Truth Telling to Terminally Ill Patients in Bulgarian Hospices

For centuries there was an informal rule not to tell the truth to cancer patients. The paternalistic model of relationships still exists in many societies in relation to the issue of informing the patient. The object of this paper is to study the issue of truth telling to terminally ill patients in Bulgarian hospices. Materials and methods. The study employed a combination of sociological and statistical methods. Self-administered questionnaires were distributed among the personnel and patients’ relatives in 17 in-patient, 12 home care hospices and 5 palliative care units. Altogether, 190 health professionals and 216 patients’ relatives responded to the questionnaires. The response rates for the personnel and the relatives were 86% and 74.5% respectively. Results. According to the personnel, there were 62.1% autonomous patients in palliative care units, and 23-24% in in-patient and home care hospices. The majority of the patients were familiar with the diagnosis (50.4% in in-patient hospices, 66.7% in home-care hospices, and 78.8% in palliative care units). There was a significant difference in the data obtained by the relatives. Most of the patients were informed by their physician before the hospice admission. 10.2%-18.5% of the patients were informed by the relatives. Conclusion. Following the recent tendencies in favor of respect for autonomy, Bulgarian physicians inform patients and try to build partnerships in most of the therapeutic relations. The issue of truth telling in case of terminally ill patients is still one of the most complex and sensitive situations presenting moral dilemma in clinical practice.