Dashing a patient's hope or just being honest?

Pangea Reunited, ASN, RN · Jun 28, 2016

"No." was the only right answer, despite the family's feelings. I also doubt the patient's question was serious to start out with. It's more likely that he was amusing himself ...or possibly expressing frustration with the futility of some aspects of his treatment.

Davey Do · Jun 28, 2016

I said it is a supplement, it won't heal him but it allows him to remain healthy, keeps albumin at a good range and all that stuff, but I couldn't say it would affect the tumor because that would be a lie.

Good job, xanderfan!

nutella, MSN, RN · Jun 28, 2016

Today I had a weird moment and I'm in bed right now and I can't help but think back on it and kind of feel like i didn't handle the situation properly. I have a quadriplegic patient and he is fairly young and due to his tumor on his spinal cord he is in this situation. I think he has a fairly good outlook on things but I think he gets bad days which is okay. The family is fairly present and every time I come in the room, they always ask me what the medications are, which can become annoying after a while since they are always the same but expected as they are concerned. Today, I brought him the Pro-Stat, he hates it (like most of my patients) and he asks me what is it for. I tell him it is a protein supplement and encourages healing. Then he says, will it get rid of my tumor? I was shocked that he asked that and I blurted stupidly no. Mom was at bedside and she said why did you tell him no, it could diminish the size or encourage healing or something. She insisted that I should have said it will help the tumor. I was in a bind at that moment, I tried to backtrack. I said it is a supplement, it won't heal him but it allows him to remain healthy, keeps albumin at a good range and all that stuff, but I couldn't say it would affect the tumor because that would be a lie. I tried to direct the conversation away from the topic but I drew a blank. The family and the patient weren't overly upset or anything. They don't seem as if they're lingering on the topic as I interacted with them throughout the day. But I just can't let it go. It might seem like something small but I felt like I was really insensitive to say no like. It just won't let me sleep tonight. I mean did I make an already hard situation worse for someone?
thoughts are welcome. Sorry for the extreme length, I just needed to talk about it, I guess.

This is very difficult on many levels and I am glad that you were able to stay truthful while pointing out that the supplement will support overall health.

It is not uncommon for the patient and /or family to dwell in in some kind of state that is close to denial or that is somewhat removed from reality.

What your patient needs - especially while he is still able to talk and understand - is a "serious illness conversation" by the doctor (could be oncology or palliative care). In that conversation, the idea is to talk about goals and make a plan for the future regarding goals for care. One of the steps is that the MD asks the patient and family for permission to talk about the illness and what if things do not get better. They ask "what is your understanding of your illness", which is an assessment of understanding. After that there is a discussion about what is important to the person and what is essential . Based on that the discussion ends in "goals for care" with a recommendation.

Those serious illness conversations are very important and ideally should happen outpatient but at times it is something that has to happen while the patient is in the hospital. While hope is important, we do not do patient a service by giving them false hope or deny reality. Having said that, the way those conversations should happen includes a trained professional who uses a script / guide to structure and guide through the conversation.

You could ask the physician/ oncologist if there is a plan for this patient / family to have a serious illness conversation and that you wonder if the patient understands the dx and prognosis/tx plan based on what you were asked.

As a palliative nurse I have seen patients with advanced cancer who had a poor understanding of their illness. In one case it went so far that the patient believed that the cancer was cured although the chemotherapy was only palliative right from the start and the surgeon found extensive disease. There was a natural tendency for the patient to just not listen to what the oncologist disclosed and not to hear the fact. But the oncologist also did not check the patients understanding of the illness as there was never the question "what do you understand about your illness?" and a lot of discussions happened with the spouse instead of the patient.

Needless to say, once the patient understood that time left was very limited, there was a lot of grief. The patient verbalized that she would have spent the last months differently if she had understood where she was heading. Now there was not much time left to travel, prepare her family or take care of any business.

Been there,done that, ASN, RN · Jun 28, 2016

"they always ask me what the medications are, which can become annoying ". :eek:

The family is seeking emotional support. The reason you can't sleep is because you made the issue all about YOU.

Instead of forcing something on the patient that he hates, advocate for him and discuss alternatives with the physician.

RNperdiem, RN · Jun 28, 2016

You would have felt worse if you had lied to them and given the patient and family false reassurance.

Denial is something that does not vanish overnight; it has a protective function. It is chipped away bit by bit by taking in the truth a little at a time. It sounds like you gave the news tactfully and truthfully.

Been there,done that, ASN, RN · Jun 28, 2016

You would have felt worse if you had lied to them and given the patient and family false reassurance.
Denial is something that does not vanish overnight; it has a protective function. It is chipped away bit by bit by taking in the truth a little at a time. It sounds like you gave the news tactfully and truthfully.

It is not OP's job to give the "news". It is OP's job to provide emotional support.

Libby1987 · Jun 28, 2016

I've gotten quite a few of these kinds of questions and without knowing anymore about this patient's profile I would have said something along the lines of.. This isn't a treatment for your tumor but maintaining your nutrition is necessary for immune health which does impact how your body can prevent and fight off infection.. and if applicable, and tolerate the treatment aimed at reducing his tumor.

Kitiger, RN · Jun 28, 2016

Denial is something that does not vanish overnight; it has a protective function. It is chipped away bit by bit by taking in the truth a little at a time. It sounds like you gave the news tactfully and truthfully.

This is exactly right.

Also, hope that is based on lies will not end well. If the patient decides he can't trust you, you will not be able to help him as much

If you had started out with lies, as his mother wanted you to do, then the truth would have been even more difficult for him.

Wuzzie · Jun 28, 2016

"they always ask me what the medications are, which can become annoying ".
The family is seeking emotional support. The reason you can't sleep is because you made the issue all about YOU.
Instead of forcing something on the patient that he hates, advocate for him and discuss alternatives with the physician.

You sort of left off the qualifier she expressed at the end of the sentence. This is her complete sentence: " The family is fairly present and every time I come in the room, they always ask me what the medications are, which can become annoying after a while since they are always the same but expected as they are concerned." We all have dealt with patients/families that have annoying but understandable behaviors. Finding them annoying, in and of itself, isn't us making it about us it's just a normal reaction. How we respond to it makes the difference. I'm having a hard time seeing where, in her interaction with the family when she was caught off guard, she made it about her. It sounds to me like she was simply being honest about the medication without giving false hope but also without publicly calling them out on their denial either. Lying to patients and families isn't giving them emotional support and certainly will destroy the trust relationship when the lie comes out. It certainly sounds to me like she was supportive in a very difficult situation. As for advocating for the patient. We really don't know that that wasn't already done or at least in the works and it isn't germane to the discussion about lying to patients. I'm interested in hearing why you feel the OP made it about them because I just don't see it.

Here.I.Stand, BSN, RN · Jun 28, 2016

It is not OP's job to give the "news". It is OP's job to provide emotional support.

I didn'the take it as her giving him "the news" as in prognosis, but answering his question truthfully. When asked if a protein supplement will shrink a tumor, the answer is simply "no..." not an "I'll get the Dr to talk to you," like we would if he asked for advice between surgical and medical treatment.

missmollie, ADN, BSN, RN · Jun 28, 2016

You gave the correct answer. The moment you lie to the family and they find out about it is the moment that family loses faith in you as a nurse.

Sometimes we can't give our families what they want to hear, but we tell them what they need to hear. It helps them work through that grief process, and that can be just as healing. Getting them to the point where they can accept what is happening allows them the ability to plan for the future.

Don't overthink it. You did your job as a nurse.