Truth disclosure on prognosis: Is it ethical not to communicate personalised risk of death?

Magnolia Cardona, John Kellett, Ebony Lewis, Mikkel Brabrand, Danielle Ní Chróinín

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Abstract

Predicting risk of death based on personalised and objective clinical indicators is an improvement over intuition and clinical judgement. Risk assessment can benefit clinicians by improving prognostic certainty, and truth disclosure helps patients and families by preventing futile management. Some argue that consent should be obtained before a patient is given an estimate of their prognosis as disclosure of bad news can overburden patients. In this article, we argue that it is unethical not to use existing person-specific information to guide diagnosis and shared decision making on management in partnership with well-informed patients. Disclosure of a poor prognosis should be normalised in personalised medicine, performed incrementally and with sensitivity so that it is acceptable to patients, and only occur if patients want to know it. However, a requirement of consent for truth disclosure should not be mandatory. Despite some level of imprecision, personalised risk estimations can be used to tailor management to the patient's informed wishes and ensure that healthcare providers and families are acting ethically in the patient's best interest.

Original languageEnglish
Article numbere13222
Number of pages3
JournalInternational Journal of Clinical Practice
Volume72
Issue number8
Early online date16 Jul 2018
DOIs
Publication statusPublished - 1 Aug 2018

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Truth Disclosure
Disclosure
Intuition
Precision Medicine
Health Personnel
Decision Making

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Cardona, Magnolia ; Kellett, John ; Lewis, Ebony ; Brabrand, Mikkel ; Ní Chróinín, Danielle. / Truth disclosure on prognosis : Is it ethical not to communicate personalised risk of death?. In: International Journal of Clinical Practice. 2018 ; Vol. 72, No. 8.
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Truth disclosure on prognosis : Is it ethical not to communicate personalised risk of death? / Cardona, Magnolia; Kellett, John; Lewis, Ebony; Brabrand, Mikkel; Ní Chróinín, Danielle.

In: International Journal of Clinical Practice, Vol. 72, No. 8, e13222, 01.08.2018.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - Is it ethical not to communicate personalised risk of death?

AU - Cardona, Magnolia

AU - Kellett, John

AU - Lewis, Ebony

AU - Brabrand, Mikkel

AU - Ní Chróinín, Danielle

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AB - Predicting risk of death based on personalised and objective clinical indicators is an improvement over intuition and clinical judgement. Risk assessment can benefit clinicians by improving prognostic certainty, and truth disclosure helps patients and families by preventing futile management. Some argue that consent should be obtained before a patient is given an estimate of their prognosis as disclosure of bad news can overburden patients. In this article, we argue that it is unethical not to use existing person-specific information to guide diagnosis and shared decision making on management in partnership with well-informed patients. Disclosure of a poor prognosis should be normalised in personalised medicine, performed incrementally and with sensitivity so that it is acceptable to patients, and only occur if patients want to know it. However, a requirement of consent for truth disclosure should not be mandatory. Despite some level of imprecision, personalised risk estimations can be used to tailor management to the patient's informed wishes and ensure that healthcare providers and families are acting ethically in the patient's best interest.

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