However, because improvements in health care quality are made through commitments to base medical care on solid scientific evidence and innovative approaches (quoted in Rosswurm and Larrabee, 1999, p.317), there is an evident need for a change in practice.
Design for change in practice is largely based on the framework proposed by Rossuwurm and Larrabee (1999). According to Rossuwurm and Larrabee (1999), design for change in practice is manifested through protocols, procedures, or standards. In the case with communicating terminal diagnosis to patients in order to improve their quality of life design relies on the mechanism of protocols distributed to medical personnel. Since the overall complexity of design determines the likelihood of change acceptance (Rossuwurm and Larrabee, 1999, p.320), protocols contain only well-structured and detailed information regarding terminal diagnosis disclosure practice and follow up procedures aimed to improve patients’ quality of life. Because feedback from patients (stakeholders) is essential when designing a change in practice (Rossuwurm and Larrabee, 1999), design also includes a questionnaire produced to measure changes in patients’ quality of life.
(1) Practice of terminal diagnosis full disclosure. A full disclosure practice assumes a condition under which accurate and clearly understandable information on patient’s diagnosis is imparted. Physicians who fully disclose to their patients may convey the information either abruptly, or in stages. It is important to understand for nurses and physicians that abrupt disclosure may be emotionally harmful if a patient is not prepared for the prognosis. As explained by Fitch (1994) once a word like “cancer” or “terminal” is heard, a mental retreat is often enacted and thus true communication may not take place until the stark essence of the initial message has been