Types of disclosure discussions between oncology nurses and patients/families: An exploratory study

There is no agreement about what should be disclosed to patients/families, except that fraud and deception are wrong. Thus, disclosure practices must be decided by individual practitioners and constitute a bioethical dilemma. There was no identifiable evidence about the disclosure patterns that nurses use. Consequently, the contribution of nurses to the decision-making of patients and families was unknown. An exploratory study using mixed methods in a concurrent, nested strategy was conducted. Both qualitative and quantitative data were obtained at the same time from a national sample of oncology nurses. The response rate was 35% with usable data from 56 subjects. Most subjects were female with all levels of nursing education.; Respondents completed three instruments: Encounter Summary, designed by the investigator to allow subjects to describe a healthcare choice and discussion that they often have with patients/families; tool, Nurses Feelings Regarding Involvement with a Bioethical Dilemma (Husted, in process, 2003); and a demographic information form.; The first research question asked what pattern of disclosure did nurses reveal in their narratives. From the literature, three possible patterns were identified and all were revealed. The disclosure patterns were reasonable patient (44.64%), interpretive (32.14%), and transparent (19.64%). The second question addressed how nurses feel in the discussions. The mean score was 25.4 (on a 0–100 scale, with the lower numbers indicative of more positive feelings). There were no individuals whose mean score was above 60. The third and fourth research questions asked if there were associations between disclosure patterns, feelings, education level, experience, effort in practice, and percent of patients who had cancer. No associations were found. Major limitations included self-report by nurses, small sample size, and potentially socially desired responses.; The importance of this study was in documenting the use of the full range of disclosure patterns by nurses. The documentation of transparent disclosure (values and opinion of the provider are divulged) is important, because it provides evidence of an undocumented area of practice. Further work is needed to take the patterns and apply them to larger samples and consider how the measurement of feelings should be used to better understand decision-making in the ethical dilemma.