Original article
Information of patients with life-threatening diseases: A survey of the attitude of Portuguese family practitioners
José A. Ferraz Gonçalvesa,
Carla AlmeidabJoana AmorimcRita BaltasardJoana BatistaeYusianmar BorrerofJoão Pedro FallégIgor FariahManuel HenriquesiHelena MaiajTeresa FernandeskMariana MoreiralSusana MoreiramCamila NevesnAna RibeirooAna SantospFilipa SilvaqSusana SoaresrCristina SousasJoana VicentetRita Xavieru
Corresponding author
a Portuguese Institute of Oncology, Palliative Care, Porto, Portugal
b Unidade de Saúde Familiar Famílias, Santa Maria da Feira, Portugal
c Unidade de Saúde Familiar Santa Clara, Póvoa de Varzim/Vila do Conde, Portugal
d Unidade de Saúde Familiar Santa Maria, Bragança, Portugal
e Unidade de Saúde Familiar Terras de Ferreira, Paços de Ferreira, Portugal
f Unidade de Saúde Familiar Lethes, Ponte de Lima, Portugal
g Unidade de Saúde Familiar Lagoa – Senhora da Hora, Matosinhos, Portugal
h Unidade de Saúde Familiar Gil Eanes, Viana do Castelo, Portugal
i Unidade de Saúde Familiar Ramalde, Aldoar, Porto, Portugal
j Unidade de Saúde Familiar Porta do Sol, Matosinhos, Portugal
k Unidade de Saúde Familiar Infesta, Matosinhos, Portugal
l Unidade de Saúde Familiar Mar, Póvoa de Varzim/Vila do Conde, Portugal
m Unidade de Saúde Familiar Arco do Prado, Gaia, Portugal
n Unidade de Saúde Familiar São Mamede Infesta, Matosinhos, Portugal
o Unidade de Saúde Familiar Oceanos, Matosinhos, Portugal
p Unidade de Saúde Familiar São João, Porto, Portugal
q Unidade de Saúde Familiar Nova Lousada, Lousada, Portugal
r Unidade de Saúde Familiar São Martinho, Penafiel, Portugal
s Unidade de Saúde Familiar Renascer, Gondomar, Portugal
t Unidade de Saúde Familiar Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal
u Unidade de Saúde Familiar Aldoar, Porto, Portugal
Ver másRead
6968
Timeswas read the article
1077
Total PDF
5891
Total HTML
Share statistics
array:24 [ "pii" => "S2444866417300697" "issn" => "24448664" "doi" => "10.1016/j.pbj.2017.05.004" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "89" "copyright" => "PBJ-Associação Porto Biomedical/Porto Biomedical Society" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Porto Biomed J. 2017;2:250-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2330 "formatos" => array:3 [ "EPUB" => 180 "HTML" => 1664 "PDF" => 486 ] ] "itemSiguiente" => array:19 [ "pii" => "S2444866417300028" "issn" => "24448664" "doi" => "10.1016/j.pbj.2017.05.002" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "87" "copyright" => "PBJ-Associação Porto Biomedical/Porto Biomedical Society" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Porto Biomed J. 2017;2:254-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1827 "formatos" => array:3 [ "EPUB" => 154 "HTML" => 1190 "PDF" => 483 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Transition to the family caregiver role in Portugal" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "254" "paginaFinal" => "259" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patrícia Fernandes Antunes, Paulo Alexandre Oliveira Marques" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Patrícia Fernandes" "apellidos" => "Antunes" ] 1 => array:2 [ "nombre" => "Paulo Alexandre Oliveira" "apellidos" => "Marques" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0200" class="elsevierStylePara elsevierViewall">This paper identifies a set of constraints experienced by FC in the caregiver role.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0205" class="elsevierStylePara elsevierViewall">This paper identifies difficulties experienced by FC.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Urgent care nurses should address the FC constraints and difficulties.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444866417300028?idApp=UINPBA00004N" "url" => "/24448664/0000000200000006/v1_201711081124/S2444866417300028/v1_201711081124/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2444866417300740" "issn" => "24448664" "doi" => "10.1016/j.pbj.2017.05.001" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "86" "copyright" => "PBJ-Associação Porto Biomedical/Porto Biomedical Society" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Porto Biomed J. 2017;2:247-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1774 "formatos" => array:3 [ "EPUB" => 164 "HTML" => 1178 "PDF" => 432 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Is there a T.R.U.M.P. brain? Implications for mental health and world peace" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "249" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Óscar F. Gonçalves, Paulo S. Boggio" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Óscar F." "apellidos" => "Gonçalves" ] 1 => array:2 [ "nombre" => "Paulo S." "apellidos" => "Boggio" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Specific mind-brain processes are associated with political attitudes.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">The risks of a T.R.U.M.P. mindset are highlighted.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">An alternative G.A.N.D.H.I. mindset is suggested.