Teaching about “Telling the Truth of Terminal Cancer”

Dena Hsin-Chen HsinChina Medical University, Taiwan;

Institute of Biological Sciences, University of Tsukuba.

Trails in Taiwan

• University;

as first year’s General Education in

English Course (five classes)

• High school;

as selective topics in Science Course

(one class)

Trails in five classes of paramedical department in medical university

• Department of Oral Hygiene (口腔衛生系 ) • Department of Public Health (公共衛生系 )• Department of Sport Medicine (運動醫學系 )• Department of Occupation Safety(職業安全系 )• Department of Cosmetics Pharmacy(藥物化粧系 )

Contents of learningTeams approach to present the topics

Pre-• Decide a chapter• Context review and references search• Design classroom activities

Presentation• Short talks, drama, cluster discussion, result of

questionnaire, invited guests talks, film show,…

Post-Summary or supplement from teacher

Review of chapter

selections

Class of Oral Hygiene 1. Organ donation

2. Animal right

3. Organ donation

4. Truth Telling

5. Euthanasia

6. Truth Telling

7. Euthanasia

Class of Cosmetics Pharmacy

1. GM foods

2. Truth Telling

3. Organ donation

4. Organ donation

5. Euthanasia

6. GM foods

7. Lifestyle and fertility

8. Euthanasia

Class of Occupation Safety

1. Cars use

2. GM foods

3. Organ donation

4. Organ donation

5. Animal rights

6. Truth Telling

7. GM foods

8. Organ donation

Class of Public Health

1. GM foods

2. GM foods

3. Lifestyle and fertility

4. Animal right

5. GM foods

6. Cars use

7. Lifestyle and fertility

8. Lifestyle and fertility

9. Truth telling

Class of Sport Medicine

1. Sustainable development

2. Sustainable development

3. GM foods

4. Truth Telling

5. Euthanasia

6. Truth Telling

7. Euthanasia

8. GM foods

9. Organ donation

10. Organ donation

Reasons of choosing Truth Telling as a Topic

• Some has experience and deep thought to share

• Popular, important and easy to understand

• Close to us , easy to prepare, in unanimity

• To prepare oneself in helping the patients

• Have ever think abut it and would like to discuss with others.

• Would like to face the truth of life

Contents of learningTeam approach to present the topics

Pre-• Decide a chapter• Context review and references search• Design classroom activities

Presentation• Short talks, drama, cluster discussion,

results of survey, invited guests' talks, film show,…

Post-Summary or supplement from teacher

Talks of team members

Use media

Cluster discussions

Survey and discussion

For example; Questionnaire Survey of public opinions in truth telling

(60 randomized samples in the campus)

1. Would you like to know if you had terminal cancer?

Yes : No = 65 : 35%

2. Would you tell your mother or father if they had terminal cancer?

Yes : No = 53 : 47%

In the class; (after the presentation)

1. Would you like to know if you had terminal cancer?

more than 90% (yes)

2. Would you tell your mother or father if they had terminal cancer?

less than 30% (yes)

Simple drama

Exciting

And Very crazy

Creative; to feel the pain

Invite guests to talks about their experiences

Arguments

Contents of learningTeam approach to present the topicsPre-• Decide a chapter• Context review and references search• Design classroom activities

Presentation• Short talks, drama, cluster discussion,

results of survey, invited guests talks, film show

Post-Summary or supplement from teacherSubmit assignments

Teacher's function; listen and ….

And listen….

Trail in High school students

Four topics( four hours)

• Autonomy

• Justice

• Benefits versus risks

• Telling the truth about terminal cancer

Benefit and risk in Nuclear Power use agree or not ? 23 : 8

Your opinions in telling the truth….. (Responses from High School Students)

Not support - 1/42 harm; refuse or give up or suicide

Not sure – 2/42wonder who can cope with the truth.... hard to prepare for..

Support – 39/42right to know, truth/lie, to benefit from knowing, personal experiences from families,impossible to hide…in the last moment will harm more

•Q1. If you only had a week to live, how would you like to spend that week?

Lots of fancy ideas. Do whatever I can do, some crazy things…no moral restriction /

stay with families, to make up for something or to live as usual,….

•Q2. Try to write a living will or advance directive (a document which says how you would like to be treated when dying) of your medical preference for your terminal stage.

……die in dignity and no pain, help me to die beautifully, save resource to others, Euthanasia, up to my parents, …

Comparisons and findings

• Difficulties in high school; Exam oriented teaching,

Not flexible in curriculum design

• Different levels of thinking in two groups.Fancy ideas / In-depth thinking;

curing / caringsurvival rate / quality of life

the truth / the art of telling treat myself / treat others

For example; Q1. If you only had a week to live, how would you like to spend that week?

•In high school; Lots of crazy ideas." I want to see…, do what I cannot do before …."

•In university; To say thanks (to my parents, to one who love

me…)

to say good bye (to have a farewell party, …)

To say sorry (to someone I...)

Letting go

Cultural influences in telling the truth about terminal cancer

During the presentation and discussion • Family Paternalism in medical decisions

• Death as a taboo

• Filial piety as a social norm to protect elderly from the truths

• Options of alternative and folk therapies

Role of teachers –

• To give space and offer facility for learning • To answer the real-life quandary; for Ex:

- Suggest the key points of communication skills in telling the truth…

- Introduce options other than traditional medical care, i.e. hospice care, natural death

- Offer the real situation in hospital settings, ex. 4 contexts of dying awareness

• To summarize and encourage

Brief targets in life education

Respect for life, consider risks and benefits, understand better in diversity

- bioethics education

• To think about one’s death

• To reflex the personal experience of death

• Self improvement in death attitudes

• To prepare for the future profession

Potential for the future

"Telling the truth about terminal patient" can be a chapter in:

• Bioethics course• Patient communication or interaction courses

and Pre-course in oncology studies.• "Life and death" education

Appropriate to put in "General education" of first or second year curriculums in medical university

Thanks for your attention, please enjoy our campus.

Topics selection of bioethics presentation

Topics selection of bioethics presentation

Department of Oral hygiene (口腔衛生系 )

• Organ donation To show the utmost love of human society • Animal right On the base of caring Animals

• Organ donation To consider more about our wishes to donate

• Truth Telling has to face the truth of life • Euthanasia A huge controversy issue; easy to search in net • Truth Telling A controversy issue, have ever think abut it,

and would like to discuss with others • Euthanasia Conflicts between humanity and benefits

Topics selection of bioethics presentation

Cosmetics Pharmacy (藥物化粧系 ) 1. GM foods Hot topics, get to know more about it

2. Truth Telling Some has experience and deep thought to share 3. Organ donation Disputable topics 4. Organ donation Should be more deliberative (even it is open now) 5. Euthanasia try to know more about it, easy to get attention 6. GM foods hot topics, lots of update references 7. Lifestyle and fertility related to female, and our personal concern

8. Euthanasia Interesting and disputable

# To learn by team works

• Students were group into team (4-6 persons a team)

• Select a chapter

• Search and read

• Design programme of class activities

Play