Um dizer que fala de vida e morte: revelações e silêncios na comunicação sobre o diagnóstico do câncer

Abstract

One of the problems faced by physicians in their practice with cancer patients refers to the dilemmas related to communication about the illness, especially because of the associations still present in the social imagination about death and suffering, which gives an important symbolic dimension to diagnosis. Interpreted as a social construct, the theme of cancer diagnosis is analyzed from the perspective of Brazilian physicians, at Ophir Loyola Hospital, a state public cancer hospital in Pará, north of Brazil, including a total of 20 informants, who agreed to take part in interviews focused on diagnosis communication, including disclosure of diagnosis and other information related to the diagnosis. Through a socio-anthropological approach, different variables are analyzed, including those related to the physician, the patient, the family and the illness, which enables comprehension and integration of the discourse in its social context, including some differences between public and private practice. Data suggest the physician-patient interaction is influenced by class condition, with its socio-historical and cultural determinant. This makes communicating diagnosis a complex phenomenon, aggravated by the limited access to health services, which contributes towards the great amount of patients who arrive at the hospital with no chances of cure. The results indicate that influence of the family on medical decision-making is determinant to the limits of information related to cancer diagnosis, including disclosure of diagnosis and prognosis. Hopelessness is frequently mentioned as a reason for non-disclosure, especially in advanced stages of cancer, with a progressive silence as the illness worsens.