opinions please on informing patiens of a diagnosis

[tinkerbell23]

THIS IS PURELY TO GET MY CREATIVE JUICES FLOWING.... i am currently working on an essay about a situation that may occur.

patient, 90yr old widow, living in care home for number of years, NO cognitive impairment, however immobile due to athritis and dependant on staff. regulary visited by daughters. developed cough and doc has confirmed that she has lung cancer after several visits to hospital for tests.

doc visiting next day to inform her of diagnosis....however daughter has asked that I make sure her mum is not told. pls note i am a student nurse.

**this is fictitional and i have already chosen my argument that she should be told, this is not my definate opinion, i am split....BUT i think there will be alot more evidence that she should be told***

just wondering your opinions xx

[boxtops]

This is a dilemma and it is in my view for the patient to decide. If the patient's notes say that she has stated that she doesn't want to be told of a life-threatening illness, then at her age, I would hope the clinicians will abide by that. However, the decision has to take into account the ability to make the decision under the Mental Capacity Act (and you say she is fine under that heading).

Q: how would you know that the daughter is conveying the mother's wishes to you, and not just saying this because she thinks it will distress her mum, believing ignorance is bliss? Who is she protecting, mum or herself, from the inevitable sadness at the diagnosis?

This brings poignant memories for me - my own mum was 93 and still had all her marbles when she died, but all along she wanted to be fully aware of what was happening, so she could come to terms with her leaving us after a long and full life, and say her goodbyes properly to all the family while she still could. Sorry to bring a personal story into your scenario, but this was real life - we could not have wept for her when we said those goodbyes, if she had not known what was happening to her.

Your lady still has the right to have a full say in her subsequent treatment, and that won't happen if she is not part of the discussion in full understanding of her medical condition. She may decide that she doesn't want treatment or surgery, and just to let her illness run its course, or she may want every treatment available to her at her age.

Good luck with the essay - let us know how you get on.

[tinkerbell23]

boxtops you basically mirror my argument...i think the real life stories can only helo the matter!!! your opinions greatly appreciated....i think that there can be alterior motives unfortunately in these situations and the question can also be why does the daughter know before the mother herself!! also as a student...it is not my place but obviuously it brings in the importance of documentation and it being accurate also...a good essay question i say!! very thought provoking.....my legal professional and ethical issues!!! xxx

[marie26]

1. The daughter has no say in this discussion, it is purely between the doctor and his patient, in fact the daughter should not know of the diagnosis unless the patient gives the doctor permission to dicuss it with her.
2. The patient visited the hospital for various tests and scans so that a diagnosis could be reached, therefore she needed to have received sufficient information about these tests so that she could give informed consent for them to be performed.
3. The patient could have told the doctor that she did not want to know any results, of course, but any discussions would be led by the doctor about the detail of how much/little she would like to know, and from there how any distressing symptoms in the future would be managed.
4. The patient is the doctor's priority at all times, and this relationship is sacrosanct. She may well be fearful of the future, and the doctor can reassure her by involving others in providing the care that is needed at this time. Palliative care can not given properly unless the patient knows as much, or as little, as she needs to know, this is also true for the family, they will need help from the palliative care services so that they can make this a meaningful experience.
5. I suggest that you read as much as possible about informed consent, the doctor/patient relationship, consultation models and codes of conduct for doctors and nurses. You will get lots of ideas from these.

[tinkerbell23]

marie a thousand thank yous for your opinion and thoughts...very helpfull i am sittng with my NMC Code of conduct aka the bible!!! lol.....x

[RATTER15]

I work in a severe Dementia unit and this type of situation often comes up, in nearly every case the resident is told of bad news, they still have rights even with limited or no mental capacity. Clearly she must be told!! especially as she still has mental capacity.

[boxtops]

Tinkerbell, re the daughter knowing - I had not read that in your Q, I had read it that the daughter said to you "if there is a terminal diagnosis can mum not be told", not "I've been told, don't tell her". Everything marie says is spot on, too.

And as you know and mention - so much weight is placed on accurate record-keeping these days, your role as a student would mean that you need to discuss that conversation with your placement mentor who may know the family and their history much better than you do. Definitely to be recorded for future reference.

As you say, a great discussion topic, you can do so much research on this. Do you know anyone who works in a hospice or community palliative care service, who you could speak to for background information? - this could be quite a common scenario for those nurses and HCAs. Having worked in a hospice for six years myself some years back, I know how much the views and wishes of the patient remain central to the whole "process" of dying.

[boxtops]

Sorry ratter, you posted while I was still typing, I didn't deliberately not refer to your post!

[tinkerbell23]

it is that the daughter has approached me and requested her mother is not informed of the diagnosis....however as you said this throws up the right to treatment or indeed to refuse etc! i do know people actually i can chat to...its good for me to gather opinions as this is an "argument" that i am creating! -and ratter i agree....very difficult situation for all isnt it...and like i say this is fictional however i bet it happens every day! x

[RATTER15]

I'm just finishing my course on palliative care, very interesting and really delves deeply and brings back memories that sometimes are best left at the back of ones mind, I found the course very difficult but interesting.

[tinkerbell23]

yeah ratter i understand what you mean....my last placement invovled alot of pallative care and in a wierd sounding way i loved it. its a privaledge. i think it is something i would be interested in when i qualify....most definately. i learned alot aswell x