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444866417300740?idApp=UINPBA00004N" "url" => "/24448664/0000000200000006/v1_201711081124/S2444866417300740/v1_201711081124/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Information of patients with life-threatening diseases: A survey of the attitude of Portuguese family practitioners" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "253" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José A. Ferraz Gonçalves, Carla Almeida, Joana Amorim, Rita Baltasar, Joana Batista, Yusianmar Borrero, João Pedro Fallé, Igor Faria, Manuel Henriques, Helena Maia, Teresa Fernandes, Mariana Moreira, Susana Moreira, Camila Neves, Ana Ribeiro, Ana Santos, Filipa Silva, Susana Soares, Cristina Sousa, Joana Vicente, Rita Xavier" "autores" => array:21 [ 0 => array:4 [ "nombre" => "José A." "apellidos" => "Ferraz Gonçalves" "email" => array:1 [ 0 => "ferrazg@ipoporto.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carla" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Joana" "apellidos" => "Amorim" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Rita" "apellidos" => "Baltasar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Joana" "apellidos" => "Batista" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Yusianmar" "apellidos" => "Borrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "João Pedro" "apellidos" => "Fallé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "Igor" "apellidos" => "Faria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "Manuel" "apellidos" => "Henriques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Helena" "apellidos" => "Maia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">j</span>" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "Teresa" "apellidos" => "Fernandes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">k</span>" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "Mariana" "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">l</span>" "identificador" => "aff0060" ] ] ] 12 => array:3 [ "nombre" => "Susana" "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">m</span>" "identificador" => "aff0065" ] ] ] 13 => array:3 [ "nombre" => "Camila" "apellidos" => "Neves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">n</span>" "identificador" => "aff0070" ] ] ] 14 => array:3 [ "nombre" => "Ana" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">o</span>" "identificador" => "aff0075" ] ] ] 15 => array:3 [ "nombre" => "Ana" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">p</span>" "identificador" => "aff0080" ] ] ] 16 => array:3 [ "nombre" => "Filipa" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">q</span>" "identificador" => "aff0085" ] ] ] 17 => array:3 [ "nombre" => "Susana" "apellidos" => "Soares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">r</span>" "identificador" => "aff0090" ] ] ] 18 => array:3 [ "nombre" => "Cristina" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">s</span>" "identificador" => "aff0095" ] ] ] 19 => array:3 [ "nombre" => "Joana" "apellidos" => "Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">t</span>" "identificador" => "aff0100" ] ] ] 20 => array:3 [ "nombre" => "Rita" "apellidos" => "Xavier" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">u</span>" "identificador" => "aff0105" ] ] ] ] "afiliaciones" => array:21 [ 0 => array:3 [ "entidad" => "Portuguese Institute of Oncology, Palliative Care, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidade de Saúde Familiar Famílias, Santa Maria da Feira, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidade de Saúde Familiar Santa Clara, Póvoa de Varzim/Vila do Conde, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidade de Saúde Familiar Santa Maria, Bragança, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidade de Saúde Familiar Terras de Ferreira, Paços de Ferreira, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidade de Saúde Familiar Lethes, Ponte de Lima, Portugal" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Unidade de Saúde Familiar Lagoa – Senhora da Hora, Matosinhos, Portugal" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Unidade de Saúde Familiar Gil Eanes, Viana do Castelo, Portugal" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Unidade de Saúde Familiar Ramalde, Aldoar, Porto, Portugal" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Unidade de Saúde Familiar Porta do Sol, Matosinhos, Portugal" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Unidade de Saúde Familiar Infesta, Matosinhos, Portugal" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Unidade de Saúde Familiar Mar, Póvoa de Varzim/Vila do Conde, Portugal" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Unidade de Saúde Familiar Arco do Prado, Gaia, Portugal" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "Unidade de Saúde Familiar São Mamede Infesta, Matosinhos, Portugal" "etiqueta" => "n" "identificador" => "aff0070" ] 14 => array:3 [ "entidad" => "Unidade de Saúde Familiar Oceanos, Matosinhos, Portugal" "etiqueta" => "o" "identificador" => "aff0075" ] 15 => array:3 [ "entidad" => "Unidade de Saúde Familiar São João, Porto, Portugal" "etiqueta" => "p" "identificador" => "aff0080" ] 16 => array:3 [ "entidad" => "Unidade de Saúde Familiar Nova Lousada, Lousada, Portugal" "etiqueta" => "q" "identificador" => "aff0085" ] 17 => array:3 [ "entidad" => "Unidade de Saúde Familiar São Martinho, Penafiel, Portugal" "etiqueta" => "r" "identificador" => "aff0090" ] 18 => array:3 [ "entidad" => "Unidade de Saúde Familiar Renascer, Gondomar, Portugal" "etiqueta" => "s" "identificador" => "aff0095" ] 19 => array:3 [ "entidad" => "Unidade de Saúde Familiar Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal" "etiqueta" => "t" "identificador" => "aff0100" ] 20 => array:3 [ "entidad" => "Unidade de Saúde Familiar Aldoar, Porto, Portugal" "etiqueta" => "u" "identificador" => "aff0105" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0020" class="elsevierStylePara elsevierViewall">The disclosure of information about diagnosis and mainly about prognosis of life-threatening diseases is one of the most difficult parts of being a doctor.