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Saldivia-Siracusa C, Dos Santos ES, González-Arriagada WA, Prado-Ribeiro AC, Brandão TB, Owosho A, Lopes MA, Epstein JB, Santos-Silva AR. Conspiracy of Silence in Head and Neck Cancer Diagnosis: A Scoping Review. Dent J (Basel) 2024; 12:214. [PMID: 39057001 PMCID: PMC11276277 DOI: 10.3390/dj12070214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Cancer disclosure represents a complex healthcare dynamic. Physicians or caregivers may be prompted to withhold diagnosis information from patients. This study aims to comprehensively map and synthesize available evidence about diagnosis nondisclosure regarding head and neck cancer (HNC) patients. Following the Joanna Briggs Institute guidelines, a scoping review was conducted across major databases without period restriction, yielding 9238 publications. After screening and selection, a descriptive synthesis was conducted. Sixteen studies were included, primarily conducted in academic settings (75%) from Europe and Asia, with a total population of 662 patients predominantly diagnosed with brain, oral, pharyngeal, or laryngeal tumors. Remarkably, 22.51% of patients were unaware of their diagnosis. Although physicians were the main source of diagnostic information (35%), they reported to often use vague terms to convey malignancy. Additionally, 13.29% of patients were aware of their diagnosis from sources other than doctors or caregivers. Caregivers (55%) supported diagnosis concealment, and physicians tended to respect family wishes. A high diagnosis-to-death interval, education, and age significantly influenced diagnosis disclosure. HNC patients expressed a desire for personalized open communication. Multiple factors influenced the decision on diagnosis disclosure. Current evidence on this topic varies significantly, and there is limited research on the consequences of nondisclosure. These findings reflect the underestimation of the patients' outlook in the diagnosis process and highlight the need for further research, aiming to establish open communication and patient autonomy during the oncological journey.
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Affiliation(s)
- Cristina Saldivia-Siracusa
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba (FOP), Universidade Estadual de Campinas (UNICAMP), São Paulo 13414-903, Brazil; (C.S.-S.); (E.S.D.S.); (A.C.P.-R.); (M.A.L.)
| | - Erison Santana Dos Santos
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba (FOP), Universidade Estadual de Campinas (UNICAMP), São Paulo 13414-903, Brazil; (C.S.-S.); (E.S.D.S.); (A.C.P.-R.); (M.A.L.)
| | | | - Ana Carolina Prado-Ribeiro
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba (FOP), Universidade Estadual de Campinas (UNICAMP), São Paulo 13414-903, Brazil; (C.S.-S.); (E.S.D.S.); (A.C.P.-R.); (M.A.L.)
- Oral Medicine Service, Sírio Libanês Hospital, São Paulo 01308-050, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo 01246-903, Brazil;
| | - Adepitan Owosho
- Departments of Diagnostic Sciences, Department of Otolaryngology—Head & Neck Surgery and Bioscience Research, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Marcio Ajudarte Lopes
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba (FOP), Universidade Estadual de Campinas (UNICAMP), São Paulo 13414-903, Brazil; (C.S.-S.); (E.S.D.S.); (A.C.P.-R.); (M.A.L.)
| | - Joel B. Epstein
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Alan Roger Santos-Silva
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba (FOP), Universidade Estadual de Campinas (UNICAMP), São Paulo 13414-903, Brazil; (C.S.-S.); (E.S.D.S.); (A.C.P.-R.); (M.A.L.)
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Huurman ME, Pijnenborg GHM, Sportel BE, van Rijsbergen GD, Hasson-Ohayon I, Boonstra N. Communicating diagnoses to individuals with a first episode psychosis: A qualitative study of individuals perspectives. Front Psychiatry 2023; 14:1098224. [PMID: 36873199 PMCID: PMC9980435 DOI: 10.3389/fpsyt.2023.1098224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Receiving the label of a psychotic disorder influences self-perception and may result in negative outcomes such as self-stigma and decreased self-esteem. The way the diagnosis is communicated to individuals may affect these outcomes. AIMS This study aims to explore the experiences and needs of individuals after a first episode of psychosis with regard to the way in which information about diagnosis, treatment options and prognosis is communicated with them. DESIGN AND METHODS A descriptive interpretative phenomenological approach was used. Fifteen individuals who experienced a first episode of psychosis participated in individual semi-structured open-ended interviews on their experiences and needs regarding the process of providing information about diagnosis, treatment options and prognosis. Inductive thematic analysis was used to analyze the interviews. RESULTS Four recurring themes where identified (1) timing (when); (2) content (what); and (3) the way information is provided (how). Individuals also reported that the provided information could elicit an emotional reaction, for which they would require specific attention, therefore the fourth theme is (4) reactions and feelings. CONCLUSION This study provides new insights into the experiences and specific information needed by individuals with a first episode of psychosis. Results suggest that individuals have different needs regarding the type of (what), how and when to receive information about diagnosis and treatment options. This requires a tailor-made process of communicating diagnosis. A guideline on when, how and what to inform, as well as providing personalized written information regarding the diagnosis and treatment options, is recommended.
