School of Health, Federation University Australia, Churchill, Victoria, Australia.
Palliat Support Care. 2022 Jun;20(3):433-444. doi: 10.1017/S1478951521001243.
Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting.
A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms ("truth disclosure") AND ("palliative care or end-of-life care or terminal care or dying") were used. The search was repeated using ("bad news") AND ("palliative care or end-of-life care or terminal care or dying") terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers.
Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: "Enablers in breaking bad news" and "Truth avoidance/disclosure." Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis.
The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.
对于医疗专业人员来说，在打破坏消息时诚实地说出真相仍然很困难，但这对于患者在做出有关治疗和临终关怀的知情决策时至关重要。本文献综述旨在探讨和研究在住院/门诊姑息治疗环境中，当传递坏消息时，医疗专业人员、患者和家属如何体验到真相的揭示。
2020 年 9 月，使用 CINAHL、Medline 和 PsycInfo 数据库，系统地搜索了 2013 年至 2020 年期间发表的同行评议的论文。使用了关键词和 MeSH 术语（“truth disclosure”）和（“palliative care or end-of-life care or terminal care or dying”）。使用（“bad news”）和（“palliative care or end-of-life care or terminal care or dying”）再次进行了搜索。对八篇论文进行了元综合，以综合发现。
元综合纳入了八篇论文，代表了五个西方国家。经过综合处理，确定了两个概念：“打破坏消息的促成因素”和“避免/揭示真相”。几个要素构成了打破坏消息的促成因素的概念，例如治疗关系、阅读线索、承认、语言/传递、时间/地点和品质。开发了一个概念模型来说明综合结果。
该概念模型展示了一种独特的方式，可以观察围绕打破坏消息时的真相揭示和避免的沟通动态。知情决策需要了解全部真相，因此，真相揭示是打破坏消息的重要组成部分。