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–3</span></a> However, most patients want to know what is happening to them and what their future is likely to be,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> although not all studies bear out this statement.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> There are many differences between countries all over the world with regard to diagnosis and prognosis disclosure practices. Even in Europe there are differences between countries, with doctors from Northern European countries being more prone to disclosure than Southern and Eastern European doctors.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6–11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Family physicians play a very important role in public health systems. In fact, they are the base of national health services, which most people resort to in all phases of life to maintain their health and when they need help. Even when other specialties are needed, contact with the general practitioner or the family doctor is maintained. Usually they cover most of the national territories. Therefore, they come into contact with patients with a wide range of different diseases including life-threatening ones, such as cancer or organ failure. Some years ago, we carried out surveys on the practice of doctors at an oncological center about information disclosure,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and on patients’ preferences and experiences with the disclosure of cancer diagnosis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Both studies were carried out in the Porto Center of the Portuguese Institute of Oncology. However, relative to what doctors in other specialties concerning this topic do, no studies have been carried out in Portugal, as far as we know, and general practitioners with such wide ranging activities have a great influence on the entire health system. Therefore, their practice and opinions are certainly very important, which is why we have carried out this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Most family medicine trainees in Northern Portugal do a one-month internship in our palliative care department. Some of these doctors, one per family practice center, were the researchers responsible for conducting the study in their center.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A questionnaire was specifically developed for this survey, based on one of the previous studies indicated above. It was evaluated by ten clinicians and modified according to their suggestions. Then the questionnaire was circulated by all the researchers involved in this survey and some of them also suggested further adjustments to the questionnaire.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The questionnaire included questions about demographic data, on informing patients and their families of diagnoses and prognoses for life-threatening diseases and involvement in treatment decisions. The questions were answered using a verbal rating scale (always, often, sometimes, rarely, never).</p><p id="par0045" class="elsevierStylePara elsevierViewall">All family doctors dealing with patients autonomously willing to participate were included.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variables were analyzed by proportions and means. To evaluate the existence or not of associations between categorical variables, the chi-square test was used. The level of significance was deemed to be 0.05. SPSS (Statistical Package for Social Sciences) version 24.0 statistical software was used to analyze the data. Missing data were omitted, an approach usually called listwise deletion or complete case analysis.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The protocol was approved by the Ethics Committee of the Northern Portuguese Health Authority and authorized by the medical directors at each center.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study was carried out in January 2013. The questionnaire was sent to 20 family health centers all over Northern Portugal. The questionnaire was delivered to 196 doctors from the about 1800 working in that region. Of these doctors, 159 (81%) participated in this study, with a range of participation between 56% and 100% of the doctors working in each center. The median age was 43 (26–64) and 108 (68%) of them were female. One hundred thirteen (71%) were married and 132 (83%) were Roman Catholic (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diagnosis</span><p id="par0065" class="elsevierStylePara elsevierViewall">One hundred seven (67%) doctors disclosed the diagnosis on principle often or always, with a significant difference between genders: 78% of men vs. 62% of women (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04). That rate rose to 81% when patients requested the disclosure. One hundred two (64%) proactively questioned patients about their wish to know the diagnosis and then decided whether to convey it or not (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Sixty-one 61 (38%) would use the term cancer often but only 11 (7%) used that word always. In this case, dividing doctors by the median age, we found that the younger ones used the term cancer more frequently than the older ones: 39 (49%) vs. 22 (28%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). One hundred nineteen (75%) used euphemisms at least sometimes. The word most used was tumor, 86 (54%), followed by lump, 41 (26%). 