Communication and Awareness about Death: A Study of a Random Sample of Dying People
Опубликовано на портале: 22-03-2007
Social science and Medicine.
1991.
Vol. 32.
No. 8.
P. 943-952.
Тематический раздел:
The literature suggests that doctors' and nurses' openness about communicating with
the terminally ill and their families has increased in the past two or three decades,
partly influenced by the hospice movement. The present study reports the perceptions
of relatives, hospital doctors, general practitioners and nurses who knew a random
sample of 639 adults dying in England in 1987. The results from professionals suggest
a general preference for openness about illness and death, tempered by the consideration
that bad news needs to be broken slowly, in a context of support, while recognising
that not everyone wishes to know all. In practice people dying from cancer were more
likely to be reported as knowing what their illness was and that they would die than
were people dying from other conditions. This difference held when controlling for
the fact that death was more likely to be medically expected in cancer. Comparisons
with 1969 show that the increases were due largely to cancer patients being told
the truth more frequently by hospital doctors. This may be due to changed practices,
or to the increase in the number of hospital episodes in the last year of life. Nevertheless,
situations of 'closed awareness' where relatives were told and patients were not,
and situations where patients were left to guess the likely outcome for themselves,
were still quite common in 1987. Nurses and hospice practitioners were only marginally
involved in breaking bad news, this remaining the province of hospital doctors and
general practitioners. Relatives in general praised the manner in which they and
patients were told, although a small proportion reported insensitive practice. In
retrospect a high proportion of both relatives and professionals felt that the levels
of awareness were best as they were, although this preference may have been influenced
by a desire to see things in a good light. Most relatives reported adequate support
and information being given by professionals to them during the patient's illness.
On the whole, doctors provided information, and friends and family provided emotional
support to relatives. Again, hospital doctors played an increasingly important role
compared to 1969 in providing information, with general practitioners' role decreasing
in this area. Gaps in information included not being told enough about what was wrong
with the patient, not being told the reasons for decisions about treatment and, to
a lesser extent, not being given information about how to care for the patient.
Ключевые слова
attitude cancer death medical interaction terminal illness врач-пациент отношение к смерти рак смертельная болезнь смерть
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