Background: When critical information about diagnosis or prognosis is partially or fully withheld from patients, a conspiracy of silence (COS) may occur. This scoping review aimed to map evidence on the reasons for, and consequences of, the COS in palliative care among patients, caregivers, and healthcare professionals (HCP). Methods: Searches were conducted in MEDLINE, Web of Science, and Scopus for studies published between 2000 and April 2025 on COS involving patients with life-limiting illness, their caregivers, and HCP in palliative care settings. Evidence was synthesized narratively, with critical appraisal of included studies. The protocol was registered on the Open Science Framework. Results: Twelve studies were included, mostly qualitative (66.67%), of moderate to high quality, predominantly European, and largely conducted in Spanish- and Portuguese-speaking contexts. Patients identified protection of family members as a major reason for COS, though their perspectives were underrepresented. Caregivers reported patient protection, cultural beliefs, expectations of recovery, and emotional overwhelm. HCP described similar motives, as well as prognostic uncertainty, limited communication skills, and fear of negative repercussions. Reported consequences included patients’ feelings of betrayal, isolation, loss of autonomy, and psychological distress; caregivers’ family conflict, complicated bereavement, and guilt; and HCP moral distress, communication barriers, and a sense of dehumanized care. Conclusions: Conspiracy of silence is a complex phenomenon that, despite good intentions, often causes harm. Compassionate, ethical communication is essential to protect autonomy and support families. Practice should strengthen HCP communication skills and disclosure policies, while research should develop interventions and expand evidence beyond cancer and high-income settings.
Ferreira-Nunes et al. (Fri,) studied this question.