|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 359-360
Truth-telling: Apply the principle of beneficence
Vinay Mathew Thomas1, Aju Mathew2
1 Department of Internal Medicine, University of Connecticut, Connecticut, USA
2 University of Kentucky Markey Cancer Center, Kentucky, USA; Department of Hematology/Oncology, MOSC Medical College, Kochi, Kerala, India
|Date of Submission||06-Mar-2020|
|Date of Acceptance||06-Mar-2020|
|Date of Web Publication||19-Jun-2020|
MOSC Medical College, Medical College Road, PO Kolenchery, Kochi - 682 311, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thomas VM, Mathew A. Truth-telling: Apply the principle of beneficence. Cancer Res Stat Treat 2020;3:359-60
It was with great interest that we read the viewpoint by Chandrasekharan, which brings up a very pertinent topic for the practice of cancer care.
The article brings up a dilemma often faced by physicians caring for patients with health conditions with poor prognosis, such as metastatic cancer, heart failure, and end-stage renal disease. Although doctors advocate for patient autonomy, we face similar dilemmas in a high-income country setting as well. In places where families are closely involved with caring for the sick, we think the principle of beneficence should take precedence. Beneficence relates to doing what is best for the patient. Often, a physician's best judgment will guide them to decide the extent of disclosure of prognosis to the patient. Most family members would also feel that a principle of beneficence should guide the “disclosure discussion” and would advocate for hiding the prognosis from the patient. They assume that disclosure of negative prognosis will negatively impact their loved one.
However, research has shown that awareness of a terminal prognosis is not associated with increased stress. In fact, it is associated with lower stress levels, better emotional and psychological well-being, and even better control of the patient's physical symptoms., Patients who are aware of their terminal prognosis are better equipped to express an “advance care plan,” which may benefit them and the family. This point is conspicuous in the outcomes of the two families in Chandrasekharan's essay. The patient who had an awareness of the terminal prognosis was more emotionally prepared. Awareness of terminal prognosis is not only beneficial for the patient but also for the caregivers. Families of patients who were aware of their prognosis had lower levels of stress, as is again evident in the stark contrast in the two situations mentioned in the essay.,
We appreciate the author's approach to the issue of “truth-telling.” We suggest that one more step could be added – we can ask a patient as to how many details they would like to know about their illness, and who else in the family could be the point person for further discussions. We propose that such a step would give the patient confidence to ask questions and obtain answers that can guide their decision-making. Such a question would place the control in the hands of the patients, where it rightfully belongs. Research all across the world, including from India, has shown that majority of patients wish to know their prognosis. Disclosing the prognosis is likely to strengthen the patient–physician relationship, if it is tactfully done with a commitment to the principle of beneficence.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Chandrasekharan A. A tale of two patients. Cancer Res Stat Treat 2020;3:1-2. [Full text]
Chittem M, Norman P, Harris PR. Relationships between perceived diagnostic disclosure, patient characteristics, psychological distress and illness perceptions in Indian cancer patients. Psychooncology 2013;22:1375-80.
Nie X, Ye D, Wang Q, Manyande A, Yang L, Qiu H, et al
. Poor-prognosis disclosure preference in cancer patient-caregiver dyads and its association with their quality of life and perceived stress: A cross-sectional survey in Mainland China. Psychooncology 2016;25:1099-105.