Does patient need to know the diagnosis?

[Ms.RN]

hello

i work in nursing home and i have a hospice patient who doesnt know that she have a terminal illness and that she is very sick. does this patient deserve to need to know what her diagnosis is? do i need to tell her what her diagnosis is? i'm afraid that if she finds out about this, she will give up and her condition will deteriorate fast. i appreciate any advice. thanks

[mrosette]

I feel for you. Please consult with charge RN. There may be cultural factors in play here. It is NOT your job to deliver that information to the patient, it belongs to the doctor and the family. Make sure you do your job to comfort, clean and care for pt. Let pt know you care about their comfort and well being, as far is information regarding Plan of Care, Medical Diagnosis, or Nursing Diagnosis, that is domain of RN, PCP and immediate next of kin.

Best Wishes to you, Maureen, 1 yr RN

[wonderbee, BSN, RN]

If she is a hospice patient and has the capability of understanding her diagnosis, she is probably cognitively intact enough to already know that she is dying. It's important that we not transfer our own negative feelings about dying onto the patients who are actually facing the experience. A death with comfort and dignity is at the heart of the hospice philosophy. Preparation for that transition from this life to the next must include the whole family, but the hospice nurse advocates for the patient. Sometimes the needs of the patient and the wants and desires of the family are at odds.

The hospice nurse should be sensitive to the needs of the patient in this regard and be ready to discuss the impending death when the issue is ripe. Are you the hospice nurse?

[aimeee, BSN, RN]

There are no easy answers here. As stated above, there may be cultural factors involved. We usually encourage disclosure to patients because if they are of sound mind they already perceive that something is very wrong with them and they are picking up on all kinds of signals from those around them. Not talking about it leaves them to deal with this fear in loneliness and they have no opportunity to complete their end of life tasks. This decision for disclosure is best reached by the family and care giving team together and then they can all decide together what the best time and circumstances are for talking about it with the patient.

[doodlemom]

I believe pt's have a right to know if they are alert and oriented to understand. Are you her nurse? This should have been covered from the start of her hospice admission - does she know she is on hospice?

[clemmm78, RN]

We don't accept patients who don't know because it is part of the palliative care process.

[NurseMatt]

Same as previous poster, a condition is they must know the dx.

[elkpark]

How can she give informed consent for any of her treatment without knowing her dx and prognosis, and how can she be receiving hospice care (or any other kind of tx) without having given consent???? Is she incompetent and a family member is her guardian, or what?

As others here have noted, it is the responsibility of the primary physician to inform the client and family about diagnosis/prognosis.

[river1951]

of course you are right about informed consent. Unfortunatelt in our world we sometimes see patient to whom the MD has never given their prognosis. Sometimes, we have found it happens when the family does not speak english and the MD cannot be bothered to get an interpreter. We must advocate for our patients. In one case, the MSW and I (she spoke spanish) had to tell the teenage girls their mother was dying. That day I would've liked to be working at McDonalds'.

It is up to the doctor to tell them, unfortunately sometimes they can't be bothered.

[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

[ginger58, ASN, RN]

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.

[gemini81sg]

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!!