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.