How should nurses approach truth-telling when a patient’s prognosis is poor and may cause distress?

• A. Withhold prognosis to avoid distress.
• B. Always disclose every detail immediately regardless of readiness.
• C. Only discuss prognosis with physicians.
• D. Provide honest information with sensitivity, gauge patient readiness, offer support resources, and involve family or surrogates as appropriate.

Answer: (D)

Providing honest information about prognosis in a compassionate, patient-centered way is essential. Start by checking how much the patient wants to know and how they want to receive information, then share what you can in clear, plain language. Deliver the news with empathy, pausing to gauge understanding and inviting questions. Acknowledge the patient’s emotions and offer immediate support, such as access to counseling, social work, palliative care, or spiritual care resources. Include the family or surrogates when appropriate and with the patient’s consent, while always respecting cultural values and the patient’s own preferences. Document the patient’s wishes regarding disclosure and involvement for future conversations.

This approach respects autonomy by honoring the patient’s information preferences, supports beneficence by providing information and resources that can help them plan, and minimizes harm by avoiding overload or timing information to match the patient’s readiness. Withholding prognosis to prevent distress or disclosing every detail regardless of readiness undermines autonomy and can cause harm or distrust, while delegating all discussions to physicians overlooks the nurse’s ongoing role in patient-centered communication and support.