Category Archives: medical care

Canadian Neighbor Pharmacy: Discussion of Advance Directives for Truth Disclosure

metastatic malignancyThis study confirms the results of previous studies on truth disclosure in a more realistic clinical setting. The patients in the current study did not have a previous diagnosis of cancer and were facing the real uncertainties of hospital admission and investigation; they were aware that their preferences would be recorded and acted on if necessary. The vast majority of patients in this study wanted to be told of a serious diagnosis and most wanted full details of their condition. Somewhat surprisingly, a clear majority of patients preferred to be alone rather than with their family when told of bad news. This is contrary to the findings of other workers. Subsequently, doctors were able to comply with patients’ wishes in almost all cases.

Individual people have specific informational needs that can only be identified by asking the individual. Respecting patient autonomy means that we should attempt to identify those who would prefer less information rather than adopting a policy of full automatic disclosure. This is consistent with the wishes expressed by patients in other studies. However, it is important that the desire to protect such patients should not lead to a lack of candor with the majority of patients who do want to know about their diagnosis. This study confirms that seeking preferences regarding truth disclosure at the outset of hospitalization is helpful and feasible in everyday practice and that the results can be used by clinicians to improve communication with patients and families in accordance with patients’ own wishes. Discussions about treatment options may mandate the disclosure of the diagnosis in some cases, and it could be argued that it is inappropriate to offer such patients the option of not receiving information, However, most of the patients who would prefer not to know of a serious condition would accept being told if that were required to provide effective treatment.

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