Subscribe to RSS
DOI: 10.1055/s-0042-1750738
Breaking the Bad News in Cancer: An In-Depth Analysis of Varying Shades of Ethical Issues
Abstract
Oncology has a range of ethical issues that are difficult to address and breaking the bad news is probably the most important and common across the world. Conventionally, breaking the bad news has been exclusively used in the situation where definitive diagnosis of cancer is to be conveyed to the patient. On a practical note, for the treating doctor, breaking the bad news is not restricted only to the confirmation of cancer and its prognosis at the initial diagnosis but also includes conveying futility of curative treatment, changing from curative to palliative treatment, recurrence/metastasis posttreatment, end of life care, and finally informing death of the patient to the family members. In addition to this, informing pregnant women that she has been diagnosed with cancer, about surgery-induced body disfigurement, loss of fertility due to chemotherapy/ radiotherapy, and of treatment-induced irreversible health complications are also challenging for the treating oncologist. On the basis of an in-depth analysis, the current review presents the various situations, complexities, and the related ethical issues in breaking the bad news in various situations from the perspective of an oncologist in detail in Indian context.
Publication History
Article published online:
02 July 2022
© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract 2021; 30 (01) 17-28
- 2 Stone EG. Evidence-based medicine and bioethics: implications for health care organizations, clinicians, and patients. Perm J 2018; 22: 18-030
- 3 Singer PA, Pellegrino ED, Siegler M. Clinical ethics revisited. BMC Med Ethics 2001; 2 (01) E1
- 4 Carrese JA, Sugarman J. The inescapable relevance of bioethics for the practicing clinician. Chest 2006; 130 (06) 1864-1872
- 5 Institute of Medicine (US) Committee on Care at the End of Life. Field MJ, Cassel CK. , editors. Approaching Death: Improving Care at the End of Life. Washington (DC): National Academies Press (US); 1997. 5, Accountability and Quality in End-of-Life Care. Accessed June 5, 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK233602/
- 6 Institute of Medicine (US). Assessing and Improving Value in Cancer Care: Workshop Summary. Washington (DC): National Academies Press (US); 2009. 7, Ethical Issues and Value in Oncology
- 7 Christen M, Ineichen C, Tanner C. How “moral” are the principles of biomedical ethics?–a cross-domain evaluation of the common morality hypothesis. BMC Med Ethics 2014; 15: 47 DOI: 10.1186/1472-6939-15-47.
- 8 Baliga MS, Rao S, Palatty PL. et al. Ethical dilemmas faced by oncologists: a qualitative study from a cancer specialty hospital in Mangalore, India. Global Bioethics Enquiry 2018; 6 (02) 106-110
- 9 Rao S, Palatty PL, Rao P. et al. Ethical dilemmas expressed by non-oncology specialists involved in diagnosis and care of cancer patients: a preliminary study. Middle East J Cancer 2018; 6 (03) 239-245
- 10 da Luz KR, Vargas MA, Schmidtt PH, Barlem EL, Tomaschewski-Barlem JG, da Rosa LM. Ethical problems experienced by oncology nurses. Rev Lat Am Enfermagem 2015; 23 (06) 1187-1194
- 11 Ong WY, Yee CM, Lee A. Ethical dilemmas in the care of cancer patients near the end of life. Singapore Med J 2012; 53 (01) 11-16
- 12 Penson RT, Doyal L, Slevin ML. Ethical issues in cancer treatment. Br J Urol 1995; 76 (Suppl. 02) 37-40
- 13 McIlfatrick S, Sullivan K, McKenna H. Exploring the ethical issues of the research interview in the cancer context. Eur J Oncol Nurs 2006; 10 (01) 39-47
- 14 Ghoshal A, Salins N, Damani A. et al. To tell or not to tell: exploring the preferences and attitudes of patients and family caregivers on disclosure of a cancer-related diagnosis and prognosis. J Glob Oncol 2019; 5: 1-12
- 15 Laxmi S, Khan JA. Does the cancer patient want to know? Results from a study in an Indian tertiary cancer center. South Asian J Cancer 2013; 2 (02) 57-61
- 16 Ghoshal A, Damani A, Muckaden MA, Yennurajalingam S, Salins N, Deodhar J. Patient's decisional control preferences of a cohort of patients with advanced cancer receiving palliative care in India. J Palliat Care 2019; 34 (03) 175-180
- 17 Olejarczyk JP, Young M. Patient Rights and Ethics. Updated 2021 Dec 30. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022
- 18 Kinsinger FS. Beneficence and the professional's moral imperative. J Chiropr Humanit 2009; 16 (01) 44-46
- 19 Say RE, Thomson R. The importance of patient preferences in treatment decisions–challenges for doctors. BMJ 2003; 327 (7414): 542-545
- 20 Kaba R, Sooriakumaran P. The evolution of the doctor-patient relationship. Int J Surg 2007; 5 (01) 57-65
- 21 Coggon J, Miola J. Autonomy, liberty, and medical decision-making. Camb Law J 2011; 70 (03) 523-547
- 22 Wancata LM, Hinshaw DB. Rethinking autonomy: decision making between patient and surgeon in advanced illnesses. Ann Transl Med 2016; 4 (04) 77 DOI: 10.3978/j.issn.2305-5839.2016.01.36.