92 (58%) disclosed the diagnosis to families on principle often to always, with the older ones doing it more frequently: 53 (67%) vs. 39 (49%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). This percentage increases to 82% if the patient is cognitively incompetent (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). For 85 (54%) the disclosure is psychologically deleterious often to always, and for 117 (74%) the disclosure has a detrimental effect on patients’ hope. On the other hand, 90 (57%) think that the disclosure gives patients control of the situation often to always and another 57 (36%) answered sometimes. In the experience of 37 (23%) doctors, families frequently ask them not to disclose the diagnosis to the patient and another 84 (53%) answered that families sometimes do that. On taking families’ opinions into account, 61 (38%) do so often to always and 75 (47%) do so sometimes.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Prognosis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Fourty-seven (30%) doctors disclose the prognosis on principle often or always and 54 (34%) do so sometimes. The rate of doctors who often disclose the prognosis rose to 48% when patients requested the disclosure. Seventy-three (46%) often questioned patients proactively about their wish to know the prognosis and then decided whether to convey it or not (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). When disclosing the prognosis, 120 (76%) doctors do not try to give a precise time to death (e.g. 3 months) but they try to give an idea which would be useful. Fifty-nine (37%) disclosed the prognosis to families on principle often to always and 57 (36%) do so sometimes; 23 (15%) doctors only do that with the patients’ authorization. The percentage of doctors who disclose the prognosis often to always increases to 70% if the patient is cognitively incompetent (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). For 69 (43%) the disclosure is psychologically deleterious often to always and another 72 (45%) answered sometimes. For 43 (27%) the disclosure has a detrimental effect on patients’ hope often to always; the older ones have that opinion more often than the younger ones: 29 (37%) vs. 14 (18%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.023). On the other hand, 69 (43%) think that the disclosure gives patients control of the situation often to always and another 61 (38%) answered sometimes. Forty-five (28%) doctors answered that families frequently ask them not to disclose the prognosis to the patient; the older ones gave that answer more often than the younger ones: 28 (35%) vs. 17 (21%). Fifty (31%) take the families’ opinion into account often to always and 85 (54%) do so sometimes.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Treatment decision</span><p id="par0075" class="elsevierStylePara elsevierViewall">One hundred eleven (70%) doctors say that patients often ask questions about the treatment they will be submitted to. One hundred two (64%) doctors include patients in treatment decisions often or always. One hundred four (65%) doctors say that families often ask questions about treatment. The families are usually included in treatment decisions by 52 (33%) of the doctors and this rate rises to 72% if the patient is cognitively incompetent. Only 13 (8%) think that the involvement of the patients in treatment decisions has a negative psychological impact, while 106 (67%) think that the involvement gives patients’ control of the situation.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Physicians’ demographic variables had no significant influence on their attitudes about the involvement of patients and families in treatment decisions.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In this study, 67% of the family physicians disclose the diagnosis of a life-threatening disease such as cancer on principle. This percentage is much higher than the 31% of oncologists in the study carried out about 13 years ago.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> The percentage of patients who are proactively questioned about their desire for information is also reasonable. This topic cannot be directly compared with the former study, but the results suggest that that practice was not common. Even if the usual practice now is to disclose more often, most doctors avoid the word cancer, using euphemisms. Curiously, the term most used was tumor, which seems to be close to cancer. The scientific literature on this topic is contradictory with some authors favoring the use of euphemisms<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> while others are against their use.