Study On Cancer Disclosure Strategy

ObjectivesCancer has become the world's foremost cause of death in illness and annual incidencerate is increasing year by year in China. Due to cancer cure difficulties and poor prognosis,made to inform patients of cancer diagnosis and condition inferior to that of "expecteddeath". Thus, it is a social condition rather than controversial issue of telling the cancerpatients the truth or not and how to tell. In the unique culture background of our country,medical staff usually tell the true condition of the patients to their families before making adecision of telling the patients or not according to their families' opinions. Moreover,families don't agree to tell the truth to the patients in consideration of the patients' strongnegative reaction to the true diagnosis. More and more studies have indicated that it isfeasible to tell the patients the medical bad news and the cancer patients' voice of right toknow is higher and higher. Under these circumstances, our country's disclosure mode isfacing severe challenges. What's more, people have many things unaccepted towards deathduring the process of cancer information, 50% or more medical expenditure are used in theprolongation of the painful dying process of the terminal cancer patients. These are neitherbeneficial for the cancer patients to get true comfort, dignity and satisfaction in the finalstages of life, nor for the effective use of health resources.This study focus on the above issues, building an academic foundation for the betterdeath education and cancer disclosure to make cancer patients understand that life anddeath are the natural course of human being, treat life, cherish life, but also bravely facedisease and death. Trying to supply a scientific evidence for the transition from "respectingthe families' opinion" to "respecting patients' right" so to better respect and satisfy thecancer patients' consent right; Seeking for the best disclosure staff, time, content and degree to make the cancer disclosure more warm, humanistic, scientific and rational, to geta best balance between "telling the truth" and "avoiding hurt"; seeking for the effectivecare interventions so to make the patients get a relatively higher life quality in the limitedlife; supplying opinions and suggestions for the constitution of the medical service policyand system to make the progress of health career more beneficial to cancer patients and thepublic Interests.MethodsThis research apply document retrieval, expert counseling and specialists paneldiscussion to discuss the death concept and relevant theories of cancer disclosure in ourcountry and develop questionnaires on death attitude and cancer disclosure of differentgroups of people. 634 medical staff, 307 non-cancer patients, 302 hospitalized cancerpatients, 305 relatives of cancer patients, together 1548 people of a level three group Ahospital were investigated on the spot; the data was recorded with software EpiData3.1and double-entry method and analyzed with SPSS13.0 software. Analysis includes generalstatistic description analysis, Wilcoxon test or Kruskal -Wallis test, x~2 test, Single-factorLogistic Regression Analysis, Multi-factors Logistic Regression Analysis andCorrespondence Analysis, etc. All tests are double-tailed tests and indicate a statisticsignificance when P＜0.05.ContentsCombining the domestic and foreign literatures with the specialists panel discussion,based on the enlightenment of Chinese traditional cultural death attitude and modern deathattitude and the research of cancer informing strategy, in theory to probe into the deathattitude in our country and the relevant theories of cancer informing strategy; Probing intothe death attitude and treatment attitude towards terminal cancer in different groups ofpersons(medical personnel and non-caner patients, cancer patients and their families),comparing the differences and affected factors of death attitude and treatment attitudetowards terminal cancer in persons with different background, so to establish an academic foundation for better cancer disclosure and death education; Investigating the attitude ofdifferent people towards cancer disclosure to liberate the medical staff and family membersfrom the dilemma of telling or not and to establish a foundation of making scientificmedical service policy and institution. Comparing the choices and its affected factors ofcancer disclosure strategies in persons with different background, probing into the suitableperson, time, place, content, way, and degree and so on for cancer disclosure to get ascientific strategy of cancer disclosure; Investigating the psychological alteration of cancerpatients and their family members after getting a cancer diagnosis to provide evidence toscientific care intervention; Analyzing the relationship of the attitudes between death,terminal cancer treatment and cancer disclosure to probe into an approach to enhance andimprove the cancer disclosure strategies.Results1. Most patients approved dying painless and with dignity and comfort, at the same time,had a strong will to live and hoped for an active treatment from the medical staff andfamily members; they could accept the death, but had some sort of denying and suspecting.age, residence, history of contacting critical patients, experience of attending funeral andreligious belief were predictors of attitudes of the patients with cancer towards thetreatment of advanced cancer and death (P＜0.05 or P＜0.01).2. The families of cancer patients assented to relegate medical therapy with an equivocalattitude to euthanasia; they showed avoidance to death despite that they could accept theend of life. Sex, marriage, education, bereavement experience, contacts to serious illness,religious belief were predictors of attitudes of the families of cancer patients towardsthe treatment of advanced cancer