General Practice

Respecting the autonomy of cancer patients when talking with their families: qualitative analysis of semistructured interviews with patients

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7059.729 (Published 21 September 1996) Cite this as: BMJ 1996;313:729
  1. John Benson, general practitionera,
  2. Nicky Britten, lecturer in medical sociologyb
  1. a 125 Newmarket Road, Cambridge CB5 8HA
  2. b Department of General Practice, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE11 6SP
  1. Correspondence to: Dr Benson.
  • Accepted 11 July 1996

Abstract

Objectives: To discover cancer patients' views about disclosure of information to their family, their family's influence over the information given them, and their preferences for doctors' behaviour if they and their family disagree, as a complement to applied ethical theory.

Design: Semistructured interviews followed by qualitative content analysis.

Setting: Mainly urban British general practice.

Subjects: 30 patients in whom cancer, excluding basal and squamous cell skin carcinomas, was diagnosed 1-7 years earlier.

Results: All subjects wished doctors to respect their views rather than those of their family, should they differ. With their consent, subjects favoured close family receiving information about their illness, all but one mentioning advantage to their family. Without such consent, six unconditionally favoured disclosure of information to their family while seven unconditionally opposed disclosure. Seventeen participants restricted their approval for such disclosure to specific circumstances. Only two participants approved of their family influencing the information that they received about their illness; all but seven wished to receive full information, the exceptions relating to information about bad prognosis.

Conclusions: Subjects favoured openness with their family but most rejected unconditional disclosure of information without their consent and their family influencing what information they would be given. They valued respect for their autonomy more highly than beneficence and considered that their own needs took priority over those of their family.

Key messages

  • We interviewed 30 patients with a diagnosis of cancer to find their views about these issues

  • While the patients favoured their family receiving information about their illness with their consent, most were opposed to their family receiving information without their consent except under specific circumstances

  • Almost all the patients were opposed to their family influencing the information that they would receive about their illness

  • The patients therefore wished their autonomy to be respected over and above any beneficent views of their relatives and considered that their needs should take priority over those of their family

Footnotes

  • Funding JB received financial support from the Scientific Foundation Board of the Royal College of General Practitioners to defray project costs and from the Unit of General Practice, University of Cambridge Medical School to defray locum costs.

  • Conflict of interest None.

  • Accepted 11 July 1996
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