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February 24, 1993

Truth Telling: A Cultural or Individual Choice?

Author Affiliations

Istituto Mario Negri Milan, Italy
University of Southern California Los Angeles

JAMA. 1993;269(8):989. doi:10.1001/jama.1993.03500080036021

To the Editor.  —Dr Surbone1 discusses cross-cultural differences in oncologists' "truth telling" when communicating with patients. While the patients described in her article were terminally ill, for the majority of cancer patients the issue of open communication should be addressed well before the terminal stage. In earlier stages full disclosure allows not only for discussion of diagnosis and prognosis but, often, for patient involvement in important decision making. For example, as Surbone points out, patients with early-stage breast cancer are obvious candidates for involvement in decision making since breast-conserving and radical surgeries appear to have equivalent outcomes. Indeed, when given a choice between surgeries, women are willing and able to decide and are almost always satisfied with the outcomes of their choice.2 Evidence does not support fears that being given a choice is detrimental to patients.3 In countries such as Italy, where these fears are strong, the