Informing or concealing - Dynamics of telling disease-related bad news among family members of older cancer patients: A qualitative study

Background: With the dramatic rise in the number of older cancer patients, the question of whether or not to tell older patients of bad news becomes an urgent and common challenge. However, existing studies concentrated on the three types of disclosure decisions and their reasons, including full disclosure, partial disclosure, and avoidance of disclosure, and the evolution process and factors influencing family members' disclosure decisions are unclear.

Objective: Explore the experience and factors of the shift between disclosure and concealment among family members of older cancer patients.

Methods: A qualitative study was employed. Semi-structured interviews were conducted with 33 family members at two general hospitals and one community hospital between December 2022 and June 2023. The interview data were analyzed using a content analysis approach.

Results: The treatment plan symbolizes the "hope of survival" and it is the fundamental factor for the shift between concealment and disclosure. There are three themes of family members in making decisions during the diagnostic and therapeutic process: (a) When bad news is approaching: Keep calm in the midst of chaos, (b) when a treatment plan is determined: Hope for survival dictates disclosure decisions, and (c) when the patient's disease deteriorated: Finding hope in hopelessness.

Conclusions: Disclosure and concealment are a complex and dynamic process. The factor of the shift lies in the "hope of survival" symbolized by the treatment plan. The key to disclosure by family members is to give patients enough hope to control or cure a patient's disease, or prolong the life of patients and improve their quality of life.