Clinicians' Routine Use of Non-disclosure: Prioritizing "Protection" over the Information Needs of Adolescents with Cancer

Abstract

This is a qualitative study of clinicians' use of partial information disclosure and its consequences for adolescents' ability to participate in the management of their cancer treatment. A total of 17 pediatric cancer patients, their families, and clinicians were observed during 15 months of ethnographic fieldwork in a hospital in Barcelona, Spain. Eighty-six hours of videotaped medical and social activities were analyzed micro-interactionally and longitudinally. Clinicians used 4 strategies to evade direct answers to adolescents' questions: contingent answers, narrow answers, non-answer responses, and question forestalling. Information withholding by clinicians was shown to greatly limit adolescents' ability to participate in the management of their treatment and to be ineffective in its implicit goals of protecting the patient and containing uncertainty and anxiety. The author concludes that if clinicians were to integrate adolescents' individual information needs into their communicative practices they would be able to better assess what information to disclose as well as how and when to disclose it.