and death(P＜0.05 or P＜0.01).3. Part of the medical staff showed ambivalent feelings about the treatment in the finalstage and showed evasion and rejection in attitude toward death. Those who had history ofcaring critical patient and experience of bereavement were tend to disapproving thatterminal-illed patients should live strongly. Those who have experience of death disposal were tend to approve of relieving the pain, providing dignity and establishing the last wishof treatment. (P＜0.05 or P＜0.01).4. "Hospice care" and "euthanasia" and other bioethical concept had been able to berecognized and accepted by the most of people; residence, age, personality, gender, familyincome and hospital experience were predictors of the non-cancer patients' attitudestoward the treatment of terminal cancer and death(P＜0.05 or P＜0.01).5. The medical staff prefer discussing death and rational treatment; family income permonth was risk factor for discussing death; education background was risk factor forrational treatment. All factors above based on the statistic evidence (P＜0.05 or P＜0.01).6. Cancer patients generally expected to know the real state of the illness. They suggestedthat most of them didn't know their real condition completely and get the psychologicalsupport that they really wanted under the influence of protective medical care, which mightinduce their distrust of the medical staff. The patients' attitudes towards informingcritical illness were significantly affected by the gender, marriage status, personality,duration of cancer information, hospitalization experience and funeral experience, withsignificant statistical differences (P＜0.05 or P＜0.01).7. Most family members believed that the medical staff should inform cancer patients abouttheir diseases after getting consent from their family members. The Logistic Regressionanalysis suggested that the time of being informed, education background, experiences oftaking care of critical patients and bereavement influenced the attitudes of family memberstowards the cancer disclosure (P＜0.05 or P＜0.01).8. Some medical staff had a serious attitude towards cancer disclosure and didn't agree totell the truth totally, whose attitude was based on that of the patients in a sense, and agreedthe family members to determine the informing. Besides, most of them didn't think thepatients had gotten the disease thoroughly. Logistic regression analysis revealed thatdepartment, occupation, job title, education background, experience of serious illness andhospitalization, a history of exposure to serious illness and dealing with death were the main factors affecting medical staff's attitude towards cancer disclosure (P＜0.05 or P＜0.01).9. Non-cancer Patients showed ambivalent feelings about cancer disclosure and directedagainst medical staff when medical staff, cancer patients and cancer patients' families hadconflict in the course of cancer disclosure. Their attitudes toward cancer-telling weresignificantly affected by their residence and hospitalization experience (P＜0.05 or P＜0.01).10. Background information on the impact of different groups of people are full ofcontradictions, only the role of different groups has a statistically significant difference inattitudes (P＜0.05 or P＜0.01); cancer patients' informed attitudes and their desire ofinformed consent were most active, and self-evaluation of their conditions was the highest.family members are not the main obstacle to the truth disclosure, while the attitudes ofnon-cancer patients and medical staff are most conservative.11. Most of the patients hoped to discuss with the professionals of cancer face to face oncediagnosed, besides, being ensured hopefully and accompanied by their relatives. Theresults of Logistic analysis showed that women, married, the patient with outgoingpersonality and minding talk about death supported for family members joining disclosure;the patient with previous hospital experience and less severe condition consciousnessapproved more timely truth-telling; the patient with higher education agreed on doctorsinforming directly.12. The family members of cancer patients stressed the importance of psychologicalevaluation of the patients, and emphasized the role they played in the process of cancertelling. They also demanded the informing arts of medical staff and relatively agreed withthe selective inform pattern more. The results of Logistic analysis showed thatresidence, gender, occupation, experience of caring the serious illness, duration after beinginformed, experience of attending funeral and bereavement, religious belief and the attitudetowards talking about death were influential factors for the family members to choose the disclosure strategy(P＜0.05 or P＜0.01).13. Medical staff got higher scores in preparation of cancer disclosure and highly agreedthat cancer patients should be informed with the emotional support of their families and ina quiet private environment once diagnosed and by a cancer disclosure group whichconsisted of the medical staff and patients' families and repeatedly informed the patients ina step by step plan. The results of Logistic analysis showed that experience ofserious illness and hospitalization, education background, family mensal income,experience of attending funeral and bereavement and dealing with death, job title anddepartment were influential factors for the medical staff's to evaluate and choose cancer-informing strategy (P＜0.05 or P＜0.01)14. The general public agreed more with the families' consent and participation in cancerdisclosure. Noncancer patients with history of contact with severely ill patients far moreagreed on items of "allow family members to keep patients' company during disclosure"and " face-to-face disclosure " than those without such history; manual laborers far moreagreed on items of "do not allow disclosure to an outsider" than