Conspiracy of Silence in Oncological Palliative Care: Perspectives and Strategies of the Healthcare Team

Abstract

Introduction: Silence about dismal news is common in palliative care, involving patients, family and the healthcare team. This phenomenon of hiding the truth – conspiracy of silence – has negative consequences and deserves attention from professionals. Objective: This study investigates and explores the strategies used by healthcare professionals to prevent and intervene in the conspiracy of silence in the context of oncological palliative care. Method: Cross-sectional qualitative study using the Interpretative Phenomenological Analysis approach. The participants were nurses, doctors and a psychologist who work in the palliative care unit of a cancer center. A semi-structured interview was applied to a sample of 12 healthcare professionals. Results: The age of the participants varied between 31 and 64 years old, mostly females, ten nurses, one physician and one psychologist. From the analysis of the interviews, the following themes emerged: perceptionof the phenomenon of the conspiracy of silence; difficulties and challenges in dealing with the conspiracy of silence in palliative care; professionals’ feelings about the conspiracy of silence; strategies to intervene and prevent the conspiracy of silence. Important strategies were reported such as honest communication without impositions, listening to the motivations that led to the silence. Conclusion: Professionals are aware of the ethical duty to tell the truth when faced with a conspiracy of silence. However, continuous training is needed to develop skills for communicating dismal news in clinical settings and in medical education.