A conspiração do silêncio em cuidados paliativos

: os actores, contextos e práticas na perspectiva da equipa multidisciplinar

Abstract

The conspiracy of silence is a process of concealment of information from the patient. It happens frequently in palliative care, a sensitive field dealing with issues of pain, suffering and death. This study arose from the desire to know the experience of the conspiracy of silence in the multidisciplinary team’s point of view in what palliative care is concerned. We believe that this research will be relevant to the improvement of the delivery of palliative care by intending to know a phenomenon that seems to be an obstacle to the creation of conditions of humanization, peacefulness and open communication, all characteristics of this type of care. In this sense, the Grounded Theory was selected as the methodological reference able to help achieve this goal. By performing participant observation, conducting interviews and focus group towards elements of the multidisciplinary team of palliative care service of the Portuguese Institute of Oncology in Oporto, we were able to describe how experienced the conspiracy of silence is in this context of care, according to the team, either for the patient, the family, or the team itself.
The analysis of data led us to understand that the patient, the family and the team are the three players involved in the conspiracy of silence in palliative care.
We have noticed that the conspiracy of silence exists, that it is taking place among these groups of people and that it can be maintained or destroyed.
The conspiracy of silence can be maintained and be considered adaptive in the sense that it carries no negative consequences and the patient can live peacefully, since it does not cause any concern. However, it may not be adaptive and, accordingly, it may create discomfort, anxiety and isolation, harden the approach of the team itself, avoid goodbyes, endure the agony of processes and cause step backs in communication. In this sense, it needs to be destroyed, and that each one of the players can provide for that to happen by using several strategies. When the conspiracy of silence is destroyed, it is expected to bring both positive and negative consequences for the three players, considering, however, that the positive outweigh the negative. The team suffers retaliation and anger when dealing with the destruction of conspiracy, in the patient there is always an initial feeling, as for the family there is an added difficulty in the experience of mourning. When one is able to deal with this process, care is easier, and one can handle it as a whole, the team ends up dealing with gratitude, all are in line with the team, the patient can have a peaceful death and one can have a better understanding of the relationships within the family. Thus, we conclude that a relationship of truth with the destruction of silence is certain to create an initial anguish and suffering, but avoids negative effects of incapability to adapt to situations in the context of palliative care.

Date of Award	2009
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	José Carlos Amado Martins (Supervisor)