Informing the cancer patient and family.
One of the questions the therapist poses himself while informing a patient is: whom shall I inform about the diagnosis, treatment and prognosis? If we unconditionally accepted the view that information belongs to the patient from an ethical and legal standpoint, we would automatically exclude the partner and the family. Therefore, the therapist should raise another question: what is the benefit to the patient? To answer the question and the resulting dilemma, we have to leverage the long experience of family therapy and tailor it to the cases we are dealing with. It should be taken into consideration that patient and family are a dynamic system which was balanced before the onset of the disease, but is now disrupted, entering into crisis. Therefore, denial mechanism and personality characteristics we have previously elaborated on, and communication among members play a crucial role in determining the information strategy and the way family should be approached. The steps to approach the patient - family are: 1) Firstly, we evaluate the patient's degree of denial and personality characteristics. Then we receive information about the patient's family so that we can have a rough idea about intrafamily dynamics. 2) Then we gather information from the nurses about the family atmosphere: simple information about the patient's and relatives' relationship like who comes to the hospital, who shows interest in the patient, whether someone is being quarrelsome or not are crucial to assess the dynamics of their relationships. 3) We summon patient and family members in our office. 4) We decide on the steps to inform the patient, and we apply them. Involving family members with the patient seems to improve the results of information and forge concession and therapeutic alliance, which are necessary parameters in the therapeutic follow-up. Usually, doctors and nurses approach patient and family using their experience. Therefore, we need a training that will equip health professionals with the necessary knowledge to approach the family.
Department of Mental Health and Behavioral Sciences, School of Health, University of Athens, Athens, Greece. gkallerg@nurs.uoa.gr
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D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D003219:Confidentiality; D003717:Denial, Psychological; D005195:Family Relations; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D009723:Nurse-Patient Relations; D028701:Patient Rights; D010361:Patients / Q000523:psychology*; D010551:Personality; D010817:Physician-Patient Relations; D011379:Prognosis; D012944:Social Support; D014342:Truth Disclosure