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Affiliation(s)
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, Netherlands
| | - Bouwina Esther Sportel
- Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, Netherlands
| | | | | | - Nynke Boonstra
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands.,KieN VIP Mental Health Care Services, Leeuwarden, Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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3
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He C, Zhu WX, Tang Y, Bai Y, Luo Z, Xu J, Wang H, Xu S, Xu J, Xiao L, Zhang R, Wang Y, Du J, Huang Y, Li X, Su T. Knowledge of a cancer diagnosis is a protective factor for the survival of patients with breast cancer: a retrospective cohort study. BMC Cancer 2021; 21:739. [PMID: 34176477 PMCID: PMC8237449 DOI: 10.1186/s12885-021-08512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The health burden of breast cancer is rising in China. The effect of informed diagnosis on long-term survival is not fully understood. This retrospective cohort study aims to explore the association between early informed diagnosis and survival time in breast cancer patients. METHODS A total of 12,327 breast cancer patients were enrolled between October 2002 and December 2016. Potential factors, including knowing the cancer diagnosis status, sex, age, clinical stage, surgery history, grade of reporting hospital and diagnostic year were, analyzed. We followed up all participants every 6 months until June 2017. Propensity score matching (PSM) was used to balance the clinicopathologic characteristics between patients who knew their diagnosis and those who did not. RESULTS By June 2017, 18.04% of the participants died of breast cancer. Before PSM, both the 3-year and 5-year survival rates of patients who knew their cancer diagnosis were longer (P < 0.001). After PSM, the above conclusion was still established. By stratified analysis, except for the subgroups of male patients and stage III patients, patients who knew their diagnosis showed a better prognosis in all the other subgroups (P < 0.05). Cox regression analysis showed that knowing a cancer diagnosis was an independent risk factor for survival in breast cancer patients (P < 0.001). CONCLUSIONS Being aware of their cancer diagnosis plays a protective role in extending the survival time of breast cancer patients, which suggests that medical staff and patients' families should disclose the cancer diagnosis to patients in a timely manner. Further prospective studies need to be made to validate our findings.
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Affiliation(s)
- Chen He
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Wen Xi Zhu
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yunxiang Tang
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Zheng Luo
- Zhoupu Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jinfang Xu
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Hao Wang
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Shuyu Xu
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Jingzhou Xu
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Lei Xiao
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Ruike Zhang
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Yajing Wang
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Jing Du
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Yujia Huang
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Xiaopan Li
- Department of Cancer Prevention and Vital Statistics, Center for Disease Control and Prevention, Pudong New Area, Shanghai, China.
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China.
| | - Tong Su
- Department of Medical Psychology, College of Psychology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China.
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Cultural implications for disclosure of diagnosis and prognosis toward terminally ill cancer patients in China: A literature review. Palliat Support Care 2021; 20:283-289. [PMID: 33947500 DOI: 10.1017/s1478951521000535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Health professionals in China tend to avoid open communication with terminally ill cancer patients concerning their diagnosis and prognosis. This review aims to explore Chinese cultural beliefs and attitudes concerning disclosure and death among health professionals and cancer patients in China and to investigate preferences of terminally ill cancer patients for a "good death." METHOD A narrative literature review was conducted in May 2020 on MEDLINE, EMBASE, and WEB OF SCIENCE to include all studies with clear study design which presented its own study data or referred to data within underlying studies, published between January 2000 and May 2020, having cancer patients and/or healthcare professionals as participants, conducted in Mainland China, Hong Kong, or Taiwan and containing relevant data concerning "medical disclosure" or "good death." Quality assessment of publications was conducted using the NIH and CASP checklists. RESULTS Primary database search revealed a total of 108 papers of which 9 were ultimately included. The additional hand search led to the inclusion of eight further papers. In total, there were 11 quantitative studies, 4 qualitative studies and 2 literature reviews included in this review. Our findings indicated that most terminally ill cancer patients in China want to know the truth about their diagnosis and prognosis and preferred to be informed by their doctors. Terminally ill cancer patients valued a good relationship with family and medical staff as well as being respected as an individual and wanted to be able to prepare for death. SIGNIFICANCE OF RESULTS Terminally ill cancer patients in China often have a substantial need for information about their condition while their preferences are widely consistent with those in Western societies. Training for health professionals needs to focus on communication skills in order to overcome barriers in patient interaction.
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Brand-Gothelf A, Hasson-Ohayon I, Hertz-Palmor N, Basel D, Gothelf D, Karnieli-Miller O. The Delivery of Diagnosis by Child Psychiatrists: Process Characteristics and Correlates of Distress. Front Psychiatry 2021; 12:632207. [PMID: 33828493 PMCID: PMC8019702 DOI: 10.3389/fpsyt.2021.632207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 11/26/2022] Open
Abstract
We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task.
