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Patient doesn't know he's terminal

Posted

In clinicals today there was a pt. who had been in hospital for about a week. He was not aware he was terminal with cancer, but the family was aware. They had not told him yet and didn't want the staff to tell him about his dx. The pt was cognitively/emotionally intact. How can a pt. not be informed of his serious health situation, and what right does the family have to withhold that from him?! As a nurse, how can you be asked to lie to a patient if they ask how they are doing, believing they just have a minor health problem that they will recover from when they are actually terminal?

i used to feel the same way as you do about this. keep in mind that the patient's family knows him better than you do. why not let the patient believe they are fine if knowing that they are going to die will cause them more harm than good. these are very subjective situation we have to deal with as nurses quite often. sometimes it can be hard to keep the family's wishes when a patient asks you how they are doing... i usually ask them "well how do you think you are doing" depending on their answer i would talk about how their vital signs are or focus on progress they have made since admission... not really lying but pointing out some positives. if they ask questions regarding a diagnosis or a test they had where the result wasn't negative i always refer those to the md.

Lovely_RN, MSN

Has 11 years experience.

It's possible that he does know but he is in serious denial.

It's possible that the patient was told at some point about his diagnosis or even managed to put two and two together all by himself. The patient may be in denial or maybe has shown that he is not capable of acquiring the necessary coping skills. In a situation like that the family may feel it best to not bring up the subject or to not bring it up again if it was brought up in the past.

Also have you considered that if the patient really wanted to know that the patient would ask the MD or nurse directly?

If the patient really wants the information they can get it but sometimes they don't really want to know so they won't ask questions that lead to a direct answer.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

This might be an ethical issue.

If the patient truly is alert with no declining cognitive function and is capable of making informed decisions regarding his care, then his terminal prognosis should not be withheld from him. Anything less than the truth might be unethical.

It is not my job to lie to a patient after determining that he/she might be unable to handle the truth.

Crux1024

Specializes in Cardiac Telemetry, Emergency, SAFE.

This might be an ethical issue.

If the patient truly is alert with no declining cognitive function and is capable of making informed decisions regarding his care, then his terminal prognosis should not be withheld from him. Anything less than the truth might be unethical.

It is not my job to lie to a patient after determining that he/she might be unable to handle the truth.

I feel the same, but when Im told a competent person's family does not want them to know their *serious* prognosis, I dont tell them. Its what we do on my floor, I guess. Im not too happy about it though. I want to tell them, but where does liability lie? Also, Im fairly certain Id get into trouble.

While it is not your job as a nurse to convey the diagnosis to the patient, a situation in which a competent adult's medical information is being shared with seemingly everyone except the individual in question raises huge ethical and legal red flags for me.

If I were his nurse, I would make sure I'm not the one who conveyed his actual diagnosis/prognosis to him -- far too much liability exposure with that -- but I would be extremely uncomfortable in going along with this conspiracy of silence, and would resent being placed in the position to have to do so.

The pt was cognitively/emotionally intact. How can a pt. not be informed of his serious health situation,

When a friend of mine's family put their mother in hospice, they didn't tell her. They instructed the staff to attach her DNR bracelet when she was asleep. My friend laughed about her waking up and seeing her new red bracelet.

Yes, this family is a dysfunctional mess.

Emergency RN

Specializes in ED, CTSurg, IVTeam, Oncology. Has 30 years experience.

IMHO, this one's a potential legal time bomb. I would suggest that you send an anonymous note detailing all your concerns to your risk management department, patient representative, and ethics board. They may be in a much better position to judge just where your institution should professionally stand in this situation.

The patient has every right to his or her diagnosis; it may be good news, or bad news, but it is HIS news. By withholding his personal health information from him and giving it to his family instead, this may already be a HIPAA violation. :uhoh3:

Good luck.

liebling5, MSN, RN

Specializes in Stroke Seizure/LTC/SNF/LTAC. Has 9 years experience.

Perhaps it's a cultural norm. For example, in at least one Asian culture (can't remember which one), the family never tells the patient (especially male elder) of a grim prognosis. Culturally, it is considered impolite.;) And, certain cultures also consider it rude to ask an "authority person" (aka you, the nurse or the doctor) direct questions about their condition. In fact, it was a norm here in the US just a generation ago to just do as you were told regarding health care. Some of the "old timers" here remember this.:uhoh3:

LiverpoolJane

Specializes in Dialysis, Nephrology & Cosmetic Surgery. Has 21 years experience.

You don't say if the patient has asked for this info and it has been with held. Some patients do not ask as they really don't want to know. My dad was diagnosed with prostate cancer about 6 years ago. He didn't ask any questions about prognosis but put his trust in the hands of the Drs and dutifully turned up to his nurse every three months for his implant and got on with his life. The frustrating part is that the family have also been kept in the dark as the Drs would not tell my mum anything my dad didn't know. If he had been given a prognosis and he was told he would have, say 3 years to live, he would not be able to cope with it. He would have worried himself so much that he probably would have lived 3 years. It's just how some people deal with it, some are brave and are determind to fight it, others curl up and die - literally - if told the facts in full. I always feel if a patient asks I will not lie, but if they don't, I won't inflict that information on them.

cardiacmadeline, RN

Specializes in cardiothoracic surgery. Has 6 years experience.

