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Nursing PICO formated question - Research Paper Example

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The disclosure of terminal prognoses constitute a relatively standard practice in the Western healthcare tradition and system, but this is not always the case in other cultures. Although public preferences worldwide generally favor open disclosure, debate concerning whether the most compassionate psychological approach is to reveal, or to conceal, the presence of terminal illness is ongoing in the global community…
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Nursing Research Paper PICO formated question
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Download file to see previous pages A terminal prognosis is generally not disclosed in Asian countries where passivity and acquiescence to authority are important traditions. Conversely, the same prognosis would usually be approached openly in the US and the UK and many European countries where autonomy and free will are widely valued. This paper aims to explore, analyze and find a way to better communicate terminal diagnosis and related prognosis to affected patients and their families.
Attitudes related to disclosure of terminal prognoses have shifted dramatically in the Western healthcare tradition, including the UK, over the past four decades (Chochinov et al, 2000). Research conducted in the 1950s and early 1960s revealed that only 10%-31% of physicians routinely disclosed a diagnosis of cancer to their patients (Fitch, 1994; Thomasma, 1994). This practice was due in large part to the widespread belief that such a diagnosis would create severe emotional disturbances that could potentially lead to suicidal acts (Thomasma, 1994). However by the late 1970s, nondisclosure practices had reversed (Fitch, 1994; Thomasma, 1994). This is evidenced by the 1979 survey results of Novack et al. which indicated that 98% of physician respondents disclosed the presence of terminal illness to their patients (qtd in Field and Copp, 1999).
Comprehensive aspects of end of life medical care have been brought to public attention through the development of both health psychology and behavioral medicine. Each field has made a unique contribution to the understanding that physical health is impacted by numerous biological, psychological, and sociological elements. The upsurge of interest in these biopsychosocial interactions led to an increase of studies in many areas, including that of coping with, and adjusting to, life-threatening illness (Fitch, 1994). Findings generally indicate that given appropriate psychological and social support, disclosure of terminal prognoses does not lead to permanent loss of hope or untimely medical decline (Fitch, 1994), the reasons most often cited for the maintenance of nondisclosure practices. Moreover, attitudes toward truth-telling in terminal illness have also been significantly affected by the biopsychosocial approach to end of life care found in hospice organizations. The hospice movement arose out of a need for palliative care for those whose needs were unmet by a medical system whose primary focus was prolonging life at all costs (Chiu et al, 2000). Hospice care has been a welcome alternative to traditional end-of-life practices (Chiu et al, 2000). In their analysis of shift from diagnosis non-disclosure to disclosure, Fields and Copp (1990) indicate the following reasons: (1) improvements in therapeutic success; (2) changing societal attitudes; and (3) in the USA, legislation enforcing the patient's right to "informed consent" (p.461).
From the critical perspective, no one wants to be the bearer of bad news and there is a great deal of tension surrounding the complex issues of whom to tell, what to tell, when to tell, and how to tell about the existence of a terminal prognosis (Fitch, 1994). Physicians frequently believe that it is their duty to have ready answers for every possible question, ...Download file to see next pagesRead More
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