Patients not understanding/accepting terminal diagnoses

[Peanut&Buttercup]

I am starting nursing school in a couple weeks, but I was curious about others' experiences with patients and their families. When my mother was diagnosed with stage 4 cancer, my parents didn't "hear" the part about her being terminal. They never understood/heard/accepted that part of the diagnosis.

I was talking to a colleague the other day. Even after three months of hospice care, she also had no idea that her husband was going to die. She said she was completely shocked when it happened.

In your experience, is this reaction normal? Is there a lack of communication between provider and patient and/or family? After my mother died, and I had a chance to reflect, I did feel that the providers weren't very upfront with us.

End of life care is something I can see myself doing in the future. I'd love to hear your experiences with this disconnect and whether it's something you try to address when it occurs.

Thanks!

[Nicolanz]

I'm a student but I've seen the conversations between doctors and patients about the diagnosis/prognosis. What I've observed is the doctor being very upfront and matter of fact about the situation and patient being in denial. No matter how it's explained, the patient just doesn't seem to understand. It's heartbreaking to watch.

[amoLucia]

Remembering Kubler-Ross' model for grief/grieving includes stages of anger, DENIAL, bargaining, depression and acceptance .Pts and family can travel straight through, skip a phase, or bounce back & forth as they deal with their grief.

I believe that information is provided by HCPs but it needs to be repeated and repeated to be absorbed at a rate that only the mourner can manage at the time. And with support provided, the travel is smoother. Hospice does provide support and information.

OP, you comment about you colleague's shock with her husband's death. I suggest that she was not yet past denial or bargaining. And depression can cloud emotions and rational thinking.

And maybe your Mom's providers weren't as communicative as possible, or maybe they WERE. But perhaps y'all just couldn't hear them due to your own grief.

I've seen where concrete interventions such as providing last rites, or getting a hospital bed for the home, getting financial documents in order, etc help to better conceptualize the seriousness and finality of the situation. So often those interventions are slipped under the rug r/t 'not the right time right now'.

And not all family are at the same point either. For whatever reasons, it is a distressing time for all.

And for you OP, if you're interested, reading up on the landmark works of Kubler-Ross and others about the stages of grief can be very informative.

Good luck with upcoming school.

[Nashvillejeanne]

Remember, denial is a protection for the family and /or the patient. Moving them along that process takes time and patience. Some never get there and that is ok. Help them where they are!!

Peace