Sick of hearing "We don't want mom (or dad) to know"

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I hear that A LOT from the children of elderly patients who have recently been diagnosed with whatever disease process.... Many, if not all of them are able to grasp the diagnosis and deserve to know. It is their right, however the Doctor will inevitably tell the children and they will run us nurses down and tell us "please don't tell mom, we just don't want her to know she has cancer" or whatever it may be. I even had a daughter tell me not to let her mother know that she has been diagnosed as a type 2 diabetic. To top it all off, some of the doctors kind of go along with it, leaving it up to the family members to decide what to tell the parent. I am a patient advocate and so of course my patient is my focus, but it is very hard with family dynamics. This in particular has been getting me lately. I know that it is a horrifying diagnosis to hear "cancer" at any age, but pretending that it doesn't exist in your elderly parent doesn't make it go away. How do you deal with family members who demand you not speak of diagnoses to the patient?

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With you on that - pretending it doesn't exist doesnt make it.go away. Sure, we wouldn't wanna dwell on that sad news, but I'm with you - a person deserves to know what they've been diagnosed with. I don't lie to my patients... even when I'm trying to get them to take their medicine ... I give a simple explanation of what they have ... maybe I'll say 'this is important' or 'the dr wants you to take this' (I work in LTC) when more appropriate, but I don't lie or withhold info. I think it's good that you stay strong enough to advocate for your patients (they are your first priority, after all) not just appease family members. They don't always know best like they think they do.

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Specializes in Critical Care.

I don't get why the situation even comes up. Your description seems reversed from how it's supposed to work; why are the patients not the first to be told their medical condition and the getting the choice to share that information with family?

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In nearly every situation I encounter the children of the elderly patient are the ones told of the condition and not the patient. It maddens me.

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Specializes in Critical Care, Postpartum.
I don't get why the situation even comes up. Your description seems reversed from how it's supposed to work; why are the patients not the first to be told their medical condition and the getting the choice to share that information with family?

I agree, but I've also had it happen to a few of my patients when I get report from the off-going nurse. Patient was newly diagnosed with cancer, yet the ones who are aware are the family members who have been there at the bedside. It's the responsibility of the doctor to tell the patient their diagnoses. I'm there for emotional support. For the patient's family who doesn't want her mom to know she has Type 2 DM, may need some education. It's not a death sentence and a little education can go a long way.

If the patient want to know the results of blood work or pending tests, I then try to set up a meeting with the MD and family and together we have a family meeting to break the news. If they want to speak with a priest, I'm there to place a call/consult one for them.

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Specializes in LTC,Hospice/palliative care,acute care.
I don't get why the situation even comes up. Your description seems reversed from how it's supposed to work; why are the patients not the first to be told their medical condition and the getting the choice to share that information with family
Because people assume everyone over the age of 65 is senile and infantile . It happens ALL THE TIME. In LTC the family often does not want mother or father to know they have gone on hospice. They just assume the parent is incapable of reading ID. A lot of docs will bow to these demands. However it's not legal. The healthcare POA kicks in when the patient is no longer capable of making their own decisions. The children need to be gently reminded of this, they also need to be educated regarding the hospice process, there is a lot of work for the dying patient to do before they die. It's inhumane to rob them of that chance. Something I tell spouses and children of our residents who are having difficulty letting go of " the caregiver in charge role" is this - letting their loved one be cared for by us and encouraging the patient to express their wishes and plan their care enables the spouse or child to honor that relationship by reassuming that role.

How many times have you (in LTC) cared for a frightened and dying LOL who settled right down minutes after you told her she will stay right there in her bed and be kept comfortable? It happens all of the time and it's a shame that so many of these people are not given the opportunity to

plan their journey before they are half way down the road.

Believe me,when you are caring for someone like this is the hospital please know that in all probability someone has tried to talk to the family. So many don't have advance directives.You would be surprised how many people do not know that 'DNR"does not mean "do not treat" and most of them think resuscitation happens in real life exactly like it does on General Hospital. I have also discovered appearances are deceiving. Often the most well spoken,well dressed family members are the most unrealistic, difficult to deal with and have the largest common sense deficit.

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Specializes in Critical Care.
I agree, but I've also had it happen to a few of my patients when I get report from the off-going nurse. Patient was newly diagnosed with cancer, yet the ones who are aware are the family members who have been there at the bedside. It's the responsibility of the doctor to tell the patient their diagnoses. I'm there for emotional support. For the patient's family who doesn't want her mom to know she has Type 2 DM, may need some education. It's not a death sentence and a little education can go a long way.

If the patient want to know the results of blood work or pending tests, I then try to set up a meeting with the MD and family and together we have a family meeting to break the news. If they want to speak with a priest, I'm there to place a call/consult one for them.

I agree with the first paragraph, but I'm perplexed by the second. Keeping the patient informed as the to progress of their plan of care, including test results, is a core part of nursing. I can see leaving it to an oncologist to explain pathology results and a complicated prognosis since that would be out of the scope of many nurse's knowledge, but you wouldn't tell a patient what their blood sugar is? Or that there H&H is low which is why you're obtaining consent to transfuse? I have worked in a teaching hospital where the residents typically wanted the opportunity to get that experience so they often shared and explained results instead of nurses. You wouldn't share that CT showed (as interpreted by an MD) a PE? You wouldn't share that a patient is having a STEMI and that's why you want to give them medications (as ordered or by MD backed protocol)?

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I understand your frustration. You need to request a meeting with the family,the doctor and your manager as to how to handle this sticky situation.

Your ethics committee also needs to be made aware.

If the patient is not cognitively impaired, you must advocate.

Good luck,let us know how it is going.

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Specializes in Critical Care, Postpartum.

@MunoRN: The second paragraph was meant regarding diagnoses like cancer, not regarding H&H and blood sugars. I worked in critical care where many of my patients were told by me on an almost daily basis. Wasn't meaning a CT scan that showed a PE (which I have told my patients), I'm talking about a CT scan or MRI that shows cancer but not yet told to the patient by the MD. As I stated before and in agreement with Been there, done that, a family meeting with MD and nurse is a great way to go.

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Specializes in Hospital Education Coordinator.

I would get a case manager, social work , maybe the MD and you together and let the family know that the patient has the right to know. Plus, they know something is wrong and probably are wondering why no one is telling them. Ignorance is not bliss

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Specializes in Acute Care, Rehab, Palliative.

Where I work the doctors tell the patient first,not the family.

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Specializes in Med Surg.

Get used to it. Many children seem to end up thinking their job is to rob their parents of their autonomy, dignity and right to be free from torture.

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