*Corresponding author:Mahdi Tarabeih, Senior lecturer, Faculty of Nursing Sciences, Tel Aviv-Jaffa Academic College, Jaffa, Israel, Sakhnin, post office: 6044, postal code: 3081000
Received: February 20, 2018; Published: February 27, 2018
To view the Full Article Peer-reviewed Article PDF
Background: Truth-telling by doctors to patients is a basic moral rule in developed healthcare systems. Not to tell the truth jeopardizes staff-patient trust, undermines the patient’s capacity for autonomy, and deprives the terminally-ill of a ‘good death’. Yet non-truth-telling is still common. This study explores and measures the extent of non-truth-telling to cancer patients in Israel’s modern health care system, why it happens and what consequences it leads to.
Research Design and Methods: This Mixed Methods study of doctors working regularly in the field of palliative care, in both hospital, community and home care settings centred on two main tools, the first a qualitative structured in-depth interview of 15 doctors (from oncology, hospice home care and family medicine); the second a much longer quantitative self-administered questionnaire for 90 practitioners (30 hospital oncologists, 30 home care specialists, and 30 family medicine specialists). The sample was made fully representative of the research population. The sampling method combined cluster, directed and convenience sampling. Data were analysed by content analysis and descriptive statistics (chiefly means and correlations).
Findings: Most oncologists had poor knowledge and a negative opinion of the 2005 act of parliament drawn up to regulate the care and treatment of terminally-ill patients. They knew and thought equally little of the palliative care approach which the Act mandated. Most doctors did not tell patients the full truth about their medical condition and avoided holding an end-of-life conversation with them or discussing Advance Medical Directives, largely out of fear and lack of the emotional resources and communications training required. Most thought truth telling took away hope and that hospice care approximated euthanasia. Many/most were reluctant to face the ‘failure’ implied in even discussing the transfer of a patient to palliative care. All doctors thought it was another doctor’s responsibility to break bad news to patients. There was a huge variance in approach to end-of-life care between hospital oncologists and home care specialists. The consequences of the above were that few patients were given the chance to plan the end-of-life they wanted for themselves and that palliative and hospice care were very much under-used.
Main Conclusion: Israeli oncologists are too fearful of patient-centred end-of-life care to be left in sole charge of it. Shared decisionmaking by all members of a multidisciplinary team would help take the responsibility off oncologists, as well as ensure a higher quality of decision-making. Medical training needs to prepare health care staff for interdisciplinary teamwork. Not sharing data/ decisions with the patient threatens both their autonomy and the quality of the decisions made without their input. The Israel Ministry of Health needs to take initiatives to firmly clarify the provisions of the 2005 Act, to provide and enforce training in its
Keywords: Advance Medical Directives; Doctor-patient communication; End-of-life care; End-of-life conversation; A good death; Hospice care; Oncologist; Palliative care; Terminally-Ill Patients Act; Truth telling