We have had a couple of situations like this and I am rather uncomfortable with it. I too think it raises ethical questions. If a patient is alert and competent, I don't think the family has any right to withhold that kind of information from the patient. It is the patient's health, they have a right to know. I once had a lady that was alert and competent who had less than 24 hours to live. The family stated they didn't want her to know she was dying. That situation didn't bother me much, because I believe the patient knew she was dying. When your family is at your bedside crying and basically saying goodbye to you, well I think the patient probably figured it out.

ShayRN

Specializes in Corrections, Cardiac, Hospice. Has 18 years experience.

I have been doing this long enough to know that regardless of what patient's families believe, a person KNOWs when they are dying. This is what I tell these families, I will not come right out and say, Hi, I am Shay and I will be your nurse tonight, you are now a patient at an inpatient hospice facility and you are here to die. BUT, If they ask me, I will NEVER lie to my patient, ever. If they have a problem with that, they can go to my boss, because I feel that is an ethical issue and I will not break my personal code of ethics for anyone. Most times I have found those that want to know the truth, ask. Those that don't want to know the truth don't ask, very simple.

Moments like these can be hard especially on your emotions, mainly your empathy for the patient. It is hard to look at someone knowing full well that they are not going to survive their condition and knowing that they have no idea that they will be passing over soon due to their illness. It comes down to following the families wishes, if they request your confidentiality in the matter then it is the right thing to do in doing so. If the patient begins to ask questions to which you feel you are not able to lie or change the subject or avoid the truth of then it is best that you tell the patient that you will ask the doctor to speak with them as the doctor will be able to give more informative answer than you are able to due to you not being aware of the full information at that time (even if you do know everything) this way you don't have to lie to the patient and it will be up to the doctor whether or not the patient is informed. Many conditions that are terminal can be excelled by factors such as the patient being stressed, this is another reason that the family may wish for the patient to not know, they probably want him to go peacefully in his sleep rather than lying awake regretting things in his life that he didn't get to do knowing that he will be passing away soon.

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 33 years experience.

Perhaps it's a cultural norm. For example, in at least one Asian culture (can't remember which one), the family never tells the patient (especially male elder) of a grim prognosis. Culturally, it is considered impolite.;) And, certain cultures also consider it rude to ask an "authority person" (aka you, the nurse or the doctor) direct questions about their condition. In fact, it was a norm here in the US just a generation ago to just do as you were told regarding health care. Some of the "old timers" here remember this.:uhoh3:

Yes. This is an extremely important thing to consider and should be handled within this context or at least considered in evaluating what to say to the patient. I've been told that in another culture, (not Asian, btw) it is the norm not to tell a dying patient what their prognosis is. I don't know why, exactly. I was very surprised to hear that. But she was quite adamant, as in "oh, no. . . we never tell them. ."

This may not be applicable at all to the OP s situation - but I mentioned it because of the conversation I had with this family member.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

wow...and we wonder why we torture people in the hospital before they die...perhaps because of this type of health practice....

hhhmmm, is this how it works....lets not tell the person what their diagnosis is, not tell them of the terminal nature, and then lets pretend that we can cure them...until they die in ignorance and pain....

how's that working for us as a culture?

I subscribe to the logic that only HE knows when we will get our wings. Terminal or not, IMO the Pt is living with Cancer and not dying from.

They gave my cousin 6 months to live, Stage 4 Cancer.......3yrs later.....with the help of Sloan Kettering.....he's doing well.

I would follow the family's lead...but only after checking the HIPPA paperwork.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

I will be a patient advocate...this generally does not include lying to a competent patient.

Kylea

Specializes in Med/Surg, LTC, Rehab, Hospice, Endocrine. Has 4 years experience.

I agree and disagree with the OP's situation. On the one hand, I would never outright lie to a patient. On the other, I have been in that situation. When a family member very close to me was diagnosed with ESLD and given a very poor prognosis, we did not discuss it with her. She had made it VERY clear through out the years that she never wanted to be told she was dying. She always said that if someone told her that info then she would spend the rest of whatever time she had obsessing about how much time she had. I do know that the MD's working with her did tell her that she wasn't going to get better; I wasn't in the room but I did speak with the MD afterwards. He said that she did agree to go into Hospice, but none of us were ever sure if she actually understood what Hospice was. She passed away a month later. And to this day I do not feel bad for not telling her. She was peaceful, and almost happy during that month.

It is a very tough situation to be put in. The family generally does know the patient better. Something you could do is ask the family why the patient hasn't been told. Perhaps they may say that the situation is similar to mine. Perhaps not. Either way, you can also talk to the MD, your supervisor, and/or the ethics committee if you are still concerned.

Bottom line, if the patient asks me, it is not my place to deliver a prognosis; that is why the MD get's paid so much more than me. But I will not lie to a patient. If he/she asks me if he/she is dying, I will ask him/her what they think. But I won't tell him/her NO if it isn't true.