Agree with Andrew's parents not to tell him his diagnosis because it would cause him distress?
Andrew is seven years old. He has recently been diagnosed with cancer and is about to begin his first round of chemotherapy.
Andrew is being given chemotherapy on the ward and his parents, Mr and Mrs Burton, have come to see Dr Simpson who is in charge of his care. So far Andrew has not taken an active interest in the details of his illness and his parents do not want the healthcare team to tell Andrew what his diagnosis is.
I see from Andrew's notes that he hasn't yet been told his diagnosis. I'm a little concerned about that. Is there a reason why?
His grandfather died of cancer last year and we're just worried that if he hears that word again he'll assume he'll die. He was so upset...
I understand your concerns, but we can explain carefully and in a way appropriate to his age. He may be young but he may well understand.
I don't think he would be able to understand. He hasn't asked us about it so far. He just talks about 'being a bit poorly'. He's only seven - he's got enough to deal with for a boy his age.
Dr Simpson met with Andrew and assessed his capacity. She decided that as he was rather unwell at the moment he wasn't able to understand the implications of his diagnosis. So she agreed with Andrew's parents that for the time being she would not tell Andrew his diagnosis. However, she explained to Andrew's parents that she would review this decision if there was any change in his condition.
Effective communication between doctors and children and young people is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to them, and what opinions or fears they have about their health or treatment. In particular you should:
a. involve children and young people in discussions about their care
b. be honest and open with them and their parents, while respecting confidentiality
c. listen to and respect their views about their health, and respond to their concerns and preferences
d. explain things using language or other forms of communication they can understand
e. consider how you and they use non-verbal communication, and the surroundings in which you meet them
f. give them opportunities to ask questions, and answer these honestly and to the best of your ability
g. do all you can to make open and truthful discussion possible, taking into account that this can be helped or hindered by the involvement of parents or other people
h. give them the same time and respect that you would give to adult patients
(0-18: guidance for all doctors, paragraph 14)