Review Question - QID 105748

This man an advanced pancreatic adenocarcinoma, which portends a very poor prognosis. In a situation where family members express the desire for a physician to withhold information from a patient, the best next step is to ask more about why the family member has this hesitation.

Patients, in general, have a right to know their diagnoses. This is not always a concrete rule, however, as instances can arise where it is not appropriate. For example, in some cultures, it is the entire family, and not individual patients, who are responsible for medical decision-making. It is not appropriate to proceed directly to disclosing or withholding information without further discussion.

McCabe et al. discuss the nuances of withholding information from a patient when the family requests it. They propose a practical 4 step approach: (1) spend time developing an understanding of the family's point of view, (2) understand the patient's true preferences for receiving information, (3) take an incremental approach to resolving requests for nondisclosure, and (4) continue to work with and include the family at key time points, when there is new information to be conveyed and when there are decisions to be made. They note that the more physicians show respect for cultural traditions; the more comfort they provide, the more trust they garner from their patients.

Incorrect answers:
Answers 2-5: These are not appropriate responses to this situation. When possible, always try to gather more information. Bringing the situation to the hospital ethics panel is rarely the correct answer.