- 23 Martis L, Westhues A. A synthesis of the literature on breaking bad news or truth telling: potential for research in India. Indian J Palliat Care 2013; 19 (01) 2-11
- 24 Zahedi F. The challenge of truth telling across cultures: a case study. J Med Ethics Hist Med 2011; 4: 11
- 25 Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics 2007; 33 (11) 627-630
- 26 Ali NS, Khalil HZ, Yousef W. A comparison of American and Egyptian cancer patients' attitudes and unmet needs. Cancer Nurs 1993; 16 (03) 193-203
- 27 Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J 2014; 16 (01) e12454
- 28 Garg P, Nagpal J. A review of literature to understand the complexity of equity, ethics and management for achieving public health goals in India. J Clin Diagn Res 2014; 8 (02) 1-6
- 29 Osamor PE, Grady C. Women's autonomy in health care decision-making in developing countries: a synthesis of the literature. Int J Womens Health 2016; 8: 191-202
- 30 Ubel PA, Scherr KA, Fagerlin A. Empowerment failure: how shortcomings in physician communication unwittingly undermine patient autonomy. Am J Bioeth 2017; 17 (11) 31-39
- 31 Monden KR, Gentry L, Cox TR. Delivering bad news to patients. Proc Bayl Univ Med Cent 2016; 29 (01) 101-102
- 32 Al-Mohaimeed AA, Sharaf FK. Breaking bad news issues: a survey among physicians. Oman Med J 2013; 28 (01) 20-25
- 33 Cox K, Britten N, Hooper R, White P. Patients' involvement in decisions about medicines: GPs' perceptions of their preferences. Br J Gen Pract 2007; 57 (543) 777-784
- 34 Eng TC, Yaakup H, Shah SA, Jaffar A, Omar K. Preferences of Malaysian cancer patients in communication of bad news. Asian Pac J Cancer Prev 2012; 13 (06) 2749-2752
- 35 Motlagh A, Yaraei N, Mafi AR. et al. Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey. Arch Iran Med 2014; 17 (04) 232-240
- 36 Buckman R. Breaking bad news: why is it still so difficult?. Br Med J (Clin Res Ed) 1984; 288 (6430): 1597-1599
- 37 Fallowfield L. Giving sad and bad news. Lancet 1993; 341 (8843): 476-478
- 38 Tuckett AG. Truth-telling in clinical practice and the arguments for and against: a review of the literature. Nurs Ethics 2004; 11 (05) 500-513
- 39 Back AL, Curtis JR. Communicating bad news. West J Med 2002; 176 (03) 177-180
- 40 Kitta A, Hagin A, Unseld M. et al. The silent transition from curative to palliative treatment: a qualitative study about cancer patients' perceptions of end-of-life discussions with oncologists. Support Care Cancer 2021; 29 (05) 2405-2413
- 41 Lim RB. End-of-life care in patients with advanced lung cancer. Ther Adv Respir Dis 2016; 10 (05) 455-467
- 42 Kinlaw K. Ethical issues in palliative care. Semin Oncol Nurs 2005; 21 (01) 63-68
- 43 Rich BA. Prognosis terminal: truth-telling in the context of end-of-life care. Camb Q Healthc Ethics 2014; 23 (02) 209-219
- 44 Tang Y. Death attitudes and truth disclosure: a survey of family caregivers of elders with terminal cancer in China. Nurs Ethics 2019; 26 (7-8): 1968-1975
- 45 McLeod-Sordjan R. Death preparedness: a concept analysis. J Adv Nurs 2014; 70 (05) 1008-1019
- 46 Naik SB. Death in the hospital: breaking the bad news to the bereaved family. Indian J Crit Care Med 2013; 17 (03) 178-181
- 47 Kent H, McDowell J. Sudden bereavement in acute care settings. Nurs Stand 2004; 19 (06) 38-42
- 48 Sengupta M, Roy A, Gupta S, Chakrabarti S, Mukhopadhyay I. Art of breaking bad news: a qualitative study in Indian healthcare perspective. Indian J Psychiatry 2022; 64 (01) 25-37
- 49 Bousquet G, Orri M, Winterman S, Brugière C, Verneuil L, Revah-Levy A. Breaking bad news in oncology: a metasynthesis. J Clin Oncol 2015; 33 (22) 2437-2443
- 50 Puchalski CM. The role of spirituality in health care. Proc Bayl Univ Med Cent 2001; 14 (04) 352-357
- 51 Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry 2012; 2012: 278730 DOI: 10.5402/2012/278730.
