Role of the Critical Care Nurse in Disclosing Difficult News

S is a nurse in the medical intensive care unit. For the past 3 days, she has cared for Ms B, a 59-year-old woman admitted with pelvic pain. Ms B was transferred to the medical intensive care unit because of hemodynamic instability after vaginal blood loss. She has undergone diagnostic tests and has a new diagnosis of uterine cancer. Ms B retains decision-making capacity but is critically ill and decisions need to be made about her treatment. Ms B has not yet been told her cancer diagnosis because she speaks Cantonese and the health care team has been working to coordinate a meeting where a certified health care interpreter can help deliver this news. However, in the meantime, a medical intern has inadvertently disclosed Ms B’s cancer diagnosis to Ms B’s aunt, Mei, while she was visiting the hospital one afternoon. Mei, although devastated by the new cancer diagnosis, is even more distraught at the thought of her niece living with the knowledge that she has cancer. Mei explains, “Doctors in China don’t tell patients they have cancer and my niece would lose hope if she learns of her diagnosis, become depressed, and no longer want to live.” Yesterday, while talking with Susan through a telephone interpreter, Ms B asked if something was seriously wrong with her. Susan was unsure what to say, so quickly redirected the conversation when the phlebotomist came into the room to collect samples for laboratory tests. Susan feels Ms B has a right to know her health information but also understands the concerns of Ms B’s aunt. Today on rounds, Mei implored the health care team to conceal Ms B’s new cancer diagnosis. The team explained that because Ms B has the ability to make her own decisions, they need to inform Ms B that they have new information about her health and ask if she wants to know more. Ms B’s attending physician has several other patients to see and plans to fit the meeting into his schedule late in the day, so he wants to use a telephone interpreter instead of an in-person interpreter. The family has reluctantly agreed to attend a meeting with the health care team and patient where, through an interpreter, Role of the Critical Care Nurse in Disclosing Difficult News