Concealment of information in clinical practice: is lying less stressful than telling the truth?

Despite international trends toward patient autonomy and shared decision making, concealment of diagnostic or prognostic information from cancer patients is still common in clinical practice. Studies conducted in different countries show that up to 60% of cancer patients are not aware of their diagnoses despite developments in cancer treatments and moves toward patient empowerment. Even in Western medical settings, oncologists are often hesitant to disclose the diagnosis directly, and often censor prognostic information favoring either nondisclosure or a conscious overestimate. In a study conducted in five United States hospices, physicians reported that they would provide frank disclosure of survival estimates only in37%ofcases. Similarly, a surveyof126Australian cancer patients showed that 87% of physicians gave the prognosis to the family first. When asked about their reasons for nondisclosure, physicians report that they do it primarily out of respect for the wishes of the family, or concern for the patient’s well-being. However, do the aforementioned reasons adequately explain the concealment practices observed? Fallowfield and Jenkins have suggested that physicians may conceal unpleasant information in an attempt to protect their own emotional well-being as much as the patients’. To date, no study has examined the extent to which physicians might benefit from concealing unpleasant information. In other words, is concealment of bad news less stressful than disclosure? Based on studies showing the beneficial role of perceived control, we hypothesized that concealment of cancer diagnosis would be less stressful than disclosure. To test whether our hypothesis had any empirical validity, we conducted a small experiment examining the emotional and physiological impact of disclosing versus concealing cancer diagnosis.