RESEARCH – October 2021

Communicating bad news to patients: truth-telling study amongst Estonian physicians and nurses

Authors: Kadri Simm, Reet Urban, Külliki Seppel, Yay Zameska, Dalia Dzaganija, Liina Animägi

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Background and aims. Over the past half a century the medical tradition of telling patients the truth about their terminal diagnosis has changed considerably. While previously such truth-telling was perceived as harmful to the patient, and thus in violation of the ancient medical ethics principle of non-maleficence, the growing importance of informed consent and patient autonomy has significantly changed these practices. Research has shown that truthtelling practices are often culturally and geographically diverse. This study aimed at mapping, for the first time, Estonian physicians and nurses’ attitudes and practices regarding truth-telling. Our hypothesis was that Estonian medical attitudes lie in-between the more autonomy-oriented US and Western-European trends and the more paternalistic tendencies of Southern and Central-Europe, as demonstrated by other research.
Methods. A web-based questionnaire with respondents from three large Estonian hospitals (in Tallinn, Tartu and Jõhvi) as well as from the members list of Estonian Union of Nurses and Family Nurses Association from May to September 2019. 455 respondents, 19% physicians (n = 86) and 81% nurses (n = 369).
Results and conclusions. Estonian medical professionals respect patients’ rights to know truthful information about themselves, even if that truth pertains to terminal diagnosis. 92% of physicians agreed that patients have the right to know, none denied it. 36% of nurses also agreed fully, while 41% would limit their communication with patients to what patients themselves requested. Several criteria influence the information that the patient is given. Generally, a patient’s social or religious background does not affect how bad news is communicated, but a patient’s understanding, emotional state, and preferences do play a role. The results of the study confirm that Estonian medical workers’ attitudes and practices of truth-telling align with those of medical workers in Northern and Western Europe. No asymmetrical attitudes to truth-telling were present for physicians. The majority of both physicians and nurses recognize the need for specialized training in communicating bad news.