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Affiliation(s)
| | | | - Nimrod Hertz-Palmor
- Sheba Medical Center, Tel Hashomer, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Dana Basel
- Sheba Medical Center, Tel Hashomer, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Tel Hashomer, Israel
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Mon SW, Ozdemir S, Zu WWM, Win H, Maw MM, Win KC, Thant KZ, Teo I, Krishnan A, Goh CR, Finkelstein EA, Malhotra C. End of life experiences of patients with advanced cancer in Myanmar: Results from the APPROACH study. Asia Pac J Clin Oncol 2020; 16:333-339. [PMID: 32573100 DOI: 10.1111/ajco.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to palliative care services is essential for attaining universal health coverage for patients with a terminal cancer. Despite this, many patients with advanced cancer in low-income countries, such as Myanmar, suffer at the end of life (EOL) due to little or no access to palliative care. However, actual evidence on EOL experiences of cancer patients in Myanmar is lacking. This paper aims to describe various dimensions of EOL experiences among patients with an advanced cancer from the largest public hospital in Myanmar. METHODS We surveyed 195 patients with stage IV cancer seeking care from outpatient oncology clinics to assess their quality of life, pain severity, pain medications taken, quality of communication with doctors, nursing care and health care coordination, and desire to end life sooner. We assessed socioeconomic status (SES) differences in each patient outcome using separate multivariate linear/logistic regressions. RESULTS Forty-one percent of the patients in our sample reported that they wish their life would end sooner. Low SES cancer patients had significantly worse quality of life, reported poor health care coordination and were more likely to report severe pain compared to high SES cancer patients visiting the same hospital. CONCLUSION To improve quality of life and pain management and to reduce EOL distress among patients with advanced cancer, there is a pressing need to develop and invest in hospital and community-level palliative care services in Myanmar.
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Affiliation(s)
- Ssu Wynn Mon
- Clinical Research Division, Department of Medical Research, Yangon, Myanmar
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Wah Wah Myint Zu
- Department of Radiotherapy, Yangon General Hospital, Yangon, Myanmar
| | - Han Win
- Clinical Research Division, Department of Medical Research, Yangon, Myanmar
| | - Myo Myint Maw
- Department of Medical Oncology, Yangon General Hospital, Yangon, Myanmar
| | - Khin Cho Win
- Department of Radiotherapy, Yangon General Hospital, Yangon, Myanmar
| | - Kyaw Zin Thant
- Clinical Research Division, Department of Medical Research, Yangon, Myanmar
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Anirudh Krishnan
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Cynthia Ruth Goh
- Department of Palliative Medicine, National Cancer Centre, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
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7
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Su T, He C, Li X, Xiao L, He J, Bai Y, Tang Y. Association between early informed diagnosis and survival time in patients with lung cancer. Psychooncology 2020; 29:878-885. [PMID: 32266740 DOI: 10.1002/pon.5360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/07/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As a malignant tumor with high mortality, lung cancer (LC) often causes great trauma to patients, and a series of negative emotions and a heavy psychological burden accompanies poor prognosis. Whether or not to inform the patients of their condition has always been a controversial topic in the medical community. This retrospective cohort study investigated the association between early informed diagnosis and survival time in patients with LC. METHODS A total of 29 825 patients with LC were enrolled between October 2002 and December 2016. The potential factors influencing LC survival were registered, including knowing their cancer diagnosis status, age, gender, pathological type, clinical stage, surgical history, hospital grade, and patient occupation. All participants were followed up every 6 months until June 2017. RESULTS In June 2017, 23.1% of the participants still survived. Their median survival time (MST) was 11.20 months (95% confidence interval [CI], 10.98-11.43). Generally, patients that knew their cancer diagnosis had longer MST than those who did not (18.33 months vs 8.77 months, P < .001). By stratified analysis, patients that knew their cancer diagnosis had longer survival time in each subgroup (P < .001, all subgroups). Cox regression analysis showed that knowing their cancer diagnosis was an independent influencing factor for survival in patients with LC (hazard ratio, 0.826; 95% CI, 0.802-0.851; P < .001). CONCLUSIONS Knowing their cancer diagnosis contributed to longer survival time in patients with LC, providing clear evidence that medical staff and patients' families should fully disclose cancer diagnoses to patients.
