Non-disclosure Of Truth To Chinese Cancer Patients in Palliative Care: Is This A Cultural Myth?

Background and Purpose:

Despite various studies have shown that Chinese cancer patients would like to know their diagnosis and prognosis, non-disclosure principle is still upheld by many Chinese families. Non-maleficence is often considered to be a main reason for not telling the truth to patients. In order to explore such cultural proposition empirically, the following research question, “Do cancer patients who are fully aware of the diagnosis and prognosis show poorer psychosocial outcomes?”

Methods:

Clinical Data Mining (CDM) was adopted as the research approach. Clinical data of Hong Kong Chinese cancer patients of a palliative care unit who died in year 2002-2005 were retrieved. Patients who scored 0 in the item of “patient insight” of the Support Team Assessment Schedule (STAS) on admission to palliative care were categorized as the group of “full awareness of diagnosis and prognosis”. Independent samples t-test and non-parametric Mann-Whitney U test were conducted to compare the differences in various factors, such as physical condition, pain level, patient's anxiety level, family's anxiety level, communication quality between patient and family, and financial difficulty between this group of patients and the remaining patients.

Results: A total of 935 patients were included in this study. Percentage of patients being fully aware of the diagnosis and prognosis was 56.8% on admission to palliative care. Patients in the group of “full awareness of diagnosis and prognosis” were found to be significantly younger in age (t= 9.11, df= 779, p<0.001), poorer in physical condition (t= -3.48, df= 786, p= 0.001), experienced significantly higher level of pain (U= 72873.5, p= 0.006), lower level of anxiety (U= 72671, p= 0.022), and better quality of communication between patient and family (U= 55943, p<0.001). No significant differences were found in family's anxiety and financial difficulty.

Conclusions and Implications: Findings in this study do not support the principle of non-maleficence in non-disclosure of truth to Chinese cancer patients. Instead, patients who are fully aware of the diagnosis and prognosis may experience lower level of anxiety and better communication with family members. Non-disclosure of truth to patients may not be beneficial for family members. In fact, cancer patients may be inevitably more aware of the diagnosis and prognosis, when they are in poorer physical condition and experience higher level of pain. However, older patients may experience more difficulties in being aware of this truth.

This study may provide preliminary support in disclosing the truth to Chinese cancer patients. Social workers in palliative care may play a pivotal role in facilitating patients and family members to re-examine the benefits of knowing the diagnosis and prognosis. Further research is suggested to investigate empirically how knowing the truth of illness can bring benefits to cancer patients in end of life care.