June 18, 2026

Navigating Truth and Protection: Communication in palliative care practice

By IAHPC Board Member Irena Laska
Executive Director, Mary Potter Palliative Care/Hospice Center, Korçë, Albania

"Please don't tell him he has cancer." 

Palliative care teams in Albania regularly hear variations of this request. Families speak from a place of love and protection, hoping to shield relatives from fear, despair, or loss of hope. Yet these conversations place healthcare professionals at a difficult intersection: where culture may clash with ethics and patient autonomy.

In palliative care, some of our most complex challenges are not clinical. Pain, breathlessness, nausea, and other symptoms can often be addressed through structured assessment and multidisciplinary care. More difficult are the moments when communication, culture, emotions, and ethical responsibilities collide.

The communication of touch is a staple at Mary Potter. Photo courtesy of Mary Potter Palliative Care/Hospice Center; used with permission.

Patients sense the truth

Over time, however, one lesson has become increasingly clear to me: silence is rarely absolute. Many patients sense the truth even when it is not explicitly spoken. They observe changes in treatment, notice the reactions of family members, and—even if facing illness largely alone—gradually form their own understanding of what is happening.

Dajana was a 48-year-old woman with advanced cancer of the base of the tongue. Although her prognosis had not been fully disclosed, she understood that her illness was progressing. As her condition advanced, Dajana lost the ability to swallow, then the ability to speak. Communication became possible only through writing.

‘Help me live. I want to eat.&rsquo

One note remains particularly vivid: "Help me live. I want to eat. Walk with me until the end. I do not want to die from hunger."

Her words expressed far more than physical distress, and she was seeking far more than information. Her words reflected fear of abandonment, a desire for dignity, and a profound need for reassurance that she would not face the end of life alone. We needed to reply with honesty, delivered with sensitivity.

When the team explored options to improve comfort and nutritional support, these were not considered possible because of the advanced stage of disease. The experience highlighted a broader challenge in palliative care: measures that improve comfort and dignity may be overlooked when cure is no longer possible.

Our experiences in Albania have shown us that communication in palliative care is not a choice between truth and silence, but a process of understanding a patient’s readiness and responding to their individual needs.

Respecting the patient’s pace

Simple questions often guide this process, such as, "What is your understanding of your illness?" and "How much would you like to know?"

These questions allow patients to determine the depth and pace of information while respecting the concerns and emotional burden carried by families. They create space for dialogue rather than confrontation.

Balancing cultural context with patient autonomy remains one of the most demanding aspects of palliative care practice in our setting. Families deserve respect for their protective intentions, yet patients should not be deprived of dignity, voice, or participation in decisions about their own care.

The ultimate balance

Ultimately, palliative care exists in the space between truth and protection. It is not about choosing one over the other, but about accompanying people through both. When communication is guided by compassion, honesty, and respect, patients and families need not face vulnerability alone.

Truth does not extinguish hope; it helps redefine it.

See Irena Laska’s bio.

Interested in reading more on the topic? Check out Embracing Conversations around Life’s Final Chapter by Gulnara Kunirova, published last year in Pallinews.