General

Breaking bad news - What should we do in this scenario?

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26 Aug 2016 - General
 

An elderly women, with background histoy of osteoporosis, mild cognitive impairment, previous bilateral hip replacement, hypertension, previous stroke, and peripheral vascular disease, was initially admiited due to weight loss, change in bowel habit, and iron deficiency anaemia,. Coloscopy showed a big colonic tumour at hepatic flexure, and CT-TAP showed liver metastasis of tumour. You have informed the family members (next-of-kin) to come in, to plan to break the bad news to the patient, and the family memebers, so that the patients will have emotional support during the stage of breaking bad news. But, the family members have informed you that please do not tell anything to the patient as she will not be able to accept the bad news, and she is not willing to know about anything bad happen to her. The family members insisist of only letting them know about the bad news and prognosis. What will you do in this scenario ?  How would you approach the patient? Will you inform the patient the bad news??

Each and every patient has the right to know what is happening to him or her. And the patient has the right to decide that whether he or she may know the situation or not. So first of all we have to find out whether the patient wants to know his or her situation or not. That is what is called autonomy. If the patient is willing to know the condition, I'll set up a friendly environment to make it private. Then I'll assess patient's perception accordingly transfer the facts to the pati...
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Hi Alan Rosmadi I do not think the disclosure of the detail of the bad news to family members first will be the ideal way. This is because the patient has the right to know what is happening to her. And the patient also has the right to choose not to know about it. We must always remember that we are treating the patient (not the family members), and we should always put the patient as our priority. I think we s...
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I think what i would do is inform the family members what the bad news are, and follow the attempt not to spill the beans to the patient. Firstly, the patient is an elderly, and i think they quite understand the consequences of old age. But as a respect to the family members, I shall not reveal anything to the patient although it is patient's rights. I have encountered this before in a hospital i used to work for and we allowed this just because the patient has psychiatric problems and we do...
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Yes, I would agree with all the comments, with Mark Edmon Tan Jennifer Winter Marinelle Castro Patient has intact capacity. She is the person that we are going to break the bad news, and we should always respect patient confidentiality. The way I ...
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I agree with Mark Edmon Tan and Jennifer Winter . Every patient has the right to autonomy. What I will do in this scenario is that I will explain to the relatives that it is my moral responsibility to disclose the patient's diagnosis. Sometimes relatives act too negatively and they pre-empt exaggerated scenarios upon learning...
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I had a feeling at the beginning of the post that it would come down to the family saying "please don't tell the patient". Unfortunately as much as I feel for them and understand that they only mean for the best for their significant other I would have to tell them patient. Mark Edmon Tan is right. As long as she is of sound mind she has the right to know as she is the patient, the family isn't....
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Can the patient decide freely for herself with no altered sensorium? If the answer is no, then we may oblige with patient's family members. If the patient's mental health is not in question, we should tell the truth. The patient needs to know her diagnosis so he/she can choose her mode of treatment. Telling a life-altering diagnosis should be done in a gentle manner though. The reverse can occur also wherein the patient does not wish to tell his/her relatives about the diagnosis. This is...
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