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> However, those opinions are based on clinical experience and good sense not on research.</p><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to prognosis, fewer physicians convey it systematically. The results of an earlier study carried out in our hospital, although not questioned directly on prognosis disclosure, suggested that prognosis is addressed less often than diagnosis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> This aspect seems to be universal.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15,16</span></a> In fact, doctors seem more reluctant to discuss a poor prognosis than a poor diagnosis. The impact that a poor prognosis may have on patients could be an explanation, but the uncertainty about prognostication, requests from family members to withhold information and the lack of proper training in communication also play a role.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15–17</span></a> However, the results of this study, surprisingly, show that doctors deemed the negative impact of diagnosis disclosure higher than that of prognosis. It is not clear why this is so. The opinion on the negative psychological impact of breaking bad news is not supported by most studies which indicate that non-disclosure has a higher probability of negatively influencing the patients’ mental health than the disclosure,<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,18</span></a> but there are exceptions.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Most doctors when disclosing the prognosis do not give a precise time to live but a general idea that can be useful for patients. This seems to be a wise attitude because the precise time that a particular patient has to live is something that nobody really knows. Therefore, trying to give a precise date for death is doomed to failure.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Many families try to prevent the disclosure of diagnosis and prognosis and many family physicians take their opinion into account. This is not rare in many countries such as those of Southern Europe.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7–9</span></a> Family doctors disclose diagnosis and prognosis to families often, mainly when the patient is cognitively incompetent. However, the disclosure is not as high as it was in the former study<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> when practically all families were informed. The practice of informing patients about their situation seems, however, to be generally improving.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients and families ask questions on treatment often and doctors mainly include patients in treatment decisions. Families are included mainly when the patient is cognitively incompetent.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding the influence of gender and age on disclosure practice, women disclose the diagnosis less often than men for unclear reasons. But what seems to be occurring is a trend of younger doctors to see the communication of bad and sad news to patients in a more positive way than the older ones.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">General practitioners disclose the diagnosis of a chronic life-threatening disease often, especially at patients’ request. It is also frequent to disclose the diagnosis to family members mainly when patients are cognitively impaired. General practitioners do not disclose the prognosis of a life-threatening disease often, even at patients’ request, especially the older ones. Most doctors take the families’ request not to disclose the prognosis into account. They think that the disclosure may affect hope but may also give patients more control of the situation.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The practice of informing patients about their situation seems to be improving, mainly among younger doctors.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres936414" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres936413" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusion" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec910505" "titulo" => "Keywords" ] 3 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 4 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 5 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Prognosis" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Treatment decision" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack316215" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-08" "fechaAceptado" => "2017-05-31" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec910505" "palabras" => array:4 [ 0 => "Family practitioners" 1 => "Diagnosis disclosure" 2 => "Prognosis disclosure" 3 => "Treatment decisions" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">The attitudes of family physicians regarding breaking bad news are heterogeneous.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Younger doctors seem to see the delivery of bad news more positively.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">This trend suggests that there will be a more open communication in the future.