Takeaway
Patients often want to share significant health news with loved ones. You can help them choose when and how to disclose this information.
Lifelong Learning in Clinical Excellence | October 11, 2021 | 2 min read
By Ambereen Mehta, MD, Johns Hopkins Medicine, Michelle McWhirter, LCSW-C, Johns Hopkins Medicine
So many emotions run through our hearts and doubts run through our minds when we must tell our patients about the progression of their disease, a disappointing test, or a failed treatment. In medicine, our primary goal is to do no harm. Yet words, when delivered without thought or preparation, or not delivered at all, can do great harm. Our patients are also tasked with sharing difficult information with their loved ones and care partners; however, they may have no training in the delivery of difficult news. One can only imagine how hard it must be for patients to have these conversations with their families.
Patients may not share with their healthcare team their struggle with disclosing disappointing information to their loved ones or care partners if they aren’t asked directly by a healthcare professional. Sometimes, patients ask the healthcare team to talk to their loved ones or care partners. Family meetings with the healthcare team can be incredibly valuable to allow loved ones and care partners to hear difficult information with the patient as a supportive presence. Other times, patients may wish to do this communication independently, but ask for advice on how best to disclose information to their families.
Here are some tips to share with patients who wish to tell their loved ones they have a serious illness:
1. Timing
Ask when your patient wants to share upsetting information with their loved ones. For example, in the setting of an inpatient hospitalization, does the patient want to share this information while in the hospital or wait until they get home?
2. Method
How does the person want to share? Do they want to do it in person, by phone, over a video call, in an email, by text message, or via another format? The method of delivering information can vary depending on who it’s being shared with. It can also be exhausting to relay news multiple times to different people. Explore whether there’s someone close to them who can help with disseminating the message.
3. Content
How much information do they want loved ones to know? Remind the patient that they’re in control of this, and it’s ok to set boundaries. They can decide the types of questions they want to answer.
4. Family dynamics
Who provides them with support? Explore what types of support the patient is looking for and which individuals in their life can provide this. Remind them that this is their story, and they’re in control of who is privileged to this sensitive information.
5. Explore emotions
What makes sharing this information difficult for the patient? What worries them about sharing it? How do they anticipate their loved ones will respond?
6. Normalize and empathize
Healthcare professionals can be uncomfortable or worried when they learn patients haven’t shared their diagnosis with loved ones or care partners. Give space for the patient to process the complexities around sharing the diagnosis. This can help them decide when and how to make the first difficult step.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.