the patient guides the conversation. While it is true that the majority of patients referred to a palliative care service know of their diagnosis and prognosis, they may not fully understand the implications until they have had the opportunity to discuss this in an atmosphere of mutual trust and respect.
What about the relatives who try to collude against the patient?
I would like to just very briefly talk about the conspiracy of silence, or collusion with the relatives. This is the situation when the relatives know what is happening to the patient, but ask the doctor or nurse not to tell the patient for fear that this may upset the patient.
This is becoming less of an issue in our country than it was twenty years ago, but it is still something which needs to be worked through with many families.
It is important to acknowledge the caring motivation the family have to do the best for their family member, mostly wanting to protect them from worry and pain. It is also important to find out the real reason they request this, what are they most afraid of: they may actually have a very good reason which the health care team should respect.
Usually we say that we cannot lie to the patient, but that we will only answer questions which the patients asks us. The end result in most cases is enormous relief when finally the patient and the family do not have to hide information or their true feelings from each other.
Presentation for the Life Planning Centre in Tokyo, Japan, 23 February 1997,
