Truth Telling and Palliative Care

  • Lidia SchapiraEmail author
  • David Steensma


Palliative medicine clinicians provide expert and compassionate care for patients living with a life-limiting illness and their caregivers. Caring and skilled clinicians recognize the importance of crafting therapeutic relationships that are based on trust and mutual respect. These relationships are a source of strength and solace for patients seeking to preserve control, integrity, and dignity in the final phases of life. Disclosing bad news and telling the truth in a compassionate yet honest manner is a continuing challenge for physicians. Transparency has become the norm in American medicine, based on the ethical principle that clinicians have a duty to inform in order to preserve patient autonomy. Moreover, the medical community favors engaging patients in sharing decisions about their care, and patients must understand their diagnosis and prognosis to make such decisions. In this chapter, we address truth telling as a complex process that involves dosing information and engaging patients and families in managing and coping with a serious and life-altering illness.


  1. Baile, W. F., Kudelka, A. P., & Beale, E. A. (1999). Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer, 86(5), 887–897.CrossRefGoogle Scholar
  2. Baile, W. F., Buckman, R., Lenzi, R., et al. (2000). SPIKES – A six step protocol for delivering bad news: Application to the patient with cancer. The Oncologist, 5(4), 302–311.CrossRefGoogle Scholar
  3. Barsky, A. J. (2017). The iatrogenic potential of the physician’s words. JAMA, 318, 2425.CrossRefGoogle Scholar
  4. Blackhall, L. J., Murphy, S. T., & Frank, G. (1995). Ethnicity and attitudes toward patient autonomy. The Journal of the American Medical Association, 274, 820–825.CrossRefGoogle Scholar
  5. Bruera, E., Neumann, C. M., Mazzocato, C., et al. (2000). Attitudes and beliefs of palliative care physicians regarding communication with terminally ill patients. Palliative Medicine, 14(4), 287–298.CrossRefGoogle Scholar
  6. Butow, P. N., Tattersall, M. H., & Goldstein, D. (1997). Communication with cancer patients in culturally diverse societies. Annals of the New York Academy of Sciences, 809, 317–329.CrossRefGoogle Scholar
  7. Epstein, R., & Street, R. (2007). Patient-centered communication in cancer care. Promoting healing and reducing suffering. Bethesda: National Cancer Institute Monograph.CrossRefGoogle Scholar
  8. Fallowfield, L. (1997). Truth sometimes hurts but deceit hurts more. Annals of the New York Academy of Sciences, 809, 525–536.CrossRefGoogle Scholar
  9. Girgis, A., & Sanson-Firsher, R. W. (1995). Breaking bad news: Consensus guidelines for medical practitioners. J Clin Oncol, 13(9), 2449–2456.Google Scholar
  10. Greene, J. D. (2003). From neural “is” to moral “ought”: What are the moral implications of neuroscientific moral psychology? Nature Reviews. Neuroscience, 4, 847–850.CrossRefGoogle Scholar
  11. Greene, J., & Haidt, J. (2002). How (and where) does moral judgment work? Trends in Cognitive Sciences, 6(12), 517–523.CrossRefGoogle Scholar
  12. Greene, J. D., Morelli, S. A., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2008). Cognitive load selectively interferes with utilitarian moral judgment. Cognition, 107, 1144–1154.CrossRefGoogle Scholar
  13. Greene, J. D., Cushman, F. A., Stewart, L. E., Lowenberg, K., Nystrom, L. E., & Cohen, J. D. (2009). Pushing moral buttons: The interaction between personal force and intention in moral judgment. Cognition, 111(3), 364–371.CrossRefGoogle Scholar
  14. Greer, J., Jacobs, J. M., El-Jawahri, A., et al. (2017). Role of patient coping. strategies in understanding the effects of early palliative care on quality of life and mood. Journal of Clinical Oncology. Scholar
  15. Jackson, V. A., Jacobsen, J., Greer, J. A., et al. (2013). The cultivation of prognostic awareness through the provision of early palliative care in the ambulatory setting: A communication guide. Journal of Palliative Medicine, 16(8), 894–900.CrossRefGoogle Scholar
  16. Jotkowitz, A., Glick, S., & Gezundheit, B. (2006). Truth-telling in a culturally diverse world. Cancer Investigation, 24(8), 786–789.CrossRefGoogle Scholar
