[ginger58]

I bet she knows. If she were to ask me about her dx I would tell her as I feel the patient has a right to know. They may have some business (mental) to work on--closure.

[nurseatheart81]

Though you are not the person who should be giving the information to the patient, I feel everyone has a right to know that. Of course, as others have mentioned, there are a lot of factors playing in this...culture, family, POA-gaurdianship, etc.

In circumstances like this I always think, "Would I want to have this type of information withheld from me?" My answer would be "no". A person should have the right to make his or her end of life decisions and take care of their last wishes, will and property/finances, insurance, burial preparation, and final good-byes. This is beneficial not only to the patient, but to the grieving family and friends as well.

Once she is notified, then the right steps should be taken to support her through this time....chaplain, hospice, palliative care, counseling, etc. I would consult with your healthcare team.....other nurses, physicians, and designated family and friends involved in this patients care.

I had a similiar case where an elderly woman had terminal cancer. She was like an angel, so delicate, sweet, and kind. She was her own POA and yet everyone knew but her. The family did not want to tell her out of fear and not really knowing how to tell her. I thought it was highly unethical of the miscommunication of our healthcare team and her multiple physicians to let this go on. Good Luck!!

[Julian Dodd]

Originally Posted by ambil

Hmm, every case is unique. It helps to ask open ended questions and to be simply truthfull in an unobtrusive way. For example, when I have such a case I say sometimes, "I'm sorry that you are so sick, it must be really hard." The response given from the patient will help you to know in what direction to lead the conversation.
Ambil

I fully agree with ambil, whereas we generally beleive that patients deserve the truth, we have to accept that everyone copes differently, the approach suggested comes straight from the pages of validation therapy, it also works with disorientated elderly good luck to all
Julian

[Hospice Nurse LPN]

I bet she knows. If she were to ask me about her dx I would tell her as I feel the patient has a right to know. They may have some business (mental) to work on--closure.

I'll never understand why some families want to withhold info.

[dari98]

I kind of have personal experence with this. My grandfather was diagnosed with leukemia we decided not to tell him because we felt like he would give up. At the time of hi diagnoses he was 86 and had already gone through prostate cancer and treatment, the doctors felt his body was not strong enough to go through any type of treatment. We feel like we made the best descion for him at that time.

[yossaria]

To me it sounds that first of all we have to find an answer to another question - does the patient want to know? and if s/he does, how much? Of course, the answer to these qs have to be addressed by somebody confident with communicating bad news, and should not be done directly, I mean, straight to the point.

Every human being has the right to know what's going on with their bodies and how this can affect their lives. However, forcing information on patients who prefer to be in denial is not less than an abuse.

[hospicenurse]

Originally Posted by yossaria

To me it sounds that first of all we have to find an answer to another question - does the patient want to know? and if s/he does, how much?

You are so right. I learned this lesson from a patient whose daughters kept insisting that we couldn't tell her her dx or px, and that she would not want to know. They wouldn't let me in to her room until we came to an agreement about it. I finally had a conversation with the lady (sanctioned by the daughters) and I asked whether she wanted to know about her condition and sure enough, she said "No". She said she wanted her daughters to deal with it and leave her out of it. It was a real eye opener for me, and I now believe that everyone has the right to know what/how much they choose. Of course, I know that she knew. She just made the choice not to deal with it.
hn

[ayla2004]

i find it hard to know that a patients diagnosis and limited prognsis, but they do not. i can understnad that the results come in and we a re waiting for the pt doctor to inofrm and the familly want to be present, this is short tem. harder still if an older person has this withheld alltogether at the familly request, i've worked with nurses who feel that they wouldn't disclose but if asked wouldn't deny that they are ill but would refer back to the medics. terminal pts often know their very ill, perhaps even unconsious bdy language by nursing staff

[a21chdchic]

6-26-2007

Number One - Is patient capable of understanding the diagnosis and prognosis?
Number Two - Does patient want to know? How honest does the patient want you to be?
This is what I would consider in making this decision. Yes the patient & family have a right to know, so they may make an informed decision about the care they are going to receive from Hospice. The criteria to be met to qualify for Hospice is to have a prognosis of 6 months or less to live. If the patient doesn't want to know or talk about it, he/she has the right to stick their head in the sand, but the primary caregiver and the person signing for admission must know both Diagnosis and Prognosis.

Ana