Patient Right to Know

[SuperRN_1]

Last week a patient's test results came back and the patient has liver cancer. The family told staff and doctors that the patient NOT be told. Patient is in her 80s and is alert and oriented. Patient and family are Catholic and Hispanic. A family member is her POA.

Doesn't the patient have the right to know?? I have worked in hospice for 4 years and have never met a family requesting the patient not be told of the diagnosis of cancer. It's usually the other way around (patient requests that family not be told).

When brainstorming with staff, some stated this could be a cultural or religious thing. Some stated that family might be worried that if patient finds out, patient will give up or lose hope.

Has anyone ever come across something like this? If the patient were to ask the Dr what she has, doesn't the Dr HAVE to tell her, regardless of the family's request? Doesn't the patient have the right to know she has cancer?

[TammyG]

This is a difficult issue. Anyone who is capable does have the right to be told their status -- if they ask. A patient also has the right to defer decision-making to a family member, even if they are capable. I agree with rngolfer53 that the patient almost always knows what is going on.

[Deenurse1]

I work in a hospice house. Our doctor usually handles this situation. Not saying "hospice" can be a common request of us from the family. I usually tell them I will do my best. The family knows their patient better than me and it may be upsetting to the patient. I do tell the family if the patient asks me if they are in hospice I won't lie, however I usually find that a patient never asks that question directly. Everyone who has posted that the patient knows what is going on is generally right. They have that sense. Usually they want to protect their famiy. My biggest frustration is when family members want medications held. Requires lots of education, sometimes they get it, sometimes they don't. I struggle with when they don't.

[toomuchbaloney]

The situation you describe is not difficult at all, it is rather straight forward.

The cognitively intact patient of legal age is entitled to be told the truth about their diagnosis, treatment options, and prognosis.

I am certain that there are Patient Rights and Responsibilities posted somewhere in your workplace. Those documents are pretty standard across the country. The professional staff may not violate them at will or at the request of another.

The family or DPOA has no standing to request or demand anything relevant to the patient's rights in this matter and should be advised of such.

The religion and race of the family is irrelevant.

Failure to clarify the rights of the patient to the family and the DPOA now will lead to much more difficult issues later, in my experience.

Be firm but respectful.

[cpbeckCHPN]

Working as an admissions nurse, I find it all to often that i am the bearer of bad news. Many times I'm in a situation where the treating physician writes "hospice consult" on order, and the hospital / facility social worker is the actual referral source. Sadly, there are many times where I walk into a situation where I'm the person dealing with a cognizant individual that is unaware of their prognosis. Personally, I find that horrendous that the family knows prior to the client.

I remember being called by my Mother to go with the rest of the family to "support" my Grandmother when she was being told that she had inop lung cancer. That's ********. It should have been presented by the physician so that she had the opportunity to deal with it as she deemed appropriate.

I will flip my badge, I will not say, "hospice", I will respect the family wishes to the best of my ability, but DPOA or not, if you are able to make your wishes known, I will not lie to you.

It's bad enough to lose your life. It's worse to not have any control over it. Isn't that what hospice is? Dying on your own terms (or as close as possible)?