  17. Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: “You got to go where he lives”. The Journal of the American Medical Association, 286(23), 2993–3001.CrossRefGoogle Scholar
  18. Katz, J. (1986). The silent world of doctor and patient. New York: The Free Press.Google Scholar
  19. Langer, S. L., Brown, J. D., & Syrjala, K. L. (2009). Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer, 115(18 Suppl), 4311–4325.CrossRefGoogle Scholar
  20. Li, S., & Chou, J. L. (1997). Communication with the cancer patient in China. Annals of the New York Academy of Sciences, 809, 243–248.CrossRefGoogle Scholar
  21. Mack, J. W., Wolfe, J., Cok, E. F., et al. (2007). Hope and prognostic disclosure. Journal of Clinical Oncology, 25(35), 5636–5642.CrossRefGoogle Scholar
  22. Maynard, D. (2003). Bad news, good news: Conversational order in everyday talk and clinical settings. Chicago: University of Chicago Press.Google Scholar
  23. McCabe, M. S., Wood, W. A., & Goldberg, R. M. (2010). When the family requests withholding the diagnosis: Who owns the truth? Journal of Oncology Practice, 6(2), 94–96.CrossRefGoogle Scholar
  24. McNeil, C. M. (2017). Banter. Journal of Clinical Oncology, 35(28), 3262–3263.CrossRefGoogle Scholar
  25. Mitchison, D., Butow, P., Sze, M., Aldridge, L., Hui, R., Vardy, J., Eisenbruch, M., Iedema, R., & Goldstein, D. (2011). Prognostic communication preferences of migrant workers and their relatives. Psychooncology, 21(5), 496–504.CrossRefGoogle Scholar
  26. Oken, D. (1962). What to tell cancer patients. A study of medical attitudes. JAMA, 175, 1120–1108.CrossRefGoogle Scholar
  27. Parker, P. A., Baile, W. F., de Moor, C., et al. (2001). Breaking bad news about cancer: Patients’ preferences for communication. Journal of Clinical Oncology, 19(7), 2049–2056.CrossRefGoogle Scholar
  28. Renz, M., Koeberle, D., Cerny, T., et al. (2009). Between utter despair and essential hope. Journal of Clinical Oncology, 27(1), 146–149.CrossRefGoogle Scholar
  29. Rosenberg, A., Wolfe, J., Wiener, L., et al. (2016). Ehtics, emotions, and the skills of talking about progressing disease with terminally ill adolescents. A review. JAMA Pediatrics, 170(12), 1216.CrossRefGoogle Scholar
  30. Schapira, L. (2003). Communication skills training in clinical oncology : The ASCO position reviewed and an optimistic personal perspective. Critical Reviews in Oncology/Hematology, 46(1), 25–31.CrossRefGoogle Scholar
  31. Simpson, M. A. (1982). Therapeutic uses of truth. In E. Wilkes (Ed.), The dying patient. Lancaster: MYP Press.Google Scholar
  32. Sisk, B., Frankel, R., Kodish, E., & Isaacson, J. H. (2016). The truth about truth-telling in American medicine: A brief history. The Permanente Journal, 20(3), 15–219.PubMedPubMedCentralGoogle Scholar
  33. Smith, T. J., Dow, L. A., Virago, E., et al. (2010). Giving honest information to patients with advanced cancer maintains hope. Oncology (Williston Park), 24(6), 521–525.Google Scholar
  34. Spiegel, D. (1999). A 43-year-old woman coping with cancer. The Journal of the American Medical Association, 282(4), 371–378.CrossRefGoogle Scholar
  35. Temel, J. S., Greer, J. A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.CrossRefGoogle Scholar
  36. Temel, J. S., Shaw, A., & Greer, J. A. (2016). Challenge of prognostic uncertainty in the modern era of cancer therapeutics. Journal of Clinical Oncology, 34(30), 3605–3608.Google Scholar
  37. The, A. M., Hak, T., Koeter, G., et al. (2000). Collusion in doctor-patient communication about imminent death: An ethnographic study. BMJ, 321(7273), 1376–1381.CrossRefGoogle Scholar
  38. Uchitomi, Y., & Ymawaki, S. (1997). Truth telling practice in cancer care in Japan. Annals of the New York Academy of Sciences, 809, 290–299.CrossRefGoogle Scholar
  39. Zimmerman, C., Swami, N., Krzyanoswka, M., et al. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 383(9930), 1721–1730.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cancer Survivorship ProgramStanford UniversityPalo AltoUSA
  2. 2.Stanford School of MedicinePalo AltoUSA
  3. 3.Advanced Medicine CenterPalo AltoUSA
  4. 4.Division of Hematological Malignancies, Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA

Personalised recommendations