Using the modified Barthel index to estimate survival in cancer patients in hospice: observational study.

conscious way to achieve their personal goals. Breaking the cycle of collusion between doctor and patient is not primarily a question of whether the patient has to be informed at all, which usually is the case, but rather how doctors and patients deal with these facts in practice. Awareness cannot be forced on the patient, it can only be supported. This requires an active, patient orientated approach from the doctor. Perhaps solutions to the problem of false optimism about recovery and not knowing a poor prognosis have to be found outside the doctor-patient relationship itself. An example of such a solution would be the involvement of “treatment brokers,” people who are trusted by the doctor and the patient and can help both parties in clarifying and communicating their (otherwise implicit) assumptions and expectations.