To speak or not to talk? Honesty and hope in oncology nursing.

Jan Hunter, lecturer in nursing on the University of Hull

In the relatively paternalistic past of the NHS, the prevailing view was that ‘doctor knows best’. If it was decided that the patient didn’t have to know that his prognosis was poor, he didn’t discover about it (unless he had the means to place two and two together or had the nerve to ask directly). Fortunately, we’re moving away from the times of selective withholding information, and honesty and telling the reality are actually at the center of patient care. Nurses, because of their ability to form strong bonds of trust with patients, are well-equipped to function leaders in discussions about disease progression and prognosis. While this cements nurses’ position as independent practitioners, it also requires us to confront one in every of the important thing challenges in cancer care: how will we reconcile truth-telling with the need to scale back suffering and provides hope to patients and caregivers?

Some patients could also be tempted to attempt to soften the blow of bad news. For example, measured disclosure of bad news over time could also be considered probably the most appropriate approach for patients we judge to be vulnerable or those we judge to have a lower ability to manage. On the surface, withholding certain information can only be seen as a “white lie” intended to guard patients and prepare them for bad news. However, irrespective of how good the intentions, making judgments about when to supply full disclosure can undermine the bond of trust between the patient and the nurse.

There are those that wonder if telling the reality all the time pays off. Kazdaglis et al. (2010) consider that the positive perception of truth-telling is merely an assumption; This is supported by Sarafaris et al. (2014) who argue that despite the necessity for patient autonomy, healthcare professionals shouldn’t reveal the reality if patients cannot address it. While these could also be valid views, rooted in the moral principles of beneficence and nonmaleficence, how do they relate to skilled expectations (reminiscent of those set out in Code of the Council of Nurses and Midwives (2015) within the UK) who advocate open and honest communication with patients about all features of care?

How wouldn’t it feel, from a patient’s perspective, to be deceived in this manner? In some cases, the reality will cause anguish, but this can be balanced by the anxiety of uncertainty. Patients have to know the reality to find a way to make decisions about their future care, adapt and prepare. When the reality is shared with compassion and time is taken to support the patient, even the toughest truth will be higher than a well-intentioned lie.

So what’s the most effective approach? Nurses should actually ask patients about their preferences from the start of their oncology path. However, this involves risks: find out how to approach a patient who preferred to be “kept secret”? How to avoid collusion with patients who need to hide the reality from their family members? How are you able to prepare patients and their family members for the challenges of advanced symptoms without talking to them truthfully and truthfully? How can we help patients look the reality in the attention if we comply with hide it from them? As nurses, we cannot comply with patients’ requests if doing so could impact their care and safety or violate our own skilled standards (Taboada, 2017).

Finally, where does hope fit into this discussion about fairness? How do you cultivate hope while telling someone their life is coming to an end? While we must recognize the importance of hope, nurses must also understand the harm attributable to offering false hope. However, truth-telling and hope should not mutually exclusive: hope in cancer patients just isn’t only for survival. While hope may involve healing, it may involve dying without pain; for death within the presence of family members; for death at home; to get the most effective care from those around you.

It’s easy to evangelise the importance of truth-telling and a positive attitude of hope. However, that you must consider how much to say, what to say and when to say it. Although honesty and openness are a fundamental principle of nursing, we cannot treat all patients in the identical way – the approach taken to sharing information should be individualized, patient-centered and rooted in a philosophy of honesty. Patients can have personal goals they need to realize before they die, and by being honest with them and supporting them through their most difficult journeys, we are able to be sure that hope can be present until the very end.

Bibliography

Kazdaglis, G. A., Arnaoutoglou, C., Karypidis, D., Memekidou, G., Spanos, G., & Papadopoulos, O. (2010). Disclosing the Truth to Terminal Cancer Patients: A Discussion of Ethical and Cultural Issues Eastern Mediterranean Health Journal .16(4).

Nursing and Midwifery Council (NMC) (2015). Code: skilled standards of practice and behavior for nurses and midwives. London: NMC.

Sarafis, P., Tsounis, A., Malliarou, M., and Lahana, E. (2014). Revealing the reality: the dilemma between instilling hope and respecting patient autonomy in on a regular basis clinical practice. Global Journal of Health Science. 6(2), 128–137.

Taboada, P. (2017). Requests to hide the reality at the top of life. Available: https://hospicecare.com/resources/ethical-issues/essays-and-articles-on-ethics-in-palliative-care/requests-to-withhold-the-truth-at-the-end-of- life/. Last access: 14/03/2017

(Visited 3756 times, 1 visit today)