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Affiliation(s)
- Tong Su
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Chen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Xiaopan Li
- Department of Cancer Prevention and Vital Statistics, Center for Disease Control and Prevention, Shanghai, China.,Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Lei Xiao
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Jingwen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yunxiang Tang
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
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8
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Tang L, Zhang Y, Pang Y, He Y, Wang Y, Fielding R, Deng L. A comparison of psychosocial care preferences of breast cancer women in Mainland China and Hong Kong. Psychooncology 2018; 28:343-350. [PMID: 30569663 DOI: 10.1002/pon.4947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022]
Abstract
PURPOSE Despite shared cultural values, Mainland China's health care system differs from that of Hong Kong. We compared preferences for psychosocial care in Mainland breast cancer women with their Hong Kong counterparts to determine core preferences for, and correlates of, clinical psychosocial care implementation. METHODS Two hundred eighty breast cancer patients from 23 hospitals located in 15 provinces across Mainland China were recruited to complete the 55-item Chinese version of the Australian National Health and Medical Research Council's National Breast Cancer Centre assessment. Items ranked by proportions of women endorsing them as "essential" for care were compared with similar rankings by Hong Kong Chinese women with breast cancer. RESULTS Valid response rate was 83% (231/280). Among 231 breast cancer patients, greater than 40% endorsed 15/55 items as essential for effective psychosocial care. Of the top 10 ranked "repeatable" items, seven items were common to both Chinese and Hong Kong breast cancer women, while of the top 10 ranked "once-only" items, nine were common. Mainland breast cancer women ranked help with anxiety and social roles higher than did their Hong Kong counterparts. Demographic factors significantly associated with psychosocial care needs included ethnicity, age, income source and level, religious beliefs, education level, marital status, residential status, and current therapies. CONCLUSIONS Chinese breast cancer patients prioritize both disease and treatment information and psychosocially sensitive care, making these core items in comprehensive psychosocial care implementation by clinicians and nurses.
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Affiliation(s)
- Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Richard Fielding
- Centre for Psycho-oncology Research & Training, Division of Behavioral Sciences, School of Public Health, The University of Hong Kong, Hong Kong
| | - Lisha Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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9
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Huang HL, Yao CA, Hu WY, Cheng SY, Hwang SJ, Chen CD, Lin WY, Lin YC, Chiu TY. Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey. J Pain Symptom Manage 2018; 55:843-850. [PMID: 29221846 DOI: 10.1016/j.jpainsymman.2017.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. METHODS This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. RESULTS Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death." CONCLUSION The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Dao Chen
- Department of Family Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chun Lin
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
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10
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Gan Y, Zheng L, Yu NX, Zhou G, Miao M, Lu Q. Why do oncologists hide the truth? Disclosure of cancer diagnoses to patients in China: A multisource assessment using mixed methods. Psychooncology 2017; 27:1457-1463. [PMID: 28833916 DOI: 10.1002/pon.4545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In the United States and most European countries, cancer diagnoses are disclosed to patients. In China, however, the trend toward full disclosure has progressed slowly. The present study aimed to explore attitudes toward truth-telling practice among physicians, patients, patients' family members, and the general population, and reasons for nondisclosure. METHODS We administered a short survey to 212 physicians, 143 patients with cancer, 413 family members of patients with cancer, and 1415 members of the general population. A MANOVA was performed to examine group differences in attitudes toward cancer disclosure. In addition, we interviewed 20 oncologists. Interview data were analyzed using NVivo10. After the interview, we administered another short survey to 143 patients with cancer. RESULTS Quantitative data indicated that physicians were the least, and patients the most, in favor of disclosure. Qualitative data among physicians and follow-up surveys among cancer patients revealed 5 reasons for the concealment of cancer diagnoses by physicians, including lack of awareness of patients' right to knowledge, cultural influences, insufficient medical resources and training, families' financial concerns, and the need to protect doctors from violence. CONCLUSION There is a discrepancy between the needs of patients and those in medical practice. These results deepen our understanding regarding the reasons for oncologists' attitudes toward nondisclosure.
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Affiliation(s)
- Yiqun Gan
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Lei Zheng
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Nancy Xiaonan Yu
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Guangyu Zhou
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Miao Miao
- School of Sociology, China University of Political Science and Law, Beijing, China
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
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Shin DW, Cho J, Kim SY, Yang HK, Park K, Kweon SS, Koh DH, Nam HS, Park JH. Patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure: A study with patient-caregiver-physician triad. Psychooncology 2017; 27:106-113. [DOI: 10.1002/pon.4467] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/11/2017] [Accepted: 05/30/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine/Supportive Care Center; Samsung Medical Center; Seoul South Korea
| | - Juhee Cho
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul South Korea
| | - So Young Kim
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju South Korea
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Keeho Park
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
| | - Sun-Seog Kweon
- Jeonnam Regional Cancer Center; Chonnam National University Hwasun Hospital; Hwansun South Korea
| | - Dai Ha Koh
- Department of Preventive Medicine; Chonbuk National University Medical School; Jeonju South Korea
| | - Hae-Sung Nam
- Cancer Control Division, Daejeon Regional Cancer Center; Chungnam National University Hospital; Daejeon South Korea
| | - Jong-Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju South Korea
- Division of Cancer Policy and Management, National Cancer Center; National Cancer Control Institute; Goyang South Korea
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12
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Association between socio-demographic factors, coping style, illness perceptions and preference for disclosure/nondisclosure of diagnosis in Chinese patients with hepatocellular carcinoma. J Health Psychol 2017; 24:1473-1483. [DOI: 10.1177/1359105317707258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We explored the association between socio-demographic factors, coping style, illness perceptions and preferences for disclosure/nondisclosure of cancer diagnosis in 384 Chinese patients with hepatocellular carcinoma. We found that (1) 69.3 percent of the patients preferred disclosure and (2) multivariate analysis showed that four variables were significantly positively associated with preference for disclosure, including active emotional-focused coping style, illness perceptions of personal control, chronic infection of hepatitis B virus, and educational level, whereas perceived emotional impact of illness and objective social support (mainly family support) were significantly associated with preference for nondisclosure. The findings provide useful information for understanding patients’ preferences for disclosure/nondisclosure of cancer diagnosis from a psychosocial perspective.
