Telling bad news to the elderly cancer patients: The role of family caregivers in the choice of non-disclosure - The Gruppo Italian di Oncologia Geriatrica (GIOGer) Study

Purpose: We investigated the caregiver's role in the choice of non-disclosure in patient-physician communication. Patients and Methods: A total of 194 family caregivers of partially informed (PI) or not-informed (NI) elderly cancer patients participated in the study protocol. PI patients received only approximate information aimed at reassurance; NI patients had no access to any information regarding their health status. The family caregiver, identified by the patient, underwent an interview regarding patient-physician communication. Results: As many as 35.2% (n=74) were caregivers for NI and 64.8% (n=136) for PI. Patients living with their spouse were better informed than patients living with their children (80.0% vs. 58.7%; p=0.02). The decision to not inform the patients mainly arose in the family (86.1% vs. 77.0% of NI and PI, respectively, p=0.12) and was due to the psychological frailty of the patient (52.8% NI vs. 32.8% PI, p=0.006) and to the fear of severe emotional distress during a fully disclosing patient-physician communication (67.0%). Caregivers for PI patients were more concerned sharing information on the prognosis (48.4%), while caregivers for NI patients were more concerned sharing information on diagnosis (44.4%). Conclusions: The choice of non-disclosure was independent from an explicit request of the patient and was associated with the caregiver's fears and needs. Because elderly patients rely on a family caregiver to cope with their disease, early intervention tailored to caregiver's needs and skills are necessary. Such interventions will avoid the risk of caregiver distress and help medical staff in managing the various aspects of clinical communication with the elderly cancer patients. (C) 2010 Elsevier Ltd. All rights reserved.