Collusion in palliative care

  • Siew Beng Khoo
Keywords: Collusion, anxiety depression, guilt, ethical issues, cultural acceptance, truth telling


Collusion is generally an act of love and protection for a close relative from knowing the bad news with regard to diagnosis and prognosis of his/her illness. Evidence from research studies showed that although truth hurts, deceit may well hurt more. Filial duties and obligations form the basis for non disclosure in some cultures while principles of informed consent and patient autonomy are ethical and legal obligations to provide patients with as much information as possible in some countries. Collusion serves to isolate the patient, cause family disruption, incurs tremendous psychosocial stress on patient and relatives and leads to poor standard of healthcare. It is vital to assess for presence of collusion from the outset and to avoid this distressing dilemma. This case report is an example of the great cost of collusion on the carer’s part.


Fallowfield LJ, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med. 2002;16:297-303.

Jenkins V, Fallowfield L, Saul J. Information needs of patients with cancer: results from a large study in UK cancer centers. Br J Cancer. 2001;84:84-51.

Fielding RG, Hung J. Preferences for information and involvement in decisions during cancer care among a Hong Kong Chinese population. Psycho-Oncology. 1996;5:321-29.

Berger JT. Culture and ethnicity in clinical care. Arch Intern Med. 1998;158;2085-2090.

Uchitomi Y, Yamawaki S. Truth telling practice in cancer care in Japan. Ann NY Acad Sci. 1997;809:290-99.

Annas G. Informed consent, cancer and truth in prognosis. N Engl J Med. 1994;330:223-5.

Sykes J, Johnson R, Hanks GW. ABC of Palliative Care. Communication with patients, families and professionals. Edited by Fallon M and O’Neill B. BMJ books, 1998.

Khoo SB. Facts and fallacies in palliative care. Asia Pacific Family Medicine. 2003;2:143-7.

Faull C, Barton R. Managing complications of cancer, chapter 12. In: Faull C, Carter Y, Woof R. Handbook of Palliative Care. Blackwell Science, 1998.

Iconomou G, Viha A, Koutras A, et al. Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: a report from Greece. Palliat Med. 2002;16:315-21.

How to Cite
KhooS. B. (2006). Collusion in palliative care. Malaysian Family Physician, 1(2 & 3), 3. Retrieved from
Original Articles