Truth-Telling at End of Life: A Case (CS364)

Outcomes1. Analyze end-of-life situations from the standpoint of cultural humility.2. Develop strategies for difficult involving discordance between family members and teams related to truth-telling.The concept truth-telling is a core ethical issue in hospice palliative medicine. Most extant literature on this topic focuses disclosure patient: ensuring that seriously ill patient has information regarding diagnosis prognosis best allows them make decisions. Less attention been paid toward making decisions incapacitated patients. This can have particular relevance where factors play role surrogate decision making.1,2 case highlights unique issues concerns may arise when addressing truth-telling.A 51-year-old male India with history mycobacterium avium infection, chronic kidney disease, diabetes, known enhancing leptomeningeal lesions uncertain etiology (tuberculosis vs inflammatory malignancy) was admitted quaternary neuroscience hospital left-sided weakness. Imaging revealed right internal capsule infarct diffuse enhancement. On day 3, he experienced seizures expansion intracranial hemorrhage imaging; underwent surgical decompression remained intubated postoperatively. Mental status declined over next 10 days, care met patient's spouse, sister, brother-in-law goals care. Family decided per stated wishes focus comfort. The wife sister were clear they be only ones given clinical by teams, despite presence multiple other at bedside. They preferred extubation framed as recommendation medical team. neurology team instructed inform mother team's comfort request caused significant distress.This presentation will address approach taken navigate complex dynamics compassionately extubated. 1. humility. 2. truth-telling. A distress. References1.Huang HL, Cheng SY, Yao CA, Hu WY, Chen CY, Chiu TY. truth telling treatment physician-led Accountable Care Organizations: discrepancies patients’ preferences physicians’ perceptions. Medicine (Baltimore). 2015;94(16):e657. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602689/2.de Pentheny O'Kelly C, Urch Brown EA. impact culture religion end life. Nephrol Dial Transplant. 2011;26(12):3838-3842. https://academic.oup.com/ndt/article/26/12/3838/1840139