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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] [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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Ni YH, Alræk T. What circumstances lead to non-disclosure of cancer-related information in China? A qualitative study. Support Care Cancer 2016; 25:811-816. [PMID: 27832368 PMCID: PMC5266771 DOI: 10.1007/s00520-016-3464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Withholding information from cancer patients is a common practice in many Asian countries, including China, Japan, and Singapore, as well as in some Western countries, such as Spain, Greece, and Italy. Much research has investigated why doctors withhold information from cancer patients generally, both in the West and the East, but little research has been done on specifically why Chinese doctors withhold such information. METHODS Three focus group interviews were conducted with a total of 16 oncologists in China. The interviews were recorded, transcribed, and translated. Qualitative data were analyzed using systematic text condensation. RESULTS The result of this study revealed numerous circumstances that can lead to non-disclosure of cancer-related information. Many of these circumstances have been described in previous studies about non-disclosure in other countries. We found two additional circumstances that have not been described in previous literature and might therefore expand our current knowledge about this phenomenon; they are contradiction between laws and fear for personal safety. CONCLUSION Numerous circumstances can lead to non-disclosure of cancer-related information. This study found two additional circumstances that might lead to non-disclosure. The findings of this study suggest further assessment and clarification about the laws that govern doctor-patient communication and that action should be taken to ensure safe working environments for Chinese oncologists.
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Affiliation(s)
- Yi Hu Ni
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Kalfarveien 31, 5020, Bergen, Norway.
| | - Terje Alræk
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Institute of Health Sciences, Kristiania University College, PB 1190 Sentrum, 0107, Oslo, Norway
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Tang WR, Hong JH, Rau KM, Wang CH, Juang YY, Lai CH, Fujimori M, Fang CK. Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices. Psychooncology 2016; 26:999-1005. [DOI: 10.1002/pon.4257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Kun-Ming Rau
- Department of Hematology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Hsu Wang
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chien-Hong Lai
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Maiko Fujimori
- Center for Suicide Prevention, National Institute of Mental Health; National Center for Neurology & Psychiatry; Tokyo Japan
| | - Chun-Kai Fang
- Department of Psychiatry, Suicide Prevention Center & Hospice and Palliative Care Center; MacKay Memorial Hospital; Taipei Taiwan
- Department of Medicine; MacKay Medical College; New Taipei Taiwan
- Department of Thanatology and Health Counseling; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
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Gu X, Cheng W. Chinese oncologists' knowledge, attitudes and practice towards palliative care and end of life issues. BMC MEDICAL EDUCATION 2016; 16:149. [PMID: 27188161 PMCID: PMC4870734 DOI: 10.1186/s12909-016-0668-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/12/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Oncologists` knowledge and attitudes to palliative care (PC) and end of life (EOF) should be highlighted in order to give them effective education. This study is intended to provide a descriptive analysis of oncologists' knowledge, attitudes and practice toward PC and EOF issues in Mainland China. METHODS The questionnaire survey with 24 items investigating oncologists' demographic information, knowledge and attitudes toward PC and EOF issues was conducted among Chinese Oncology clinicians. RESULTS The participants had a mean of 10.10 years practice in oncology. 43 (31.2%) participants had received PC education. 73.9% of the participants believed that PC should be considered when patients were not suitable to take surgery, radiotherapy, chemotherapy and other anti-cancer therapies. 72.5% of the participants believed that early PC integration can improve the quality of life in patients. Most of the oncology clinicians (73.9%) believed that the doctor-in-charge was the appropriate person to inform patients of the diagnosis. However, only 11 participants chose to inform the diagnosis and disease prognosis to the patients, whereas 39.9% of the participants chose to disclose it to Family/Caregivers first. Besides, Chinese oncologists were obviously unfamiliar with the concepts of euthanasia and related issues. CONCLUSIONS This study indicated the insufficient knowledge toward PC and related issues of the Chinese oncologists. More attention should be paid on the education of PC among Oncologists in Mainland China.