- 52 Hepner A, Negrini D, Hase EA. et al. Cancer during pregnancy: the oncologist overview. World J Oncol 2019; 10 (01) 28-34
- 53 Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist 2002; 7 (04) 279-287
- 54 Dotters-Katz S, McNeil M, Limmer J, Kuller J. Cancer and pregnancy: the clinician's perspective. Obstet Gynecol Surv 2014; 69 (05) 277-286
- 55 Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: disentangling treatment modalities. ESMO Open 2016; 1 (03) e000016 DOI: 10.1136/esmoopen-2015-000016.
- 56 Alpuim Costa D, Nobre JG, de Almeida SB. et al. Cancer during pregnancy: how to handle the bioethical dilemmas?-a scoping review with paradigmatic cases-based analysis. Front Oncol 2020; 10: 598508 DOI: 10.3389/fonc.2020.598508.
- 57 Salani R, Billingsley CC, Crafton SM. Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 2014; 211 (01) 7-14
- 58 Amant F, Berveiller P, Boere IA. et al. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30 (10) 1601-1612
- 59 Schenck DP. Ethical considerations in the treatment of head and neck cancer. Cancer Contr 2002; 9 (05) 410-419
- 60 Fingeret MC, Vidrine DJ, Reece GP, Gillenwater AM, Gritz ER. Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer. Head Neck 2010; 32 (03) 301-309
- 61 Manimala NJ, Nealon SW, Heinsimer KR, Wiegand LR. Advances in penile reconstructive techniques for primary penile tumors. AME Med J 2019; 4: 43 DOI: 10.21037/amj.2019.11.04.
- 62 O'Neill S, Barns M, Vujovic F, Lozinskiy M. The role of penectomy in penile cancer-evolving paradigms. Transl Androl Urol 2020; 9 (06) 3191-3194
- 63 Selby LV, Aquina CT, Pawlik TM. When a patient regrets having undergone a carefully and jointly considered treatment plan, how should her physician respond?. AMA J Ethics 2020; 22 (05) E352-E357
- 64 Rumsey N, Harcourt D. Body image and disfigurement: issues and interventions. Body Image 2004; 1 (01) 83-97
- 65 Brydøy M, Fosså SD, Dahl O, Bjøro T. Gonadal dysfunction and fertility problems in cancer survivors. Acta Oncol 2007; 46 (04) 480-489
- 66 Demeestere I, Ferster A. Fertility preservation counselling for childhood cancer survivors. Lancet Oncol 2020; 21 (03) 329-330
- 67 Burns KC, Hoefgen H, Strine A, Dasgupta R. Fertility preservation options in pediatric and adolescent patients with cancer. Cancer 2018; 124 (09) 1867-1876
- 68 Harada M, Osuga Y. Fertility preservation for female cancer patients. Int J Clin Oncol 2019; 24 (01) 28-33
- 69 Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-an emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65 (11) e27297 DOI: 10.1002/pbc.27297.
- 70 Holman DA. Fertility preservation in gynecologic cancer. Semin Oncol Nurs 2019; 35 (02) 202-210
- 71 Del-Pozo-Lérida S, Salvador C, Martínez-Soler F, Tortosa A, Perucho M, Giménez-Bonafé P. Preservation of fertility in patients with cancer (Review). (Review) Oncol Rep 2019; 41 (05) 2607-2614
- 72 Lau GA, Schaeffer AJ. Pediatric oncofertility: an update. Transl Androl Urol 2020; 9 (05) 2416-2421
- 73 Gegechkori N, Haines L, Lin JJ. Long-term and latent side effects of specific cancer types. Med Clin North Am 2017; 101 (06) 1053-1073
- 74 Westerink NL, Nuver J, Lefrandt JD, Vrieling AH, Gietema JA, Walenkamp AM. Cancer treatment induced metabolic syndrome: improving outcome with lifestyle. Crit Rev Oncol Hematol 2016; 108: 128-136
- 75 Chueh HW, Yoo JH. Metabolic syndrome induced by anticancer treatment in childhood cancer survivors. Ann Pediatr Endocrinol Metab 2017; 22 (02) 82-89