Wattanapisit Sanhapan, Wattanapisit Apichai, Laksanapiya Pornnapat, Tipwong Arunee
MD, MSc, MRCFPT, Palliative Care Unit, Thasala Hospital, Nakhon Si Thammarat, Thailand. Email:
MD, FRCFPT, Academic Fellowship, (Family Medicine), Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.
Malays Fam Physician. 2024 Sep 10;19:54. doi: 10.51866/oa.574. eCollection 2024.
Communication is a key element of palliative care. The concealment of advanced-stage diseases is a communication challenge. This study aimed to explore the patterns and difficulties in communication regarding the concealment of advanced-stage cancer between caregivers and patients. Methods: This qualitative study employed an interpretive phenomenological approach and was conducted at a district hospital in Thailand. Semi-structured in-depth interviews were performed to collect data from caregivers (i.e. family members) of patients regarding the concealment of advanced-stage cancer. The data analysis followed an inductive thematic approach.
Ten in-depth interviews were conducted among the caregivers of patients aged 57-97 years. Four themes emerged: (i) reasons for concealing the diagnosis and prognosis (personality of patients and concerns about negative effects), (ii) communication patterns between caregivers and patients (communicating symptoms/signs instead of the diagnosis/prognosis and distorting information), (iii) difficulties and challenges in maintaining concealment (feelings of guilt, hesitation in sharing the information and suspicion of patients' awareness of their diagnosis/prognosis) and (iv) communication support from healthcare professionals (avoiding informing patients about their diagnosis/prognosis, supporting decision-making and disclosing the information).
The concealment of advanced-stage cancer is perceived as an appropriate communication approach among some caregivers. Communicating information about advanced-stage cancer is dynamic. Some caregivers and families consider disclosing the information in the future. Healthcare professionals can support communication throughout care. Future studies should focus on decision-making and communication processes for better handling of information concealment or the conspiracy of silence in palliative care.
沟通是姑息治疗的关键要素。隐瞒晚期疾病是一项沟通挑战。本研究旨在探讨照顾者与患者之间就隐瞒晚期癌症进行沟通的模式及困难。方法：本定性研究采用诠释现象学方法，在泰国一家地区医院开展。进行半结构化深度访谈，以收集患者照顾者（即家庭成员）关于隐瞒晚期癌症的相关数据。数据分析采用归纳主题法。
对年龄在57 - 97岁患者的照顾者进行了10次深度访谈。出现了四个主题：（i）隐瞒诊断和预后的原因（患者个性及对负面影响的担忧），（ii）照顾者与患者之间的沟通模式（交流症状/体征而非诊断/预后以及歪曲信息），（iii）维持隐瞒的困难与挑战（内疚感、分享信息时的犹豫以及怀疑患者知晓其诊断/预后），以及（iv）医护人员的沟通支持（避免告知患者其诊断/预后、支持决策制定以及披露信息）。
在一些照顾者看来，隐瞒晚期癌症是一种合适的沟通方式。关于晚期癌症的信息沟通是动态的。一些照顾者和家庭考虑在未来披露信息。医护人员可在整个护理过程中支持沟通。未来研究应聚焦于决策制定和沟通过程，以便更好地处理姑息治疗中信息隐瞒或沉默共谋的问题。
