RESUMEN
BACKGROUND: The observed cultural changes in truth-telling attitudes suggest a radical change in the practice of delivering information to cancer patients, but limited research is available from countries known for their policy of non-disclosure. This study estimates the proportion of Italian who died of cancer who had received information about diagnosis and prognosis, and explores the variables associated with disclosure. MATERIALS AND METHODS: This is a mortality follow-back survey of 1271 non-professional caregivers of Italians who died of cancer in 2002, representative of the approximate 160 000 Italian annual cancer deaths. Caregivers were interviewed after the patient's death about the process of diagnosis and prognosis disclosure. RESULTS: It was estimated that 37% of people who died of cancer had received information about diagnosis and 13% about poor prognosis. A consistent proportion, although non-informed, knew the diagnosis (29%) and the poor prognosis (50%). The probability to be informed was higher for patients living in the north of Italy, young, well educated, with longer survival, and with breast or head and neck tumor. CONCLUSIONS: These findings suggest that not necessarily the observed cultural changes towards a less paternalistic approach in medical care translate into an effective change in the quantity of information delivered to the patients.
Asunto(s)
Actitud Frente a la Salud , Encuestas Epidemiológicas , Neoplasias/diagnóstico , Revelación de la Verdad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Conducta de Elección , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Neoplasias/psicología , Vigilancia de la Población , Pronóstico , Revelación de la Verdad/éticaRESUMEN
In 1998, the Italian Ministry of Health urged the Italian Society of Nephrology (SIN) to draft recommendations for uniform decision-making procedures in the field of dialysis. In accordance with the Ministry's specifications, at the time the Society approved diagnostic protocols regarding clinical questions, but without fully recognizing the multiple issues arising in complex medical situations where dialysis is likely to go on for a long time. The authors propose some guidelines for ethical conduct and their application, with special regard to medico-legal dilemmas, together with the principles of clinical guidelines that would further improve the "perceived quality" of chronic dialytic treatment.