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Affiliation(s)
- Xiaoli Gu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, Dong An Road, Shanghai, People's Republic of China
| | - Wenwu Cheng
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, Dong An Road, Shanghai, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Huang B, Chen H, Deng Y, Yi T, Wang Y, Jiang Y. Diagnosis, disease stage, and distress of Chinese cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:73. [PMID: 27004220 DOI: 10.3978/j.issn.2305-5839.2016.02.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective is to assess how cancer patients know about their diagnosis what they know about their real stage, and the relationship between cancer stage and psychological distress. METHODS A questionnaire including the Distress Thermometer was delivered to 422 cancer inpatients. Multivariate logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Most of patients (68.7%) knew the bad news immediately after diagnosis. Half of patients knew their diagnosis directly from medical reports. Nearly one third of patients were informed by doctors. Cancer stages, which patients believed, differed significantly from their real disease stages (P<0.001). Over half of patients did not know their real disease stages. Patients with stage I-III cancer were more likely to know their real disease stage than patients with stage IV cancer (P<0.001). Distress scores of cancer patients were determined by the real cancer stage (P=0.012), not the stage which patients believed. CONCLUSIONS Although most of participants knew the bad news immediately after diagnosis, less than half of them knew their real disease stage. Patient with stage I-III cancer was more likely to know the real disease stage and had a DT score <4 than patient with stage IV disease.
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Affiliation(s)
- Boyan Huang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Huiping Chen
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yaotiao Deng
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Tingwu Yi
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yuqing Wang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Jiang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Cao W, Qi X, Yao T, Han X, Feng X. How doctors communicate the initial diagnosis of cancer matters: cancer disclosure and its relationship with Patients' hope and trust. Psychooncology 2016; 26:640-648. [PMID: 26776310 DOI: 10.1002/pon.4063] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study is to examine the relationships between perceived initial cancer disclosure communication with doctors, levels of hope, and levels of trust in doctors among cancer patients in China. METHODS A total number of 192 cancer inpatients in a cancer hospital in China were surveyed. Perceived disclosure strategies, levels of hope, levels of trust in their doctors, as well as the demographic information were obtained from the participants. RESULTS In addition to age, patients who had higher levels of perceived emotional support from doctors, or higher levels of perceived personalized disclosure from doctors, or higher levels of perceived discussion of multiple treatment plans with doctors were more likely to have higher levels of trust in doctors. In addition to perceived health status, perceived emotional support from doctors significantly predicted participants' levels of hope. That is, patients who had higher higher levels of perceived doctors' emotional support were more likely to have higher levels of hope. Key disclosure person was a marginally significant variable, that is, patients who were mainly disclosed by family members might have higher levels of hope compared with patients who were mainly disclosed by doctors. CONCLUSIONS When communicating with a cancer patient, doctors might not ignore the importance of emotional support during cancer diagnosis communication. Doctors might want to involve family and collaborate with family to find out ways of personalized disclosure. During the communication process, doctors could provide their patients with multiple treatment options and discuss the benefits and side effects of each treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Weidan Cao
- School of Media and Communication; Temple University; Philadelphia PA USA
| | - Xiaona Qi
- Harbin Medical University Cancer Hospital; Harbin China
| | - Ting Yao
- School of Nursing and Medical Techniques; Jianghan University; Wuhan China
| | - Xuanye Han
- The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Xujing Feng
- Harbin Medical University Cancer Hospital; Harbin China
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Wei S, Chen F, Chen H, Guo Y, Hui D, Yennurajalingam S, Chisholm G, Liu E, Liao Z, Yang L, Cheng H, Zhou Y, Guo H, Bruera E. Patients' and Family Members' Decision-Making and Information Disclosure Preferences in a Single-Center Survey in China: A Pilot Study. Am J Hosp Palliat Care 2015; 33:733-41. [PMID: 26019263 DOI: 10.1177/1049909115588302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Understanding the medical decision-making and information disclosure preferences is important for care quality. OBJECTIVES To examine the feasibility of using the questionnaires and to identify modifications needed in the following study. DESIGN Thirty-three pairs of patients with advanced cancers and their caregivers were asked to complete the questionnaires. RESULTS More than 60% of patients and caregivers had an educational level of middle school and below. The active, passive, or shared decision-making preferences for patients were 33.3%, 39.4%, and 27.3%, respectively. Twenty of 33 patients and 24 of 33 caregivers misunderstood the questions. CONCLUSIONS Low educational levels may be the reason for poor understanding imprecision. It is necessary to use the modification version of the questionnaires in developing countries.