</p></li></ul></p></span>" ] "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Family practice is the specialty with the highest number of doctors and covers all of Portugal, but, as far as we know, no studies have been carried out on the attitudes and practices of Portuguese family practice doctors about breaking bad news. However, the attitude of these doctors may have a high impact on patients.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To study the practice of family physicians on breaking bad news.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A questionnaire, specifically developed for this survey, was given to 196 doctors about 10% of the family physicians of Northern Portugal.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">One hundred fifty-nine (81%) of them participated in this study. The median age was 43 (26–64) and 108 (68%) of them were female. One hundred and seven (67%) doctors disclosed on principle the diagnosis and that rate rose to 81% when patients requested the disclosure. One hundred and two (64%) proactively questioned patients about their wish to know the diagnosis and then decided whether to convey it or not. Forty-seven 47 (30%) doctors disclosed the prognosis on principle and that rate rose to 48% when patients requested the disclosure. Seventy-three (46%) often questioned patients proactively about their wish to know the prognosis and then decided whether to convey it or not. One hundred and two (64%) doctors frequently include patients in treatment decisions. Physicians think that the disclosure may affect hope but may also give patients more control of the situation.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Family practitioners disclose the diagnosis of a chronic life-threatening disease often, especially at patients’ request. General practitioners do not disclose the prognosis of a life-threatening disease often, even at patients’ request.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age (years)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>35–44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>45–54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>55–64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Marital status</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Single \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Divorced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Religion</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Catholic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Number of patients with life-threatening diseases in the last year</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10–14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>15–29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1582955.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Demographic data.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prognosis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">On principle</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">At patient request</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Ask patients if they want to know</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1582953.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Diagnosis and prognosis disclosure to patients.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prognosis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">On principle</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">At families request</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">If patient authorizes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">If the patient is cognitively incompetent</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Always/often \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1582954.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnosis and prognosis disclosure to families.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breaking Bad News" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.K. Vandekieft" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Fam Phys" "fecha" => "2001" "volumen" => "64" "paginaInicial" => "1975" "paginaFinal" => "1978" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breaking bad news: the S-P-I-K-E-S strategy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. Buckman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Commun Oncol" "fecha" => "2005" "volumen" => "2" "paginaInicial" => "138" "paginaFinal" => "142" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complexities in prognostication in advanced cancer: “to help them live their lives the way they want to”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.B. Lamont" 1 => "N.A. Christakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.290.1.98" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2003" "volumen" => "290" "paginaInicial" => "98" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12837717" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0920996414000723" "estado" => "S300" "issn" => "09209964" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Truth may hurt but deceit hurts more: communication in palliative care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.J. Fallowfield" 1 => "V.A. Jenkins" 2 => "H.A. Beveridge" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0269216302pm575oa" "Revista" => array:6 [ "tituloSerie" => "Palliat