Patient doesn't know he's terminal

[AmericanChai]

In clinicals today there was a pt. who had been in hospital for about a week. He was not aware he was terminal with cancer, but the family was aware. They had not told him yet and didn't want the staff to tell him about his dx. The pt was cognitively/emotionally intact. How can a pt. not be informed of his serious health situation, and what right does the family have to withhold that from him?! As a nurse, how can you be asked to lie to a patient if they ask how they are doing, believing they just have a minor health problem that they will recover from when they are actually terminal?

[KyPinkRN]

i used to feel the same way as you do about this. keep in mind that the patient's family knows him better than you do. why not let the patient believe they are fine if knowing that they are going to die will cause them more harm than good. these are very subjective situation we have to deal with as nurses quite often. sometimes it can be hard to keep the family's wishes when a patient asks you how they are doing... i usually ask them "well how do you think you are doing" depending on their answer i would talk about how their vital signs are or focus on progress they have made since admission... not really lying but pointing out some positives. if they ask questions regarding a diagnosis or a test they had where the result wasn't negative i always refer those to the md.

[Lovely_RN, MSN]

It's possible that he does know but he is in serious denial.

It's possible that the patient was told at some point about his diagnosis or even managed to put two and two together all by himself. The patient may be in denial or maybe has shown that he is not capable of acquiring the necessary coping skills. In a situation like that the family may feel it best to not bring up the subject or to not bring it up again if it was brought up in the past.

Also have you considered that if the patient really wanted to know that the patient would ask the MD or nurse directly?

If the patient really wants the information they can get it but sometimes they don't really want to know so they won't ask questions that lead to a direct answer.

[TheCommuter, BSN, RN]

This might be an ethical issue.

If the patient truly is alert with no declining cognitive function and is capable of making informed decisions regarding his care, then his terminal prognosis should not be withheld from him. Anything less than the truth might be unethical.

It is not my job to lie to a patient after determining that he/she might be unable to handle the truth.

[Crux1024]

This might be an ethical issue.

If the patient truly is alert with no declining cognitive function and is capable of making informed decisions regarding his care, then his terminal prognosis should not be withheld from him. Anything less than the truth might be unethical.

It is not my job to lie to a patient after determining that he/she might be unable to handle the truth.

I feel the same, but when Im told a competent person's family does not want them to know their *serious* prognosis, I dont tell them. Its what we do on my floor, I guess. Im not too happy about it though. I want to tell them, but where does liability lie? Also, Im fairly certain Id get into trouble.

[thehipcrip]

While it is not your job as a nurse to convey the diagnosis to the patient, a situation in which a competent adult's medical information is being shared with seemingly everyone except the individual in question raises huge ethical and legal red flags for me.

If I were his nurse, I would make sure I'm not the one who conveyed his actual diagnosis/prognosis to him -- far too much liability exposure with that -- but I would be extremely uncomfortable in going along with this conspiracy of silence, and would resent being placed in the position to have to do so.

[dannyc12]

The pt was cognitively/emotionally intact. How can a pt. not be informed of his serious health situation,

When a friend of mine's family put their mother in hospice, they didn't tell her. They instructed the staff to attach her DNR bracelet when she was asleep. My friend laughed about her waking up and seeing her new red bracelet.

Yes, this family is a dysfunctional mess.

[Emergency RN]

IMHO, this one's a potential legal time bomb. I would suggest that you send an anonymous note detailing all your concerns to your risk management department, patient representative, and ethics board. They may be in a much better position to judge just where your institution should professionally stand in this situation.

The patient has every right to his or her diagnosis; it may be good news, or bad news, but it is HIS news. By withholding his personal health information from him and giving it to his family instead, this may already be a HIPAA violation.

Good luck.

[liebling5, MSN, RN]

Perhaps it's a cultural norm. For example, in at least one Asian culture (can't remember which one), the family never tells the patient (especially male elder) of a grim prognosis. Culturally, it is considered impolite. And, certain cultures also consider it rude to ask an "authority person" (aka you, the nurse or the doctor) direct questions about their condition. In fact, it was a norm here in the US just a generation ago to just do as you were told regarding health care. Some of the "old timers" here remember this.

[LiverpoolJane]

You don't say if the patient has asked for this info and it has been with held. Some patients do not ask as they really don't want to know. My dad was diagnosed with prostate cancer about 6 years ago. He didn't ask any questions about prognosis but put his trust in the hands of the Drs and dutifully turned up to his nurse every three months for his implant and got on with his life. The frustrating part is that the family have also been kept in the dark as the Drs would not tell my mum anything my dad didn't know. If he had been given a prognosis and he was told he would have, say 3 years to live, he would not be able to cope with it. He would have worried himself so much that he probably would have lived 3 years. It's just how some people deal with it, some are brave and are determind to fight it, others curl up and die - literally - if told the facts in full. I always feel if a patient asks I will not lie, but if they don't, I won't inflict that information on them.

[cardiacmadeline, RN]

We have had a couple of situations like this and I am rather uncomfortable with it. I too think it raises ethical questions. If a patient is alert and competent, I don't think the family has any right to withhold that kind of information from the patient. It is the patient's health, they have a right to know. I once had a lady that was alert and competent who had less than 24 hours to live. The family stated they didn't want her to know she was dying. That situation didn't bother me much, because I believe the patient knew she was dying. When your family is at your bedside crying and basically saying goodbye to you, well I think the patient probably figured it out.

[ShayRN]

I have been doing this long enough to know that regardless of what patient's families believe, a person KNOWs when they are dying. This is what I tell these families, I will not come right out and say, Hi, I am Shay and I will be your nurse tonight, you are now a patient at an inpatient hospice facility and you are here to die. BUT, If they ask me, I will NEVER lie to my patient, ever. If they have a problem with that, they can go to my boss, because I feel that is an ethical issue and I will not break my personal code of ethics for anyone. Most times I have found those that want to know the truth, ask. Those that don't want to know the truth don't ask, very simple.