Don't tell mother she has cancer

November 1, 2007

When family members ask physicians not to disclose bad news to ill loved ones, clinicians often struggle to balance their obligation to be truthful to the patient with the family’s belief that the information would be harmful. To help clinicians more successfully manage these conflicts, researchers at the University of Pittsburgh School of Medicine, in collaboration with colleagues at Stanford University, have developed an approach based on negotiation skills and described in the Nov. 1 issue of the Journal of Clinical Oncology.

“While the topic of patient nondisclosure raises many ethical questions, these situations are too often thought of as dilemmas in which one party must win and the other must lose,” said Robert M. Arnold, M.D., study co-author and professor of palliative care and medical ethics at the University of Pittsburgh School of Medicine. “We propose that by understanding the cultural factors that underlie divergent points of views and the use of skillful negotiation techniques, a balanced solution can be reached that satisfies all parties – the patient, family and physician.”

Although clinicians in the U.S. often view requests for nondisclosure as contrary to common medical ethics and norms of clinical practice, many families and patients, nonetheless, do not want bad news disclosed. “Family members, who may have the patient’s best interests at heart, may believe that the patient would give up hope if given the news. These requests put physicians in difficult situations in which they feel as though the patient has a right to know, yet the family is adamant that the patient not be told," said Dr. Arnold.

Because a physician may feel as though he or she is being asked to do something unethical, it is common to overreact to a nondisclosure request, according to Dr. Arnold. A common mistake is to respond to a nondisclosure request with a categorical, “We can’t do that,” he said. By over-reacting in this manner, however, a physician may lose the opportunity to learn why the family is asking and inadvertently heighten tensions. To avoid this, a physician should attempt to understand the family’s viewpoint by starting a conversation with something like, “Tell me about your concerns,” and respond with empathy to the family’s distress.

“Emotions are central to these disputes,” said Dr. Arnold. “Given that it is a topic that both parties care about deeply, it is not surprising that issues of pride, respect and self-esteem often surface.”

Dr. Arnold also suggests that the physician talk to the family about what the patient would want, state his or her views in a non-confrontational manner and propose a negotiated approach in which the physician asks the patient how much he or she wants to know.

“By using empathy and understanding and applying communication and negotiation skills to these conversations, nondisclosure requests from families can be successfully resolved in the vast majority of cases,” said Dr. Arnold.

Source: University of Pittsburgh

Explore further: Docs should be aware of family beliefs regarding nondisclosure

Related Stories

Docs should be aware of family beliefs regarding nondisclosure

September 7, 2017
(HealthDay)—Physicians should be aware of societal codes of conduct that affect family beliefs and behaviors regarding information disclosure to pediatric patients, according to a study published online Sept. 5 in JAMA ...

Talking to terminally ill adolescents about progressing disease

October 17, 2016
A new review article published online by JAMA Pediatrics uses a hypothetical case scenario to explore the ethics, emotions and skills for talking to terminally adolescents about their progressing disease.

In Ethiopia, HIV disclosure is low

January 2, 2013
In Ethiopia, where more than 1.2 million people are infected with HIV, disclosure of infection by patients is important in the fight against the disease. A new study led by a Brown sociology researcher investigates HIV-positive ...

Recommended for you

Researchers use a molecular Trojan horse to deliver chemotherapeutic drug to cancer cells

February 23, 2018
A research team at the University of California, Riverside has discovered a way for chemotherapy drug paclitaxel to target migrating, or circulating, cancer cells, which are responsible for the development of tumor metastases.

Study tracks evolutionary transition to destructive cancer

February 23, 2018
Evolution describes how all living forms cope with challenges in their environment, as they struggle to persevere against formidable odds. Mutation and selective pressure—cornerstones of Darwin's theory—are the means ...

Lab-grown 'mini tumours' could personalise cancer treatment

February 23, 2018
Testing cancer drugs on miniature replicas of a patient's tumour could help doctors tailor treatment, according to new research.

An under-the-radar immune cell shows potential in fight against cancer

February 23, 2018
One of the rarest of immune cells, unknown to scientists a decade ago, might prove to be a potent weapon in stopping cancer from spreading in the body, according to new research from the University of British Columbia.

Putting black skin cancer to sleep—for good

February 22, 2018
An international research team has succeeded in stopping the growth of malignant melanoma by reactivating a protective mechanism that prevents tumor cells from dividing. The team used chemical agents to block the enzymes ...

Cancer risk associated with key epigenetic changes occurring through normal aging process

February 22, 2018
Some scientists have hypothesized that tumor-promoting changes in cells during cancer development—particularly an epigenetic change involving DNA methylation—arise from rogue cells escaping a natural cell deterioration ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.