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Affiliation(s)
- Shanshan Wei
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Fanglin Chen
- Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Hongyan Chen
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - En Liu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Zhongli Liao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Li Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Heng Cheng
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Yuanyuan Zhou
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Hong Guo
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sun W, Wang Z, Fang S, Li M. Factors influencing the attitudes of Chinese cancer patients and their families toward the disclosure of a cancer diagnosis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:20-25. [PMID: 24931287 DOI: 10.1007/s13187-014-0687-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The disclosure of a cancer diagnosis to patients has been a core topic in oncology departments. Previous studies have demonstrated that Chinese cancer patients and their families differ in their attitudes toward cancer diagnosis disclosure. However, the influencing factors regarding their different attitudes remain unknown. In the present study, a questionnaire was delivered to 266 cancer patients and 266 matched family members. The results showed that cancer patients were more likely to desire to be informed of their condition than family members (85 vs. 18%, P < 0.01). The patients' age had a significant influence on their attitudes (P < 0.01), while the family members' gender, profession, educational level, and their relationship with the patients could significantly affect their attitudes (all P < 0.05). Further multivariate analyses indicated that a family member's gender (odds ratio (OR) = 2.928, 95% confidence interval (CI) 1.379-6.213, P = 0.005), profession (OR = 2.814, 95% CI 1.548-5.119, P = 0.001), and educational level (OR = 0.105, 95% CI 0.053-0.211, P < 0.001) remained significant variables. Due to a lower educational level, only 74% of families knew about chemotherapy, and 90% of families were not familiar with molecular targeted therapy. However, 78% of patients expected to be cured of their cancer, 16.5% expected to reduce the severity of their condition, and 4.9% expected to lengthen their lives. Therefore, physicians have a responsibility to appropriately provide knowledge regarding cancer to the patients' families if their educational level is lower and if they have no knowledge of recent treatments, which may improve their acceptability of a cancer diagnosis for patients.
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Affiliation(s)
- Wenwen Sun
- Department of Oncology, Shandong Cancer Hospital, No.440 Jiyan Road, Jinan, Shandong, 250117, People's Republic of China
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Experiences of truth disclosure in terminally ill cancer patients in palliative home care. Palliat Support Care 2015; 9:173-80. [PMID: 24468485 DOI: 10.1017/s1478951511000046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to explore the experiences and preferences of terminally ill cancer patients regarding truth telling in the communication of poor prognoses. METHOD We recorded and transcribed interviews with 45 patients who knew their cancer was terminal, and analyzed their responses hermeneutically. RESULTS Patients identified three different modes of truth: (1) the absolute objective truth that they are dying; (2) the partial truth about their condition including some facts but not all of the details; and (3) the desired truth, originating in the patient's own beliefs about a healthy or better life. Coping strategies were related to patients' preferred mode of truth: (1) facing the truth in order to take action; (2) facing some parts of the truth in order to maintain hope; and (3) hovering between facing and avoiding the truth. In their struggle for existential survival, patients used different coping strategies, changing from one to another depending upon the circumstances. SIGNIFICANCE OF RESULTS Varying use of different coping strategies impacts on patient preferences concerning communication about bad news with their doctors. Truth-telling entails more than merely providing information related to the forthcoming death. It also concerns how physicians or other healthcare staff can support the patient's existential survival by fine-tuning the communication of "truth" according to the individuals' preferences.
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Discordance between perceived and actual cancer stage among cancer patients in Korea: a nationwide survey. PLoS One 2014; 9:e90483. [PMID: 24817193 PMCID: PMC4015901 DOI: 10.1371/journal.pone.0090483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 02/03/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea. METHODS Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis. RESULTS The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30-0.87), recurrence (OR = 0.64, 95% CI = 0.50-0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39-0.72). CONCLUSION There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.
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Obeidat RF, Homish GG, Lally RM. Shared Decision Making Among Individuals With Cancer in Non-Western Cultures: A Literature Review. Oncol Nurs Forum 2013; 40:454-63. [DOI: 10.1188/13.onf.454-463] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bai Q, Zhang Z, Lu X, Shi Y, Liu X, Chan H. Attitudes towards palliative care among patients and health professionals in Henan, China. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x10y.0000000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Xue D, Wheeler JL, Abernethy AP. Cultural differences in truth-telling to cancer patients: Chinese and American approaches to the disclosure of ‘bad news’. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wuensch A, Tang L, Goelz T, Zhang Y, Stubenrauch S, Song L, Hong Y, Zhang H, Wirsching M, Fritzsche K. Breaking bad news in China - the dilemma of patients' autonomy and traditional norms. A first communication skills training for Chinese oncologists and caretakers. Psychooncology 2012; 22:1192-5. [DOI: 10.1002/pon.3112] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 04/03/2012] [Accepted: 04/24/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center; Freiburg Germany
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - Lilli Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psychosocial Oncology; Peking University School of Oncology; Beijing Cancer Hospital & Institute; Beijing China
| | - Tanja Goelz
- Department of Internal Medicine, Haematology and Oncology; University Medical Center; Freiburg Germany
| | - Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psychosocial Oncology; Peking University School of Oncology; Beijing Cancer Hospital & Institute; Beijing China
| | - Sara Stubenrauch
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center; Freiburg Germany
| | - Lili Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psychosocial Oncology; Peking University School of Oncology; Beijing Cancer Hospital & Institute; Beijing China
| | - Ye Hong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psychosocial Oncology; Peking University School of Oncology; Beijing Cancer Hospital & Institute; Beijing China
| | - Haiwei Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psychosocial Oncology; Peking University School of Oncology; Beijing Cancer Hospital & Institute; Beijing China
| | - Michael Wirsching
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center; Freiburg Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center; Freiburg Germany
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Liu ZM, Liu C, Li JY, Yu CH, Jiang Y. The attitude of oncology physicians and nurses to the acceptance of new drugs for gene therapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:248-253. [PMID: 20957467 DOI: 10.1007/s13187-010-0172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
With the efficacy of gene therapy verified in phase III trials, cancer patients will consider whether to accept gene therapy sooner or later. The purpose of this study is to investigate the attitudes of oncology physicians and nurses regarding effective gene therapy. A questionnaire was administered to 368 oncology physicians and nurses. A total of 328 valid questionnaires were returned (response rate, 89.1%). Gene therapy was considered as very safe or safe by 256 (78.0%) participants. Regardless of the stage of cancer, participants who advised patients to enroll in clinical trials and considered gene therapy as safe tended to accept the effective gene therapy. Gene therapy is considered to be a safe treatment. Most participants are willing to accept effective and verified gene therapy on the assumption that they themselves suffer from cancers.
