Experiences of Health Care Providers in Using Therapeutic White Lies in Patient Ethical Care Process
- Alireza Nikbakht Nasrabadi - Professor, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Soodabeh Joolaee - 1. Professor, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran. 2. Research Associate, Center for Evaluation & Outcome Sciences (CHEOS), University of British Columbia, Vancouver, Canada
- Elham Navvab - Associate professor, Department of Management and Critical Care, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Maryam Esmaeilie - Associate professor, Department of Management and Critical Care, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Mahboubeh Shali - Ph.D. Candidate, Department of Managment and Critical Care, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran [M.shali@zums.ac.ir]
Abstract
Background: Unfolding the whole truth in treatment is an ethical principle and an essential part of patients' rights. Sometimes, under certain circumstances, members of the treatment team find themselves in a plight where they are forced to lie or tell white lies. The purpose of this study was to analyze the experiences of treatment team about telling white lies in specific patient care conditions.
Methods: The present study is a qualitative one (content analysis). The study sample consisted of 14 members of the treatment team working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. The data were collected through in-depth and semi-structured interviews in two focus groups and based on the actual experiences of treatment team regarding white lies in the patient care process. The process of data analysis was performed according to the proposed steps of Graneheim and Lundman. To ensure the validity and reliability of the data, Lincoln and Guba paradigm was applied.
Results: The analysis of data yielded 420 primary codes, 10 categories, and 3 main themes. The resulting themes included specific circumstances justifying the need to tell white lies, reasons for white lying, and the strategies to circumvent such lies.
Conclusion: Unfolding the truth must be considered an ethical principle. However, the point at issue and the main challenge is providing the conditions to prepare the patient for hearing the facts and the optimal ways of telling such facts. Moreover, treatment team should be informed how to deal with the probable reactions of the patients after telling them the truth.
References:
- Sarafis P, Tsounis A, Malliarou M, Lahana E. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Glob J Health Sci. 2014;6(2):128-37.
- Nazari-Tavakkoli S, Foroozandeh M. Truthfull-ness, comparative study of the teachings of Is-lamic ethics and principles of medical ethics. Med Ethics. 2015;9(32):167-94.
- Kazdaglis GA, Arnaoutoglou C, Karypidis D, Memekidou G, Spanos G, Papadopoulos O. Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. East Mediterr Health J. 2010;16(4):442-7.
- Zamani A, Shahsanai A, Kivan S, Hemmatti S, Mokarian F. Iranian physicians and patients attitude toward truth telling of cancer. J Isfahan Med School. 2011;29(143):752-60.
- Tuckett AG. The experience of lying in demen-tia care: qualitative findings from residential aged care in Australia. Nurs Ethics. 2011;000(00):1-14.
- Seaman AT, Stone AM. Little white lies: interrogating the (Un)acceptability of deception in the context of dementia. Qual Health Res. 2017;27(1):60-73.
- James IA, Wood-Mitchell AJ, Waterworth AM, Mackenzie LE, Cunningham J. Lying to people with dementia: developing ethical guidelines for care settings. Int J Geriatr Psychiatry. 2006; 21(8):800-1.
- Banihashemi K. Medical ethics and bad news delivery to patients. Ethics Sci Technol. 2009;4 (1-2):115-30.
- Ehsani M, Taleghani F, Hematti S, Abazari P. Perceptions of patients, families, physicians and nurses regarding challenges in cancer disclosure: A descriptive qualitative study. Eur J Oncol Nurs. 2016;25:55-61.
- Montazeri A, Vahdani M, Haji-Mahmoodi M, Jarvandi S, Ebrahimi M. Cancer patient education in Iran: a descriptive study. Support Care Cancer. 2002;10(2):169-73.
- Atrak H, Mollabakhshi M. Lying to patient with a good intent. J Med Ethics Hist Med. 2012;5(4):1-12.
- Jayasekara RS. Focus groups in nursing research: methodological perspectives. Nurs Outlook. 2012;60(6):411-6.
- Speziale H, Streubert H, Carpenter D. Qualitative research in nursing: advancing the humanistic imperative. 5th ed. China: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2011. 419 p.
- Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.
- Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88.
- Ghiyasvandian S, Mousavizadeh SN, Dehghan Nayeri N, Haghani H. The effect of decision aid's pakage in selected treatment by patients with early stage breast cancer and decision making outcomes. J Fasa Univ Med Sci. 2013;3(3):271-9.
- Wood-Mitchell A, Waterworth A, Stephenson M, James I. Lying to people with dementia: sparking the debate. J Dementia Care. 2006;14 (6):30.
- Elvish R, James I, Milne D. Lying in dementia care: an example of a culture that deceives in people’s best interests. Aging Ment Health. 2010;14(3):255-62.
- Russell G. Dementia diagnosis and white lies: a necessary evil for carers of dementia patients? Int J Care Caring. 2018;2(1):133-7.
- Wood-Mitchell A, James I, Waterworth A, Swann A, Ballard C. Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing. 2008;37(5):547-52.
- Sadat-Hoseini A, Aramesh K. Ethical challenges about palliative pediatric. Med Ethics J. 2013;7(25):55-81.
- Abbasi M, Gooshki ES, Movahedi H, Saffari S. Spiritual care at the end of life. J Med Ethics. 2015;8(30):97-131.
- Dong F, Zheng R, Chen X, Wang Y, Zhou H, Sun R. Caring for dying cancer patients in the Chinese cultural context: A qualitative study from the perspectives of physicians and nurses. Eur J Oncol Nurs. 2016;21:189-96.
- López-Sierra H, Rodríguez-Sánchez J. The supportive roles of religion and spirituality in end of life and palliative care of patients with cancer in a culturally diverse context: a literature review. Curr Opin Support Palliat Care. 2015;9(1):87-95.
- Sheykh Talimi M, Shariati Nasab S, Omani Samani R. Comparative study on medical con- fidentiality in sexually transmitted diseases. Iran J Med Ethics Hist Med. 2015;8(3):87-97.
- Yazdanian A, Abdolahzade M. Confidentiality; right of patient and civil responsibility of the doctor. Med Ethics J. 2016;10(35):199-227.
- Day AM, James IA, Meyer TD, Lee DR. Do people with dementia find lies and deception in dementia care acceptable? Aging Ment Health. 2011;15(7):822-9.
- Mahasti-Jouybari L, Ghana S, Sarrafi-Kheir-abadi S, Sanagoo A. The nurses' experiences of breaking bad news to the patients and theirrelatives. Med Ethics. 2013;7(24):11-31.
- Culley H, Barber R, Hope A, James I. Therapeutic lying in dementia care. Nurs Stand. 2013;28(1):35-9.