Objectives: To determine the level of knowledge of patients and their families regarding the diagnosis and prognosis of terminal illness, as well as patient, family, and clinician attitudes on the information process. Finally an attempt is made to quantify the "conspiracy of silence" (SC) in a palliative care unit. Materials and methods: A descriptive and longitudinal observational study was conducted on a population of admitted patients, their families, and clinician of a palliative care unit. Quantified variables: number of admission days, patient-family relationship, knowledge level (unknown, suspeced or known), observed attitudes of the three populations, and increase or not in knowledge level (increase in knowledge of the diagnosis or prognosis during admission). Descriptive statistics and Student t test for independent samples were used to analyse the data. Results: A total of 59 (55.6%) patients could be evaluated on SC; 20 (34%) women and 39 (66%) men, 49 (84.5%) of whom were oncology patients and 9 (15.5%) not. The mean age was 76 years (+/- 9) and the mean hospital stay was 27.6 days (+/- 30). There were 58 caregivers, of whom 25 (43%) were spouse or partner, 20 (34%) son or daughter, 11(19%) brother or sister, and 2 (3,4%) cousin/uncle/daughter-in-law. Four clinicians were involved. At admission, 14% were unaware of the diagnosis and 71% were unaware of the prognosis. At discharge, 8% were unaware of the diagnosis, and 57% unaware of the prognosis. As regards attitudes, 50% of patients (admission and discharge) did not speak, refuse, avoided, around 40% did not show a negative attitude to the information given. The family (at admission and discharge) 55% wanted to protect the patient, 35% did not show a negative attitude. None of the professionals had any difficulties. A total of 11(18.6%) patients increased their knowledge level, and there was SC in 64.4% of the sample (38 patients). Conclusions: There is greater knowledge of the diagnosis than prognosis, and there is progress in the knowledge process during admission. Even though there are non-progressing patients that showed no negative attitude (neither they nor their families) to the knowledge of their illness, we believe a deeper study of the situation is required, and reflection by the professionals on the conditions that favour the conspiracy of silence. (C) 2011 Sociedad Espanola de Cuidados Paliativos. Published by Elsevier Espana, S.L. All rights reserved.