Med" "fecha" => "2002" "volumen" => "16" "paginaInicial" => "297" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12132542" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preferences of cancer patients regarding communication of bad news: a systematic literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Fujimori" 1 => "Y. Uchitomi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jjco/hyn159" "Revista" => array:6 [ "tituloSerie" => "Jpn J Clin Oncol" "fecha" => "2009" "volumen" => "39" "paginaInicial" => "201" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19190099" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Attitudes toward informing the cancer patient – a survey of Norwegian physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.H. Loge" 1 => "S. Kaasa" 2 => "Ø. Ekeberg" 3 => "E. Falkum" 4 => "K. Hytten" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "1996" "volumen" => "32A" "paginaInicial" => "1344" "paginaFinal" => "1348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8869097" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physicians’ attitudes to and problems with truth-telling to cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Grassi" 1 => "T. Giraldi" 2 => "E.G. Messina" 3 => "K. Magnani" 4 => "E. Valle" 5 => "G. Cartei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer" "fecha" => "2000" "volumen" => "8" "paginaInicial" => "40" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10650896" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer diagnosis disclosure in a Spanish hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Estapé" 1 => "H. Palombo" 2 => "E. Hernandez" 3 => "M. Daniels" 4 => "T. Estapé" 5 => "J.J. Grau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Oncol" "fecha" => "1992" "volumen" => "3" "paginaInicial" => "451" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1498063" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disclosure of diagnostic information to cancer patients in Greece" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Mystakidou" 1 => "C. Liossi" 2 => "L. Viachos" 3 => "J. Papadimitriou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/026921639601000303" "Revista" => array:6 [ "tituloSerie" => "Palliat Med" "fecha" => "1996" "volumen" => "10" "paginaInicial" => "195" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8817589" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and prognosis disclosure among cancer patients. Results from an Italian mortality follow-back survey" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Costantini" 1 => "G. Morasso" 2 => "M. Montella" 3 => "P. Borgia" 4 => "R. Cecioni" 5 => "M. Beccaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/annonc/mdl028" "Revista" => array:6 [ "tituloSerie" => "Ann Oncol" "fecha" => "2006" "volumen" => "17" "paginaInicial" => "853" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16551764" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Attitudes of Polish physicians and medical students toward breaking bad news, Euthanasia and morphine administration in cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Leppert" 1 => "M. Majkowicz" 2 => "M. Forycka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13187-013-0553-2" "Revista" => array:6 [ "tituloSerie" => "J Cancer Educ" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "603" "paginaFinal" => "610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24170311" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis disclosure in a Portuguese oncological centre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Ferraz Gonçalves" 1 => "S. Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/026921601676515878" "Revista" => array:6 [ "tituloSerie" => "Palliat Med" "fecha" => "2001" "volumen" => "15" "paginaInicial" => "35" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11212466" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breaking bad news: experiences and preferences of advanced cancer patients at a Portuguese oncology centre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Gonçalves" 1 => "Á. Marques" 2 => "S. Rocha" 3 => "P. Leitão" 4 => "T. Mesquita" 5 => "S. Moutinho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0269216305pm1070oa" "Revista" => array:6 [ "tituloSerie" => "Palliat Med" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "526" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16295284" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychosocial aspects of care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Twycross" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Introducing palliative care" "paginaInicial" => "21" "paginaFinal" => "30" "edicion" => "4th ed." "serieFecha" => "2003" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Hancock" 1 => "J.M. Clayton" 2 => "S.M. Parker" 3 => "S. Wal der" 4 => "P.N. Butow" 5 => "S. Carrick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0269216307080823" "Revista" => array:6 [ "tituloSerie" => "Palliat Med" "fecha" => "2007" "volumen" => "21" "paginaInicial" => "507" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846091" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "‘Hitting you over the head’: oncologists’ disclosure of prognosis to advanced cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Gordon" 1 => "C.K. Daugherty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bioethics" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "142" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12812182" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What are terminally ill cancer patients told about their expected deaths?. A study of cancer physicians’ self-reports of prognosis disclosure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.K. Daugherty" 1 => "F.J. Hlubocky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2008.17.2221" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "5988" "paginaFinal" => "5993" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19029419" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Horikawa" 1 => "T. Yamazaki" 2 => "M. Sagawa" 3 => "T. Nagata" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gen Hosp Psychiat" "fecha" => "1999" "volumen" => "21" "paginaInicial" => "368" "paginaFinal" => "373" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychiatric morbidity among cancer patients and awareness of illness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.C. Atesci" 1 => "B. Baltalarli" 2 => "N.K. Oguzhanoglu" 3 => "F. Karadag" 4 => "O. Ozdel" 5 => "N. Karagoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00520-003-0585-y" "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer" "fecha" => "2004" "volumen" => "12" "paginaInicial" => "161" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14747937" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolution of truth-telling attitudes and practices in Italy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Surbone" 1 => "C. Ritossa" 2 => "A.G. Spagnolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.critrevonc.2004.09.002" "Revista" => array:6 [ "tituloSerie" => "Crit Rev Oncol Hematol" "fecha" => "2004" "volumen" => "52" "paginaInicial" => "165" "paginaFinal" => "172" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15582784" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack316215" "titulo" => "Acknowledgments" "texto" => "<p id="par0130" class="elsevierStylePara elsevierViewall">This work was supported in part by the North Portugal Section of the Portuguese League against Cancer.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24448664/0000000200000006/v1_201711081124/S2444866417300697/v1_201711081124/en/main.assets" "Apartado" => array:4 [ "identificador" => "56201" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24448664/0000000200000006/v1_201711081124/S2444866417300697/v1_201711081124/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444866417300697?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 58 | 3 | 61 |
| 2024 September | 155 | 9 | 164 |
| 2024 August | 104 | 11 | 115 |
| 2024 July | 66 | 4 | 70 |
| 2024 June | 77 | 4 | 81 |
| 2024 May | 86 | 2 | 88 |
| 2024 April | 76 | 29 | 105 |
| 2024 March | 71 | 11 | 82 |
| 2024 February | 76 | 5 | 81 |
| 2024 January | 103 | 9 | 112 |
| 2023 December | 64 | 13 | 77 |
| 2023 November | 61 | 14 | 75 |
| 2023 October | 95 | 5 | 100 |
| 2023 September | 67 | 2 | 69 |
| 2023 August | 105 | 11 | 116 |
| 2023 July | 82 | 7 | 89 |
| 2023 June | 62 | 7 | 69 |
| 2023 May | 107 | 6 | 113 |
| 2023 April | 74 | 7 | 81 |
| 2023 March | 104 | 3 | 107 |
| 2023 February | 69 | 10 | 79 |
| 2023 January | 68 | 7 | 75 |
| 2022 December | 65 | 8 | 73 |
| 2022 November | 84 | 15 | 99 |
| 2022 October | 69 | 9 | 78 |
| 2022 September | 69 | 19 | 88 |
| 2022 August | 63 | 11 | 74 |
| 2022 July | 40 | 15 | 55 |
| 2022 June | 55 | 15 | 70 |
| 2022 May | 58 | 19 | 77 |
| 2022 April | 37 | 18 | 55 |
| 2022 March | 74 | 11 | 85 |
| 2022 February | 83 | 11 | 94 |
| 2022 January | 66 | 11 | 77 |
| 2021 December | 59 | 14 | 73 |
| 2021 November | 67 | 14 | 81 |
| 2021 October | 78 | 17 | 95 |
| 2021 September | 65 | 10 | 75 |
| 2021 August | 75 | 7 | 82 |
| 2021 July | 43 | 10 | 53 |
| 2021 June | 63 | 10 | 73 |
| 2021 May | 54 | 9 | 63 |
| 2021 April | 147 | 17 | 164 |
| 2021 March | 106 | 10 | 116 |
| 2021 February | 80 | 12 | 92 |
| 2021 January | 66 | 16 | 82 |
| 2020 December | 66 | 8 | 74 |
| 2020 November | 71 | 8 | 79 |
| 2020 October | 51 | 6 | 57 |
| 2020 September | 71 | 10 | 81 |
| 2020 August | 52 | 13 | 65 |
| 2020 July | 61 | 18 | 79 |
| 2020 June | 52 | 7 | 59 |
| 2020 May | 68 | 10 | 78 |
| 2020 April | 90 | 9 | 99 |
| 2020 March | 114 | 10 | 124 |
| 2020 February | 97 | 11 | 108 |
| 2020 January | 70 | 10 | 80 |
| 2019 December | 39 | 8 | 47 |
| 2019 November | 31 | 4 | 35 |
| 2019 October | 26 | 9 | 35 |
| 2019 September | 18 | 16 | 34 |
| 2019 August | 52 | 7 | 59 |
| 2019 July | 60 | 6 | 66 |
| 2019 June | 84 | 33 | 117 |
| 2019 May | 92 | 48 | 140 |
| 2019 April | 58 | 10 | 68 |
| 2019 March | 90 | 6 | 96 |
| 2019 February | 82 | 6 | 88 |
| 2019 January | 87 | 4 | 91 |
| 2018 December | 102 | 3 | 105 |
| 2018 November | 88 | 6 | 94 |
| 2018 October | 140 | 9 | 149 |
| 2018 September | 27 | 6 | 33 |
| 2018 August | 40 | 28 | 68 |
| 2018 July | 39 | 21 | 60 |
| 2018 June | 34 | 19 | 53 |
| 2018 May | 33 | 20 | 53 |
| 2018 April | 66 | 26 | 92 |
| 2018 March | 94 | 39 | 133 |
| 2018 February | 65 | 32 | 97 |
| 2018 January | 27 | 17 | 44 |
| 2017 December | 28 | 24 | 52 |
| 2017 November | 28 | 23 | 51 |
| 2017 October | 0 | 11 | 11 |
| 2017 September | 0 | 11 | 11 |
| 2017 August | 2 | 12 | 14 |
| 2017 July | 0 | 6 | 6 |
Show all