Best time to divulge information to dying patients

[eiluch]

When is the best time for a clinician/family member to tell a dying patient of his true condition?

[mammo]

You want to gather the family members and tell them first.  This allows them time to grasp what they are being told so that they don't fall apart in front of their loved one and make things worse. Ask if they have any questions. Then allow a close family member to accompany you while you tell the patient, and then leave them all alone to deal with it as a family. But before you leave ask again if anyone has any questions, and if so answer them, if not tell them to have you paged should they have any.  The best time to tell is as soon as you know without a doubt that the patient is dying.  Giving a family this kind of information is very stressful, for all and painful.  The patient usually has a suspicion that they are dying.  Just put yourself in the patient's place and think of how you would want to be told.  Then put yourself in the family's position and think of how you would want the news presented.  Think of any questions you may have...like will they be in pain, etc.  This way you can offer information without them having to ask.  Let them know that you have to tell their loved one, and if one of them would like to accompany you they can, and then the rest can visit.  I don't think anyone would want a crowd when reciving this information.

[eiluch]

Thank you for the comments. All this time my previous instructors discuss that only doctors should divulge the information, and yet, nurses are the ones who were left with patients. I am glad you answered my queries... I am preparing myself in case I'm faced with patients having similar dilemma... I think (though I haven't really encountered such) that it is stressful on the part of the patient, challenging and stressful on the part of the clinician, and painful on the part of the relatives.
Is there a softer way of divulging such information? It's true that patients always have the right to be informed, and yet, there is paternalism on the part of the doctor.
Another question: When do you know that it is the high time to do it?

[zzzmykids]

It is so close to me right now. My Momma passed Feb. 11....this year.  She had been going down hill for some time but the December and on it was pnuemonia after pnuemonia, her lungs just couldn't work well enough to breathe. We, me, wasn't told until her doctors came in at the hospital, four days before she died and told me this last one, a heart attack, would not be recovered from. Telling me she had little time and she would be kept comfortable at the hospice across the street. When Momma woke up, I asked her if she wanted to go home to Jesus and Gramma and her Dad or did she want to plan the 60th wedding anniversary and fight the four months to get there. She wanted to make it to the 60th. I told her it was against the odds and she would have to do things that were beyond DNR. After the second day, she was tired, didn't want the forced air and wanted the morphine. She had made her choice. She wanted to go home.
I stayed with her all the rest of her life and a few hours after. She knew, she chose and the night before she was going down hill, and she said she talked to Gramma.
I hated her going, but for the past three years this fine, brilliant woman lived a lonely and knowlege of how little she could do anymore, life. I miss her. zzzmykids

[mammo]

As soon as possible.  The patient deserves to know so that he/she can do whatever they feel is necessary, regarding family and personal matters.  It's bad enough to be dying, but to lose precious time only to learn that you are dying, makes one feel betrayed. It's so unfair to the patient.  Their time is limited and by knowing they can make the best of the time they do have,