Truth-telling at the end of life: A pilot study on the perspective of patients and professional caregivers

Objective: To describe the attitudes towards truth-telling of both terminal patients and professional caregivers, and to determine their perceived barriers to full information exchange. Methods: In-depth inter-views with 17 terminal patients selected through GPs and staff members of Flemish palliative care centres, and 3 focus groups with different professional caregivers. Analysis was based on grounded theory. Results: There was considerable variability in the preferences of patients regarding when and how they wanted to be informed of their diagnosis, prognosis, expected disease course and end-of-life decisions. Major ambivalence was observed regarding the degree to which patients wanted to hear 'the whole truth'. Patients and caregivers agreed that truth-telling should be a 'dosed and gradual' process. Several barriers to more complete and timely truth-telling were identified. Conclusion: The preferences of both patients and caregivers for step-by-step -and hence slow and limited-information prevents terminal patients from reaching the level of information needed for informed end-of-life decision-making. Practice implications: The preference of patients and caregivers to 'dose' the truth may entail some risks, such as a 'Catch 22' situation in which both patients and caregivers wait for a signal from each other before starting a dialogue about impending death. (C) 2007 Elsevier Ireland Ltd. All rights reserved.