Someone you know has cancer. Should I hide my diagnosis from them?

A radiotherapy technician looks at a computer screen at the National Oncology Center in Sana’a, Yemen, December 28, 2022. Photo credit: Reuters/Khaled Abdullah

Recently, a friend desperately texted me asking for a doctor’s opinion on a problem she encountered. She told me about her relative who was recently diagnosed with cancer. Her family started treatment but did not inform the patient. The patient fainted during the first dose of chemotherapy and had to be admitted to the ward. After learning of her diagnosis from other patients hospitalized there, she was shocked and they decided to stop further treatment.

A friend of mine wanted to know if it was ethical and legal to hide a cancer diagnosis and start treatment without the patient’s consent.

According to Dr. Jenifer Jeba, a palliative care consultant at Christian Medical College (CMC) in Vellore, this situation is actually quite common.Most of her patient’s relatives have requested that she not reveal the diagnosis to the patient. collusion: A relative is a doctor collude With them, withhold information from the patient.

In Western countries, patient autonomy Physicians should provide all patients with information about their diagnosis and available treatment options. This allows patients to make informed treatment decisions. However, South and Southeast Asian countries, including China and India, do. collective autonomy: Where the patient’s family plays an important role in treatment decisions.

Dr. Dheeraj K., Senior Psychiatrist at CMC Vellore, said: “Their main objective in these scenarios is to protect the patient from truth and despair.”

According to him, relatives expect patients to have trouble coping with information, worry, and sometimes even avoid treatment. We are also concerned about our ability to provide [and] We might do this because of the widespread belief that being diagnosed with cancer reduces quality of life and often leads to death,” he added. not the death penalty it is conventional.

However, studies in many cancer treatment centers, including in Southeast Asian countries, have found that most patients want to know their diagnosis. These studiesboth doctors and relatives routinely grossly underestimate the willingness of patients to learn their diagnosis. rice field. explained Painful and depressing.

According to Dr. Arnab Mukherjee, a psycho-oncologist at Tata Medical Center in Kolkata, patients who are unaware of their diagnosis have a more difficult time. They expect treatment to make them feel better and are disappointed when it does not. Patients then gradually lose trust in the treatment team and process.

If life expectancy is actually short, they spend the last few days of their lives figuring out what’s going on rather than seeking care and support that can help them. Knowing is about meeting people with the patient, tying up unresolved endings, asking (or forgiving) forgiveness – all leading to a peaceful and dignified death.

At least the scientific evidence is clear: revealing the diagnosis to the patient do not adversely affect patient quality of life and even better disease outcomes.

Of course, delivering bad news is not easy. Physicians use techniques such as SPIKES (which stands for “Set, Aware, Invite, Know, Empathize, Summarize”) to deliver bad news to their patients. However, the patient’s relatives and bystanders may not have the necessary skills. It is important to provide information that the patient can be satisfied with.

Dr. JV Punitha, a medical consultant at Apollo Hospital in Trichy, often uses metaphors to explain the importance of clarifying the diagnosis when speaking to relatives of patients. She likens not revealing it to blindfolding someone with a fear of heights to the top of a very high elevator.

“If you lie to a person in an elevator and say you’re standing on the ground, it’s likely that something is wrong with you, so it just raises your suspicions,” she said. Sooner or later, you’ll figure out the truth by noticing the symptoms, such as a relative exploding emotionally or requesting to speak to the doctor alone. You won’t believe a lot of things.”

Patients often prefer to know their diagnosis together Their family, not after the family has already been spoken of.they also expected Offer some form of hope and have all treatment options explained. However, there may be a small subset of patients who do not want to know their diagnosis. So if a patient wants to know, it’s important to check with them first and then find a way to communicate the information.

of constitution of india Give patients legal autonomy to make decisions related to their treatment. Physicians who treat patients without valid consent are criminally liable. However, to the author’s knowledge, no incident has ever been reported in India in which a doctor was accused in this way. .

Physicians should therefore rely on patient assessment to clarify the diagnosis in an empathetic manner and involve the patient in decision-making as much as possible.

Dr. Christianez Ratna Kiruba is passionate about medical ethics and patient advocacy and is currently an MD in General Medicine at Christian Medical College, Vellore.

Dr. Parth Sharma is an aspiring prevention and support oncologist, currently MD in Community Medicine at Maulana Azad Medical College, Delhi, and founder of Nivarana, a digital public health information platform.