Background Patients with cancer need adequate information about diagnosis, treatment options, and possible outcomes and prognosis to make therapeutic decisions. In cultures where the family plays the dominant role in healthcare decisions, doctors are often requested to collude in withholding distressing information from the patient. This challenging situation has not been well studied and there is limited knowledge on the different factors that may contribute to collusion.
Objective To study the prevalence of collusion among adult cancer patients attending a palliative care outpatient clinic and the contributing factors.
Methods The healthcare records of 306 adult cancer patients who had visited the palliative care outpatient clinic at least three times with follow-up until death were retrospectively reviewed. Details on information shared and why it was not shared were retrieved from the documentation in the communication sheet in the patient chart. The prevalence, sociodemographic and clinical factors that could contribute to collusion in doctor–patient communication were studied.
Results Collusion was present in 40% of cases at the time of referral to the palliative care outpatient clinic (collusion regarding diagnosis in 18%; collusion regarding prognosis in 40%). Collusion was later addressed in 35%. Collusion was significantly higher among female patients (p=0.005), manual workers (p=0.035), those not accompanied by a spouse (p=0.000) and with no oncological treatment (p=0.001).
Conclusions Collusion regarding diagnosis or prognosis is common among cancer patients referred for palliative care. It was more prevalent among female patients, manual workers, patients who had not received oncological treatment, and patients not accompanied by a spouse.
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Contributors JJ designed and conceived the study, helped with data collection and interpretation of results, and wrote the manuscript. AJ helped with data collection and analysis and reviewed the final manuscript. RK and RG helped with interpretation and statistical analysis and reviewed the final manuscript.
Competing interests None declared.
Ethics approval Institutional Review Board, Christian Medical College, Vellore, India.
Provenance and peer review Not commissioned; externally peer reviewed.
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