1. Teaching about Telling the Truth of Terminal Cancer Dena Hsin-Chen Hsin China Medical University, Taiwan; Institute of Biological Sciences, University of Tsukuba.

2. Trails in Taiwan University; as first years General Education in English Course (five classes) High school; as selective topics in Science Course (one class)

3. Trails in five classes of paramedical department in medical university Department of Oral Hygiene ( ) Department of Public Health ( ) Department of Sport Medicine ( ) Department of Occupation Safety( ) Department of Cosmetics Pharmacy( )

4. Contents of learning Teams 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

5. 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

6. 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

7. Contents of learning Team 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

8. Talks of team members

9. Use media

10. Cluster discussions

11. Survey and discussion

12. 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%

13. 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)

14. Simple drama

15. Exciting

16. And Very crazy

17. Creative; to feel the pain

18. Invite guests to talks about their experiences

19. Arguments

20. Contents of learning Team 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 Submit assignments

21. Teacher's function; listen and ….

22. And listen….

23. Trail in High school students

24. Four topics( four hours) Autonomy Justice Benefits versus risks Telling the truth about terminal cancer

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

26. Your opinions in telling the truth….. (Responses from High School Students) Not support - 1/42 harm; refuse or give up or suicide Not sure – 2/42 wonder who can cope with the truth.... hard to prepare for.. Support – 39/42 right to know, truth/lie, to benefit from knowing, personal experiences from families, impossible to hide…in the last moment will harm more

27. 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, …

28. 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 / caring survival rate / quality of life the truth / the art of telling treat myself / treat others

29. 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

30. 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

31. 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

32. Brief targets in life education Respect for life, consider risks and benefits, understand better in diversity - bioethics education To think about ones death To reflex the personal experience of death Self improvement in death attitudes To prepare for the future profession

33. 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

34. Thanks for your attention, please enjoy our campus.

35. Topics selection of bioethics presentation

36. Department of Oral hygiene ( ) 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

37. Topics selection of bioethics presentation Cosmetics Pharmacy ( ) 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

38. # 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

39. Play