feel hopeless and unable to cope with the problem. Nevertheless, some believe that sharing information may strengthen a trusting relationship between patients and medical professionals. Extensive efforts are in process in some societies to make patient rights to know the truth as a natural part of medical practice. However, in some cases, the principles of respect for patient autonomy require us to accept patient's refusal to know the truth, with the provision that he assigns someone to receive information and make medical decisions on his behalf. In conclusion, it is suggested that healthcare professionals should not act on a unique presumption in all cases and they should explore what the real interest of patient is, in order to respect individual autonomy.
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