office workers.15. After a period of psychological adjustment, most patients and their families couldcalmly accept the reality of cancer. After being informed of cancer diagnosis, most of thepatients and their families showed negative sentiment, and whether at the time of the cancerdisclosure, or after a period of time, the incidence of the adverse mood of the families ishigher than that of the patients themselves. The results of Logistic analysis suggested thatthe age, gender, funeral experiences were the influencing factors of the patients and theirfamilies to produce adverse mood (P＜0.05 or P＜0.01).16. There was a close relationship between the attitude towards death and the attitudetowards disclosure: the people who could accept the deaths were more likely to have apositive attitude towards cancer disclosure, adversely, people who had a vague attitudetowards death were apt to have an ambiguous attitude towards cancer disclosure; the peoplewho couldn't accept death were more likely to deny cancer disclosure. Conclusion1. It is feasible to tell the patients and their family members the real condition; the medicalstaffs should especially think much of the full right of consent of those patients andfamilies who are male, married and experienced hospitalization and funeral experiences,fully realize and understand the cancer patients and their relatives' dilemma mood of theterminal cancer treatment, inquire their last wish for terminal treatment, see them off in thecomfortable, dignity and satisfactory dying process.2. Principle of no cheating should be obeyed especially for those patients who are in theearly stage of diagnosis. Humanized cancer disclosure strategy should consider thepersonal background, personality, health history and the attitude towards death of thepatient, etc; and need to assess the desire to know of cancer patients, identify the patientsbeing informed; and need to establish a separate conversation room to ensure that theinterference is not exist in the cancer disclosure environment; need the accompaniment andemotional support of the family members; need the doctors' fully fulfillment of theirdisclosure responsibility and telling the disease diagnosis and changes in time; need todesigned, step-by-step and repeatedly inform, and reserve room for hope;need observe andevacuate the ill-natured emotion of patients after informed the real condition.3. Medical staff should avoid conflicting with family members and develop the harmonicmedical relationship. Health professionals should pay attention to the families of thehumanistic care and actualize the psychological intervention and health education varyfrom person to person and should fully aware and understand the ambivalent mood aboutthe terminal cancer therapy and cancer disclosure of patients and families, Medical staffshould respect the opinions of the families, especially with high academic qualifications,more experienced, either consult and cooperate with them or educate and guide them, and itis better to give the family members a psychological adaptation period before telling thetrue condition of cancer to the patients, at the same time encourage families tocommunicate with patients, provide patients for adequate psychological and social support. 4. Medical staff should try to overcome the error in the understanding of cancer disclosureand be responsible for improving the quality of life, initiate the research of cancerdisclosure strategies, volunteer to study and practice the knowledge of psychology,sociology and communication, strengthen exchanges and communication betweencolleagues, pay attention to enriching and accumulating of their own life and workexperiences and manage to self-culture the natural and optimistic attitude towards life anddeath, continuously improve the cancer disclosure skills; the patients' roles playing, as wellas the establishment of the routing training systems of hospice care wards, ICU and so onare feasible ways for the medical staff to enhance the life and death cognition and thecancer disclosure responsibility.5. The realization of the transition from "respect for the views of family members" to"respect the rights of people" and from "curative treatment" to "palliative care" need amore open atmosphere for death and cancer disclosure, and early intervention in thetargeted death education, and constant reduction of the difference between urban and ruralareas, and development and promotion of social economy and culture level, need in allsectors of the whole society to work together as well as need to guide actively by all themedical staff. Through carrying out the death and life education by the utilization of themass multi-channel approach, can change people's attitude towards cancer disclosure,improve patients' consent status. The cancer patients who are less experienced, young andrural are the emphasized person for death education.6. "Hospice care" and "euthanasia" and other bioethical concept gradually become themainstream of today's society. So on this basic, the government can constitute relevantpolicies and regulations. The government should implement the Chinese characterizedhospice care to meet the cancer patients' need and vigorously publicize it, should makeeffort to achieve the consensus of "while anti-disease-free, treat the disease in time, hospicecare while no cure " in the whole society.Innovation 1. This study was to explore truth-telling strategy by the approaching of the brand-newperspective of death attitude and the attitude of the treatment of terminal cancer.2. On the basis of informed consent in cancer patients, the sensitive issues, such as theattitude towards cancer disclosure, the treatment of terminal cancer and death survey werecarried out3. This study was conducted through multidimension, and the research on non-cancerpatients was filling the blank at home and abroad.