Chapter 1: Interpersonal challenges
The family is unaware of illness severity
In your early discussions, you may discover that the family isn’t aware of the severity of the illness or doesn't realize that the individual is imminently dying.
- The individual hasn’t been connected to the healthcare system or hasn't sought medical care.
- The health care team hasn’t discussed the prognosis with the patient and family.
- The health care team hasn’t explained the progression of the illness or condition.
- Health care providers were vague and used euphemisms, such as “He’s very sick,” instead of clearly stating that the individual is dying.
- The individual and/or family refused to have these discussions. (Some cultures discourage talk about serious illness, dying or death.)
- The individual and/or family is in denial.
- A palliative care consult hasn't occurred.
- Advanced directives or documentation to withhold resuscitation haven’t been discussed or completed.
Even if previous discussions with health care providers have occurred, you may be unaware of these conversations and you may not have access to relevant historical documentation. It may be necessary to start at the beginning. You may feel frustrated that these conversations have become your responsibility; but this is an opportunity to make a lasting difference to a family. Proceed gently, humbly, and sensitively.
For additional information, see Module 3, Explaining clinical information and what to expect; and Module 4, Decision-making.
For additional information about cultural considerations when delivering bad news, see Module 6, Supporting the patient and family - Chapter 2, Respecting and responding to cultural practice and traditions.