Don't Tell Mom/dad/wife

  1. how do you handle the "don't tell Mom how sick she really is" demand. had one recently where the husband didn't want us to tell the wife that she if getting chemo. she was not competent, but had not been judged so by a court of law. since cancer had mets to the brain, was this really a good call to give chemo anyway. anyone else had experiences and how did you handle them.............
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    About cokie

    Joined: Dec '02; Posts: 118; Likes: 1


  3. by   Hellllllo Nurse
    In hospice, we had one family member ask us not to say the word "hospice" when we answered the phone so that other family members wouldn't know the pt was dying!
    Also had a family member ask us to take off our badges when entering the pt's room so that she would not see the word "hospice."
    We did not comply with either request.

    This is a hard situation. When this has happened with my pts and families, I try and feel out the pt to see what they know and how they feel. I say things like "How are you feeling about your illness?"
    "How do you see the course of your illness progressing?"
    "Do you have any concerns about your illness that you'd like to talk about?" and similar questions.
    However, this has always been w/ competent pts.

    Is the doc involved? Has the family asked him not to tell and has he agreed?
    What does he think?

    In one case, I saw where a doc had written an order not to tell the pt she was terminal at the family's request. This was a very repressed and non-communicative family, anyway. We didn't tell and I think it would not have done any good to tell anyway.
  4. by   911fltrn
    When Im asked to do such things i politely refuse! I will not lie to a patient. Reality is rough at times!
    Last edit by 911fltrn on Apr 2, '03
  5. by   lever5
    This is a hard one. I have had this happen many times in my practice. I find if I keep my opinion to myself and become a sounding board for the family they usually make the right decision for everyone. Sometimes it is not the decision I would make, but it is the right one for them.
  6. by   NsgTiger
    I just can not understand the thought of not telling the patient about their health status. I might understand if a patient told me that they did not want to know about their own status. But how can a family member possibly make that call for another person? The patient has a right to know. It is not up to anyone else to make that decision. Don't the people making these requests see the point of patient's right to know?
    Maybe I am missing an important point here. If so, someone please enlighten me...
  7. by   obeyacts2
    I had a lady with suspected uterine CA. She had months of vaginal bleeding as heavy as a period. You dont have to be a nurse to figure out this isnt normal in a 82 yr old. Finally the family THAT SHHE LIVED WITH took her to the gyn. The dtr took me aside after the biopsy and matter what the results Mom isnt to know anything..then instructed the MDs ofice to call her with the results at work. At the same time the gave her a lab slip with orders for CA-125 blood draw, regular blood panels, hematocrit,etc. The old lady was NOT demented, confused, ALZ, etc.....just old and somewhat frail. She asked me as I took her to the lab what the blood tests were for. I told her the truth, that CA 125 tests for certain markers in the blood that MAY indicate ovarian cancer. She wasnt terribly upset. I took this situation to the agency I work for becuase I felt as a caregiver I was in a bad situation. I told my agency and I told that family I WOULD NOT LIE TO A COMPETENT PATIENT FOR ANY REASON. Period. The agency took the high road and puit me on another case. The CNA/HHA that replaced me ran into the same conflict. The patient knew something was wrong and grillied the CNAs as to an opinion. It just made it worse for me as she knew I was attending school and assumed I would be more knowledgeable. I think it is cruel to not tell the truth even if it is hurtful of shocking, assuming the patient is legally competent.

  8. by   emily_mom
    We had an elderly woman with brain and liver mets. Her family asked for us not to tell her, as she had dementia. I didn't (not my job as an intern), but I believe we complied with that. I don't know how they explained the mastectomy 5 years earlier or why she was orange. She didn't seem to notice though.

    My grandfather-in-law had liver CA and no one told him. I didn't agree with it, because I thought he deserved the time to put his affairs in order and make peace with life. However, beware a MIL scorned, so I didn't say a word. He was getting demented too, although I chalk that up to the untreated CA. Hard to say.
  9. by   sunnygirl272
    i can see if the patient is those cases, they aren't really gonna get the jist anyhoo...but it is just so wrong to not tell an adult pt their own diagnosis/prognosis.

  10. by   ktwlpn
    Originally posted by cokie
    how do you handle the "don't tell Mom how sick she really is" demand. had one recently where the husband didn't want us to tell the wife that she if getting chemo. she was not competent, but had not been judged so by a court of law. since cancer had mets to the brain, was this really a good call to give chemo anyway. anyone else had experiences and how did you handle them.............
    I don't believe anyone has the right to take away another's right to know....I always encourage the family to open a dialogue with staff and try to get the docs involved...My mother's sister did this to my grandmother yrs ago-she was in her 90's and went in to have her gallbladder out and they discovered that her sx were being caused by ca-she died 10 days later but my aunt insisted she not be told she was dying.She was alert and oriented prior to her surgery and remained so until her last hours.My aunt robbed my grandmother of the chance to make peace with her children and come clean regarding some deep dark family secrets.She took that crap to her grave-and it was several years before the truth came out and bit her children on their azzez...I'll never forgive her for that-and my mom took her burden to her grave...Some families are just nuts,ya know? We see similar situations in the LTC-I have lost count of how many of our residents have arrived after being told by their family that they are coming over for a "tour" and then dumping them and sneaking out the back aunt also did that to my grandmother sevral yrs before she died...Mum-mum looked out her bedroom window and saw the ambulance and wondered who in the nieghborhood was was her ride to the home....
  11. by   dianthe1013
    My grandmother went to the ED the Monday before Thanksgiving with unbearable abdominal pain. It turned out that cancer had completely replaced one of her adrenal glands. She died one week later.

    None of her kids told her this was expected. They thought they didn't need to burden her with it. After all, she was constantly doped to the gills to control the pain. They didn't think she'd even know what they were talking about.

    Sad situation all around.

    Dropping someone off at LTC and "sneaking" away before they realize what's going on? That's horrible.

  12. by   deespoohbear
    I could not comply with a request not to tell a patient how sick they were if the patient was competent. If a patient is competent they have every right to know what is happening to their bodies. I would tell the family to address their concerns to the physician and let him handle it.

    I think most people know when they are dying. My MIL knew she was never leaving the hospital alive. She went in with what was bilateral pneumonia and never recovered. Up until the last days I don't think any of us realized just how sick she was and that includes the doctors. It was the freakiest thing. My hubby and I had just finished visiting her after supper. We went out to eat and came home. The nurse called me and said I better come back in because she had taken a turn for the worse. I asked her what had happened and she said that my MIL's brother had been there to see her that night. Right after he left she turned bad. He was the only person she hadn't seen in the four weeks she had been in the hospital. Right after he left, she went downhill and died the next morning.

    We never kept anything secret from her but I think she knew that she was in bad shape.

    Sorry to hijack the thread....:imbar

    Yeah, I think it is wrong to be deceptive to patients.
  13. by   nurseandmom
    I agree that the patient has the right to know and it steams me when the docs speak to the children of elderly patients who are perfectly competent before speakin to the patient.

    I once had a 23 year old man whose father wanted to control the entire situation and was giving me orders about what visitors his son could and couldn't have and how all the test results should be given to him. The son was fully competent and didn't even live at home and in fact was married.

    We have recently been told that to respect cultural differences we should be aware that in some cultures it is normal not to speak to the patients only to the head of the family. I don't think I agree with that either.
  14. by   purplemania
    It is not only cruel to deny a competent adult their autonomy, but it is also illegal. The patient has a right to know. How can they give informed consent? Remember that the patient is the priority, not the family.