El pacto de silencio en el final de la vida. Un análisis cualitativo sobre la perspectiva de los implicados en el fenómeno

Abstract

Introduction: The pact of silence, despite being a relatively frequent situation, has been hardly explored from the point of view of the subjects involved. Objective: To analyze and understand the characteristics of the phenomenon through the perspectives of all those involved (patient, family, and professionals). Method: A study with qualitative methodology carried out in Area IX of the SMS (Murcia region health system) using a focal group approach (2 groups of professionals and 1 group of relatives of the terminally ill), as well as a biographical method (using the narrative/life history of the terminal patient). Results: The conspiracy of silence negatively impacts coping in the terminally ill. There is a large emotional and cultural component that sometimes blocks communication between professionals, family, and patients. Palliative care professionals are better suited than primary care providers to deal with relationships and communications with terminal patients. Patients considered that knowledge of their diagnosis/prognosis was beneficial. Conclusions: The pact of silence has a marked sociocultural character. Professionals or relatives cannot be held responsible for this situation without considering the context in which it takes place (death as a modern taboo). Professionals who care for terminal patients must be trained in palliative care and communication skills.