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Affiliation(s)
- Zi-ming Liu
- Department of Medical Oncology of Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Is therapeutic non-disclosure still possible? A study on the awareness of cancer diagnosis in China. Support Care Cancer 2010; 19:1191-5. [DOI: 10.1007/s00520-010-0937-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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31
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Sittisombut S, Maxwell C, Love EJ, Sitthi-Amorn C. Physicians' attitudes and practices regarding advanced end-of-life care planning for terminally ill patients at Chiang Mai University Hospital, Thailand. Nurs Health Sci 2009; 11:23-8. [DOI: 10.1111/j.1442-2018.2008.00416.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hsu CY, O'Connor M, Lee S. Understandings of death and dying for people of Chinese origin. DEATH STUDIES 2009; 33:153-174. [PMID: 19143109 DOI: 10.1080/07481180802440431] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article introduces the primary beliefs about ancestor worship, Taoism, Confucianism, Buddhism and traditional Chinese medicine that have influenced Chinese people for thousands of years, particularly in relation to death and dying. These cultures and traditions remain important for Chinese people wherever they live. Over a long period, Chinese people have integrated these philosophies and religions to form the basis of their culture and traditions. Although they agree that death is a natural part of the life span, a unique belief about death and dying has emerged among the Chinese from this integration. From this, the people find a significant definition of death and dying.
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Affiliation(s)
- Chiung-yin Hsu
- School of Nursing & Midwifery, Monash University, Australia
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Li JY, Liu C, Zou LQ, Huang MJ, Yu CH, You GY, Jiang YD, Li H, Jiang Y. To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis. J Clin Nurs 2008; 17:2463-70. [DOI: 10.1111/j.1365-2702.2007.02237.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Panagopoulou E, Mintziori G, Montgomery A, Kapoukranidou D, Benos A. Concealment of Information in Clinical Practice: Is Lying Less Stressful Than Telling the Truth? J Clin Oncol 2008; 26:1175-7. [DOI: 10.1200/jco.2007.12.8751] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Efharis Panagopoulou
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Gesthimani Mintziori
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Anthony Montgomery
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Dorothea Kapoukranidou
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Alexis Benos
- From the Lab of Hygiene; Lab of Physiology, Medical School, Aristotle University, Thessaloniki, Greece
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Jiang Y, Liu C, Li JY, Huang MJ, Yao WX, Zhang R, Yao B, Du XB, Chen J, Xie K, Zhao X, Wei YQ. Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer. Psychooncology 2008; 16:928-36. [PMID: 17285684 DOI: 10.1002/pon.1156] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cancer patients and their families differed in their attitude toward truth telling. The objective is to investigate different attitudes of Chinese patients or families toward whether and how to disclose diagnosis to patients with different stages of cancer and to examine the difference between the two groups. METHODS A questionnaire was delivered to 1023 participants. RESULTS Three hundred and eighty-two patients and 482 families completed the questionnaire. Cancer patients were more likely than families to believe that patient should be informed of the diagnosis (early-stage, 90.8 vs 69.9%, P<0.001; terminal stage, 60.5 vs 34.4%, P<0.001), and that doctor-in-charge was the appropriate person to disclose the diagnosis. Most participants thought that patient should be disclosed immediately after the diagnosis. Nearly half of participants reported that patient should be disclosed in a quiet and undisturbed room. When the hypothetic diagnosis changed from early-stage cancer to terminal illness, the number of participants, who wanted patient to know the diagnosis, decreased significantly. CONCLUSION Our findings indicated that Chinese cancer patients and their families differed in their attitude toward truth telling and the attitudes toward such a disclosure were influenced by disease stage. Physicians should realize this phenomenon and pay more attention to the skills of how to disclose the cancer diagnosis.
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Affiliation(s)
- Yu Jiang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
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