Exploring how to tell the truth and preserve hope: can a balance between communication and empathy be calculated?

Abstract

Background & Aims: When told the harsh truth about severe disease, a patient might despair and lose all hope. Without knowing the truth, however, the patient cannot participate in decision making and adjust life according to his illness. The present study aims to analyze the relationships between hope and truth in the decision on how much information to disclose to a patient with severe gastrointestinal disease. Methods: The decision analysis is based on the economic concepts of indifference curves and utility function. An inverse linear relationship exists between hope and truth; as more truth becomes revealed, the amount of hope declines. The utility function and the corresponding indifference curve of hope plotted versus truth describe the patient’s personal choices among different combinations of hope and truth. The optimal choice among various combinations of hope and truth corresponds with the point at which the inverse hope-truth line meets the indifference curve. Results: In situations in which hope drops steeply as more medical facts are being revealed, the utility to the patient is maximized with less truth being told. With a less pronounced truth-related decline in hope, utility is maximized at higher levels of truth, and, occasionally, utility is maximized only after all medical facts have been disclosed. The lesser the impact of truth on hope, the more truth is being tolerated. Conclusions: A caring gastroenterologist trying to optimize his/her patient’s well-being should try to assess the potential influence of truth on the patient’s psyche and dispense it accordingly.