truth telling: the case of lebanon

Truth Telling: The Case

of Lebanon

Arafat Tfayli, MD Associate Professor of Clinical Medicine

American University of Beirut Medical Center

Email: [email protected]

PATIENT

HEALTH

CARE

PROVIDERS

PATIENT

HEALTH

CARE

PROVIDERS

FAMILY

Truth Telling

• Health care provider perspective

• Patient perspective

• Family perspective

Health Care Providers

• A cross sectional survey regarding truth

telling attitudes among Lebanese

physicians.

• Target population: physicians practicing in

the Greater Beirut Area.

Hamadeh G., Adib S. Soc. Sci. Med. 47(9), pp. 1289-94. 1998


• Paraclinical specialties excluded

(anesthesiology, radiology, pathology, and

laboratory medicine)

• Specialties not expected to have contact

with adult cancer patients were also

excluded (pediatrics, psychiatry and

dermatology).


• 2,000 eligible physicians.

• 268 physicians contacted.

• 212 (79%) filled the questionnaire.

• All 26 Oncologists in the area were included.




• Cross sectional study to assess the

knowledge, attitudes and practices of

physicians and nurses on palliative care.

• 3,757 health care workers (1,873 nurses and

1,884 physicians)

• 868 questionnaires were properly filled

(23% response rate). (34% of nurses and

12% of physicians)

Huijer H, Dimassi H and Abboud S. Palliative and Supportive Care 7,339-347. 2009


• 20-25% of physicians reported that they tell

their terminally ill patients about their

diagnosis.

• Only 8.3% of oncologists do.

Huijer H, Dimassi H and Abboud S. Palliative and Supportive Care 7,339-347. 2009


• Study aimed at assessing the changes in

attitudes regarding cancer disclosure among

medical students at AUBMC.

• Seventy medical students interviewed twice,

at beginning of medical training and 4 years

later.

Hamadeh G, Adib S. Journal of Medical Ethics 27,354-355, 2001


Hamadeh G, Adib S. Journal of Medical Ethics 27,354-355, 2001

Baseline (%) 4 years later (%)

Prefer to disclose cancer

diagnosis to the patient

84 86

Patient’s medical awareness is a

factor in deciding whether to tell

patient or not

74 57

I consider deception as beneficial 60 31

I know what is in my “patient’s

best interest”

78 57

Physicians often resort to

deception

16 54

Patients Perspective

• Study aimed at assessing the public’s

opinion and expectations on disclosure of

medical information.

• Three groups were interviewed:

– 100 patients with cancer

– 100 patients with non cancerous medical illness

– 300 healthy subjects.

Adib S, Hamadeh G. Journal of Medical Ethics. 25:399-403. 1999


• Mean age: 37 years

• 60% had at least a high school degree.

• 63% indicated strong level of religious

practice

• 42% had a lower preference for disclosure

of serious or terminal diagnosis.



• Cancer patients were significantly more

likely to prefer disclosure compared to

healthy participants and non- cancer

outpatients (62 vs. 50%).

• Younger and more educated participants

were more likely to prefer disclosure.



• A structured interview with 10 cancer

patients getting palliative care.

• The interview aimed at assessing their

experience receiving palliative care.

• One theme was aimed at assessing the need

to communicate.

Doumit M, Huijer H, Kelley J. European Journal of Oncology Nursing. 11,309-319, 2007


• 2 quotes:

– The only time I felt relieved is when my sister

told me that I have cancer. Deep in my heart, I

knew it since the beginning….

– I felt very bothered at the beginning because

my family lied to me about my disease. I prefer

the truth, I am not a small child…..For me, I

prefer the truth from the beginning of the road.

It is much better.

Doumit M, Huijer H, Kelley J. European Journal of Oncology Nursing. 11,309-319, 2007


• A structured interview with 10 cancer

patients whose main aim is to assess the

communication and truth-telling preferences

of Lebanese cancer patients.

Doumit M, Huijer H. Contemporary Nurse 28,74-82, 2008


• On communication with family members:

– “there is a lot of openness between my wife, my

son and me. We talk about my condition….. It

helps a lot. It strengthens the morale and it

makes me forget my disease…..”



• On communication with health care

workers:

– “The physician should understand his patient. If

the patient is ready to understand the truth, then

he should talk to him. I prefer the

truth……Nurses and physicians have to come

and talk with the patient, your psychology will

be relaxed”



• The importance of choosing the right

words:

– The example of the king and his advisors.


Conclusion

• Lebanese cancer patients generally like to

be told about their illness

• The family plays a pivotal (sometimes

obstructing) role.

• More up to date data needs to be generated

as cultural norms and beliefs evolve over

time.

Thank you

[email protected]

truth telling: the case of lebanon

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