Background:Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China.Objective:The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling.Research design:A quantitative survey with three closed-ended questionnaires was conducted.Participants:In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, (...) and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure.Ethical considerations:This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement.Findings:A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis ( p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients.Discussion:The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed.Conclusion:Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient’s willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient’s care team, especially nurses, could be integrated in the process of truth-telling. (shrink)

L(ow) tone in Mandarin Chinese causes both downstep and post-low-bouncing. Downstep refers to the lowering of a H(igh) tone after a L tone, which is usually measured by comparing the H tones in a “H…HLH…H” sentence with a “H…HHH…H” sentence (cross-comparison), investigating whether downstep sets a new pitch register for the scaling of subsequent tones. Post-low-bouncing refers to the raising of a H tone after a focused L tone. The current study investigates how downstep and post-low-bouncing interact with focus and (...) phrasing in Mandarin Chinese. In the experiment, we systematically manipulated (a) the tonal environment by embedding two syllables with either LH or HH tone (syllable X and Y) sentence-medially in the same carrier sentences containing only H tones; (b) boundary strength between X and Y by introducing either a syllable boundary or a phonological phrase boundary; and (c) information structure by either placing a contrastive focus in the HL/HH word (XF), syllable Y (YF), or the sentence-final word (ZF). A wide-focus condition served as the baseline. With systematic control of focus and boundary strength around the L tone, the current study shows that the downstep effect in Mandarin is quite robust, lasting for 3–5 H tones after the L tone, but eventually levelling back again to the register reference line of a H tone. The way how focus and phrasing interact with the downstep effect is unexpected. Firstly, sentence-final focus has no anticipatory effect on shortening the downstep effect; instead, it makes the downstep effect lasts longer as compared to the wide focus condition. Secondly, the downstep effect still shows when the H tone after the L tone is on-focus (YF), in a weaker manner than the wide focus condition, and is overridden by the post-focus-compression. Thirdly, the downstep effect gets greater when the boundary after the L tone is stronger, because the L tone is longer and more likely to be creaky. We further analyzed downstep by measuring the F0 drop between the two H tones surrounding the L tone (sequential-comparison). Comparing it with F0 drop in all-H sentences (i.e., declination), it showed that the downstep effect was much greater and more robust than declination. However, creaky voice in the L tone was not the direct cause of downstep. At last, when the L tone was under focus (XF), it caused a post-low-bouncing effect, which is weakened by a phonological phrase boundary. Altogether, the results showed that although intonation is largely controlled by informative functions, the physical-articulatory controls are relatively persistent, varying within the pitch range of 2.5 semitones. Downstep and post-low-bouncing in Mandarin Chinese thus seem to be mainly due to physical-articulatory movement on varying pitch, with the gradual tonal F0 change meeting the requirement of smooth transition across syllables, and avoiding confusion in informative F0 control. (shrink)