Abstract
The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence.
Highlights
The conspiracy of silence is described in scientific literature as an agreement among family, friends, and/or health professionals to modify the information given to a patient; this agreement may be explicit or implicit [1,2,3,4]
The objective of this behavior is to hide the diagnosis, prognosis, and/or the seriousness of the situation [1,2,3], and, as pointed out by Vergara Lacalle [5], the most crucial information seems to be the one dealing with prognosis
The family seems to have more information, not on a formal level, but because of their proximity to the older person. This circumstance seems to make the professionals act guided by their personal preferences and experiences, rather than by professional guidelines. This situation is reminiscent of some of the results shown by Cejudo López et al [32], where the doctor would behave in a paternalistic way with the patient-family, because the doctor would approach the decision-making based on what they would have undertaken if the patient were a member of their family
Summary
The conspiracy of silence is described in scientific literature as an agreement among family, friends, and/or health professionals to modify the information given to a patient; this agreement may be explicit or implicit [1,2,3,4] The objective of this behavior is to hide the diagnosis, prognosis, and/or the seriousness of the situation [1,2,3], and, as pointed out by Vergara Lacalle [5], the most crucial information seems to be the one dealing with prognosis. Even if the patient wants to have information about their state, the family [1,6,9] or health professionals [6,9]
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