Secrecy: Unshared Realities

"Withstanding ambivalence is of particular importance"-Controversies among experts on dealing with desire to die in palliative care

In order to investigate controversies surrounding the desire to die phenomenon in palliative care by analyzing expert opinions on the topic, we carried out a secondary qualitative data analysis of free text comments collected during a Delphi survey that was designed to develop a conversation aid for dealing with desire to die in everyday clinical practice. Between 01/2018 and 03/2018, a two-round Delphi survey was carried out with national (German) and international palliative care experts. Free text comments were reinvestigated to identify controversies surrounding the desire to die phenomenon. An additional in-depth analysis focused on statements expressing attitudes towards proactively addressing (potential) desires to die. Within the Delphi survey, 103 of 149 multi-professional participants (almost all of them with practical and only six with exclusively theoretical expertise in palliative care) generated 444 free text comments. Thereof, we identified three main categories related to dealing with desire to die: "outer framework", "extended care system" and "health-professional-patient-relationship". Ambivalences, taboos and uncertainties surrounding desire to die in palliative care became apparent. Experts are divided concerning the practice of proactively addressing desire to die. Even if these conversations-especially the proactive approach-are also viewed critically, we conclude that open-ended and respectful communication about desire to die between health professionals and patients can be understood as an eligible intervention in palliative care. Proactively addressing the topic is a possible way to open up such conversations.

Shared Reality: From Sharing-Is-Believing to Merging Minds

Humans are fundamentally motivated to create a sense of shared reality—the perceived commonality of inner states (feeling, beliefs, and concerns about the world) with other people. This shared reality establishes a sense of both social connection and understanding the world. Research on shared reality has burgeoned in recent decades. We first review evidence for a basic building block of shared-reality creation: sharing-is-believing, whereby communicators tune their descriptions to align with their communication partner’s attitude about something, which in turn shapes their recall. Next, we describe recent developments moving beyond this basic building block to explore generalized shared reality about the world at large, which promotes interpersonal closeness and epistemic certainty. Together, this body of work exemplifies the synergy between relational and epistemic motives. Finally, we discuss the potential for another form of shared reality—shared relevance—to bridge disparate realities.

Thinking Through Secrets: Rethinking the Role of Thought Suppression in Secrecy

Having secrets on the mind is associated with lower well-being, and a common view of secrets is that people work to suppress and avoid them-but might people actually want to think about their secrets? Four studies examining more than 11,000 real-world secrets found that the answer depends on the importance of the secret: People generally seek to engage with thoughts of significant secrets and seek to suppress thoughts of trivial secrets. Inconsistent with an ironic process account, adopting the strategy to suppress thoughts of a secret was not related to a tendency to think about the secret. Instead, adopting the strategy to engage with thoughts of a secret was related the tendency to think about the secret. Moreover, the temporal focus of one's thoughts moderated the relationship between mind-wandering to the secret and well-being, with a focus on the past exacerbating a harmful link. These results suggest that people do not universally seek to suppress their secrets; they also seek to engage with them, although not always effectively.