Case study: what went wrong?

[SharonH, RN]

I'm interested in seeing what you guys think about this situation and how it should have been handled. There are actually two parts to this, but I will only post part one first.

You enter the room of KG, a pleasant, 78 y/o African-American female. When you greet her, she starts to cry. She states, "My children told me today that they found cancer on my lungs. It's just a tiny spot on the tip of my lung and they could just scrape it off but the doctors don't think I would survive the surgery. I've been sitting here all day trying to figure out why they would think that. I am in good health otherwise, I don't understand why they won't even try to save me. Is it because I'm poor or Black or is it because I'm old they don't think I care about living anymore? I can't believe they are just going to let me die without even trying to help me!"

You spend a few moments with Mrs. KG comforting her and then you return to the nurses' station so you can review her chart. You find that she has indeed been diagnosed with lung cancer, but it is a large tumor that is inoperable. It is not as Mrs. KG has been told "a tiny spot on the tip of her lung which can be scraped off".

What went wrong here? Who, if anybody is to blame? How should the nurse address the situation?

[pickledpepperRN]

Thank you for this excellent case study.

How about more?

This gives an opportunity to discuss and think about an important aspect of nursing.

I for one often need to learn the same lessons more than once.

Like, "Don't assume."

[miniaussie]

I agree with previous postings on this. When a patient hears the word cancer they panic. It is a scarey word especially if you have been told you have it. It does appear that the family is trying to protect her from knowing the truth. Sometimes not telling the truth about a prognosis can be more harmful as appears in this case if in fact this is what happened. A family conference should definitely be held to address these issues. Perhaps the family is in denial. The patient if aware of things should be told the truth by the doc and possibly already had been. This is tough to answer until all the facts on the communications are in.