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Tsui-Hsia Hsu, I. Chuan Li
Abstract
Keywords: attitude, cancer patient, disclosure prognosis, inform prognosis
Attitude of Prognostic Disclosure to terminal Cancer Patients: a Systematic Review of the Literature
Tsui-Hsia Hsu, I. Chuan Li
Abstract
Background
Informed consent is not easy to cancer patients, especially for in the Chinese culture In developed countries, patient autonomy is important including terminal ill patients. . However,it has been found that terminal cancer patients are not been informed prognosis of their disease and it is common in Chinese cultural society. The determinators of whether the truth telling to paatietns when they have been diagnosed as cancer are attitudes of health professionals and families of cancer patients. The study reported that more than 90% of the families of cancer patients decide to take "lie" instead of truth telling to their families who have been diagnosed as cancer and more than 80% of families control the treatment decisions (Huang, 2004).
More and more studies show that both patients and health professionals benefit when patients are well informed and play a significant role in deciding how to manage their health conditions.If patients can be full informaed their disease conditions andpossible outcomes under different choices of treatments and the related clinical care, including benefits, harms, limitations, alternatives, and uncertainties, they get more benefits from their participation in the treatment process
Purpose
In this a systematic review study, we can understand the attitude of prognostic disclosure of terminal cancer from medicine professionals, patients and their families, advantages, disadvantages and barriers of prognostic disclosure, maybe it is as a reference base for clinical practice, future research and care policy making.
Methods
Literature publish including CINAHL, Cochrane Library, MEDLIN, Pub med, National Digital Library of Theses and Dissertations and CEPS Chinese electronic journals databases were searched in 1998-2012. Using the following search terms include attitude, cancer patient, prognosis disclosure truth disclosure, truth telling, terminal, end of life. Literature exclusion criteria are non-research articles, the subjects less than 18 years old, Pilot study, un-free full text available, repeat and irrelevant references. After selecting conditions preclude compliance with the conditions of the document screening, using standard literature Joanna Briggs Institute Review. A total of 17 relevant articles were identified and included in the current study.
Results
- Quality of Research
The initial search yielded over 92 references, many of which were not specifically relevant to our topic but were more broadly related to cancer and clinical issues related to general communication issues. After the deletion of duplicates, we identified 17 articles that appeared relevant to our aim. Most of the studies conducted in Asian countries, including Japan and China, and the most descriptive cross-sectional study. By the Registered Nurses Association of evidence of clinical guidelines Ontario (RNAO) in 2005 published the rating, 16 quantitative research articles are all Level 3 (good research design non-experimental studies).
- Attitude of Prognostic Disclosure to terminal Cancer Patients
The majority studies tend to agree that terminal cancer patients should be informed prognosis (Ali, 2010; Alifrangis et al, 2011;. Cherny et al, 2011). 38.7% -78.2% medical professionals think terminal cancer patients should be informed prognosis (Cherny et al, 2011;.Fumis et al, 2012; Zeng et al, 2011). 12.2% physicians and 46.2% nurses said they never disclosure prognosis to terminal cancer patients; however, 51% of physicians said they would inform the patient of imminent death (Merav et al, 2009.) 31.3% -88% patients expressed hope that professionals inform their life limited (Alifrangis et al, 2011;. Fumis et al, 2012.).
- Patient participation in terminal care decisions
Only three studies explore about what attitudes of terminal cancer patients are for theirparticipation in decision-making and results showed that 91.8% patients favor physicians to informthem about their diseases, 65.8% of them would like to participate in the terminal care decision (Cherny et al., 2011).However, there is one study showed that patients did not willing to be informed and to discussed with them about their end of life care (Dahlstrand et al., 2008). 16% patients do not want to discuss their prognosis and terminal care with their family (Alifrangis et al., 201 1).
- Timing and the Environment
There are 7 studies explore the timing of disclosure prognosis. 2 studies reported that cancer disease prognosis must be progressive inform (Cherny et al, 2011;.. Miyata et al, 2005) and 3 studies suggest that the diagnosisinformed should be immediately (Jiang et al, 2006;. Jiang et al, 2007;.. Li et al, 2008).There are 4 studies have shown that the best inform place is a quiet space without any interference, followed by the bedside in the hospital (Jiang et al, 2006;. Jiang et al, 2007;. Li et al, 2008;.. Otani et al, 2011).
- Advantages and Disadvantages of prognostic disclosure
35.5%-92.7% health professionals expressed advantages of fully informing cancer terminal patients outweigh disadvantages and 55.4%-92.7% health professionals agree that the disclosure prognosis can promote competent decision making of patients and facilitate appropriate healthcare provision. But 32.2% health professionals think if cancer patients know too much information, it will cause difficulties to take care (Cherny et al., 2011; Zeng et al., 2011), 70% health professionals think inappropriate information disclosure about cancer easily leads to medical disputes(Zeng et al., 2011)B
30.7% -54% health professionals said they need to have enough time to deal with patients with emotional problems (Cherny et al, 2011;. Otani et al, 2011.). 47.5%-78% health professionals said they had not been received at disclosure skills training, 28% -70% health professionals expressed disclosure training needs (Cherny et al, 2011;. BN Merav et al, 2009;. Nwankwo & Ezeome, 2011).
Conclusions
To disclosure bad news of terminal with cancer patients and their families is not easy. It seems to declare death will be coming, that impact on patients and their families is very heavy. This results show that the majority of terminal cancer patients expect to be disclosure prognosis, but most had not been informed. Most of health professionals expressed advantages of fully informing cancer terminal patients outweigh disadvantages and they think the disclosure prognosis it can promote competent decision making of patients and facilitate appropriate healthcare provision. But some health professionals said it is difficult to disclosure prognosis in terminal cancer patients, they need the skill training to disclosur prognosis with terminal cancer patients and this demand requirement to be met.
There is such a high demand for disclosur prognosis with terminal cancer patients, if professionals , especially physicians, do not have the relevant skills, will only increasing distress, unable to play a good role to inform, and plan a skill of disclosur prognosis training program to provide professional is the focus issue for future.
Tsui-Hsia Hsu, School of Nursing, National Yang-Ming University
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E-mail: tracy@hpa.gov.tw
I-Chuan Li RN, PhD , Institute of Clinical and Community Health Nursing,, National Yang-Ming University