Therapeutic relations versus medical information in cancer patients
KARKANIAS A., IAKOVIDIS V., BEDENIDIS C.
On a national scale, medical information and especially the full disclosure of prognosis fall quite short of the desired international standards. informed patientí percentages are lower than the ones expected and vary from culture to culture, from one geographic area to another, from hospital to hospital, even from one department to another in the same hospital.
Today, it is supposed that the truth should be revealed to a cancer patient who would like to be informed, in order for him/her to express a factual opinion about his/her health.
Despite the large research work and training efforts on this matter -in liaison psychiatry- only a few changes have been recorded in everyday medical practice.
According to the indicative cross-cultural research condured by the National Representatives of the Psycho-Oncology Society, the full disclosure of the truth, including prognosis, ranged from a low of 24% in Greece to a high of 98% in Finland.
Both doctors and patients want to inform and be informed. However, during the information process factors independent from the will of both sides intervene. Some therapists already have inherent fears in their personalities. To those are added fears that they acquire during their medical training, together with the paternalistic position of the family, and in a deeper level, the unconscious fear for the patientís death or the trherapistís own death. All of these are some of the factors that lead to the concealment of the truth and result in preserving silence.
Although diagnostic information marks the beginning of the therapeutic relation in a life-threatening illness, it is the therapeutic relation itself that is important.
This relation is, or should be, a long-term one and along with the information, supports the patientís morale and instills in the patient a feeling of continuity that is not to give up under difficult circumstances. In this way it has a greater value than information, as it not only performs more functions but also affects the long-term course of the illness.
Patient, family and therapist all find difficulty in dealing with the strong feelings that develop during the therapeutic relation. Anger, worry, sadness, desperation, anxiety of dependence or death are some of them associated with the patient. The family feels guilty and socially rejected, while the therapist at times, feels anger towards the patient, because his omnipotence is threatened, as well as anxiety when dealing with therapeutic deadlocks. Even though everyone agrees that the therapeutic relation is unique, as well as the best "cure" for the patient, no considerable educational effort has been undertaken that will focus on the therapeutic relation and the viability of the feelings that develop during it.
Clinical experience and research conducted by many centers today show the need to alter the educational activities of liaison psychiatry. The training of therapists in technical abilities of information and the feelings that deve-lop during the therapeutic relation, remain unclassified. It is necessary that this channel leads to educational efforts so that therapists can be mental health specialists and through experimental processes be able to adopt a more involved and sensitive stance towards the patient.
Difficulties faced by the therapists in handling these feelings as well as their tendency to be emotionally detached are the key points which must addressed.
Key words: Cancer, doctor/patient relationship, communication, information, training.