You are caring for a 64-year-old man who presented with painless jaundice and fatigue, but is otherwise in his normal state of health. With the family in the room, you tell the patient that you are concerned about possible causes including cancer, and are recommending a CT of the abdomen and pelvis. The patient’s son follows you out of the room. He shared that he is worried that a cancer diagnosis will cause his father much emotional harm, and that in their culture, the children make the medical decision for their elders. He asked that you tell him the information, but not his father. He shared that he is his father’s power of attorney for health care decisions. What is the best next step to handle this situation?

A. Counsel the son that complete informed consent for treatment requires that his father hear
all information – good or bad – to make the best choices consistent with his wishes.
B. Honor the family culture by ordering the CT, and then reviewing the results of the test with the adult children.
C. To minimize patient stress, review the CT results with the patient when the children are not in the room.
D. Return to the patient’s room to explore his understanding of his illness and wishes for hearing new information and treatment options.

The correct answer is D.

Patients have the right to manage the flow of medical information and to define their role in medical decision-making. At the core of patient-centered care is the ethical principle of autonomy, stating that people are in control of the choice related to the care of their bodies. Usually, autonomy manifests as people make decisions about what therapies they want, and which they don’t. In this case, the patient may have differing views from his family about how he prefers to hear information about his health and how he would like medical decisions to be made. It is necessary for providers to attempt to better understand the patient and family’s perspective and concerns, and to hopefully synthesize information-sharing strategies which are acceptable for everybody. Answer A is incorrect, because it presumes that the patient expects and wants to hear all information to make an informed decision. Answer B is incorrect, because it excludes the decision-sharing process with the patient. Answer C is incorrect because it may harm the patient in context with cultural values, damage the patient’s and family’s trust.

Fast Facts and Concepts #219: Responding to Requests For Non-Disclosure Of Medical Information