A request for nondisclosure: don't tell mother.Edit
Hallenbeck J, Arnold R.
J Clin Oncol. 2007 Nov 1;25(31):5030-4.
Sometimes physicians are faced with the situation in which a patient’s family does not wish to tell them about their diagnosis, such as in the case of a diagnosis of cancer. The authors of this article propose a method by which the physician can accommodate the family while at the same time continuing to uphold informed consent and patient autonomy. In the United States, physicians view requests for nondisclosure as a threatening departure from norms of clinical practice, however, from a global perspective, we are in the minority. In most other countries the primary recipient of bad news is the family, not the patient. The authors propose the following strategy for handling a request for nondisclosure:
- Do not over-react – by over-reacting, the physician loses the opportunity to learn why the family is asking for nondisclosure.
- Attempt to understand the family’s viewpoint – in some cases, discussion may reveal that the patient had clearly stated that he or she did not want to be informed.
- Be flexible – after understanding the family’s view, you can offer to think through with them the implications of their reasoning.
- Respond empathically to the family’s distress – statements such as “I understand this must be a difficult time for you and your family” or “I see how worried you are about your mom” are important in establishing an empathic connection.
- Talk to the family about what the patient would want – in some cases, the family’s view may differ from the patient’s.
- States your views as your views – statements such as “I believe or I think” are better than saying “the patient has a right.”
- Propose a negotiated approach – the physician may propose talking with the patient regarding his or her wishes without trying to talk the patient into anything.
It is important to remember in the case of nondisclosure to approach with an open mind. The conversation must be framed as a negotiation, a joint effort for treating the patient, not as a one-sided argument where only one side wins.
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