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

中文翻译：

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告知或隐瞒——老年癌症患者家属告知疾病相关坏消息的动态：一项定性研究


随着老年癌症患者数量的急剧增加，是否向老年患者告知坏消息成为一个紧迫而普遍的挑战。然而，现有研究主要集中在完全披露、部分披露和回避披露三种披露决策及其原因上，对家族成员披露决策的演变过程和影响因素尚不清楚。探讨老年癌症患者家属在公开与隐瞒之间转变的经历和因素。采用了定性研究。 2022年12月至2023年6月期间，对两家综合医院和一家社区医院的33名家庭成员进行了半结构化访谈。采用内容分析法对访谈数据进行了分析。治疗方案象征着“生存的希望”，是隐瞒与公开转变的根本因素。在诊断和治疗过程中，家属做出决定时有三个主题：（a）坏消息临近时：混乱中保持冷静；（b）治疗方案确定时：生存的希望决定披露决定，以及（c）当患者的病情恶化时：在绝望中寻找希望。披露和隐瞒是一个复杂且动态的过程。转变的因素在于治疗方案所象征的“生存希望”。家属披露的关键是给患者足够的希望，控制或治愈患者的疾病，或者延长患者的生命，提高患者的生活质量。