How do you deliver bad news to your elderly mother? She "feels fine" although she coughs & is short of breath. She has stage 4 lung cancer.

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How do you deliver bad news to your elderly mother? She "feels fine" although she coughs & is short of breath. She has stage 4 lung cancer.

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Mom is 87 and has survived thyroid cancer. Although they saw something in her lungs before. It seemed to be a "scar." Long story short, last CT scan shows that she has stage 4 lung cancer. It kills me to have to deliver the bad news. She seems to be in good spirits and talks about traveling in the future, etc. Never had to deliver news to a parent before that they are slowly dying. I will ask her, but I know she doesn't want treatment. Doctor said would only add a few months... not really a good option. I keep thinking of all the different scenarios of how this will turn out. My sister and I decided to wait till after Christmas. That's all I've been thinking about since we heard the news 3 weeks ago. Any suggestions on how to go about this? I think we might need to give her Xanax when we tell her the news. Has anybody ever had something prescribed to their parent for devastating news such as this? My mother is a very emotional person like myself. I have a pretty good idea on how she's going to react.. She possibly could go into full denial about this as well.

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I'm sorry you have to deal with this, I think it's rotten of doctors to inform family members rather than break the news personally, face to face and available to answer questions. I think I would say something like "mom, the doctor called with the CT results and they say it's cancer", and beyond that take your cues from her. I wouldn't mention dying unless she does. And you don't really know at this point what the future will look like in the short term, so if she wants to go into denial and live as though everything is fine I can't see anything wrong with that so long as you have your plan B firmly in place.

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I think any of us would be VERY emotional at being told we have but months to live. I think you are prepared for her to be, and she has a right to be, and you should expect her to be. I believe her doctor should deliver the news that this is stage four, and the prognosis, and should tell her that there is little option in terms of treatment, but that hospice can keep her comfortable. All forms that are not already done in terms of POLST and advanced directives need to be done asap.
The only thing you can do is let her cry, tell her that you will be there for her, and tell her that you will follow her directions, be certain she is medicated to keep her comfortable, get hospice care for her. You will have support of nursing, social workers and clergy if you wish it.
I am so dreadfully sorry. There is no happy way to receive this news. No matter how much drugging you do.
The doctors delivering this news will help with the denial but YOU must make it clear to him you believe she will go into denial so that he is HONEST. There is no good way for bad news. When I had breast cancer and said to my doctor "What do you think it is" He said "An occult breast cancer though it could be lymphoma". When I said "I never get sick; what can it be that is GOOD" he said "Cat scratch fever, but I don't think so". I could laugh about it later, but at the time it was shocking and brutal. There is no good way to hear very bad news. I just am so sorry.
As to the final way she reacts, that is something you have little control of. After getting the truth, you can live with how she chooses to handle it. If she never does accept it, then know that is one way to handle it and allow her the dignity of her reaction.

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Why on earth hasn't the doctor told her? You march her into his office and make him tell her while you and your sister are with her. He handles the medical questions, and you handle the emotional support.

That's how it went with my dad. He had NO idea he had cancer, and I went with him to his appointment to hear the results of an MRI from his doctor. He walked in and said, "Well, I'm sorry to say you have inoperable cancer in your liver. I'm afraid anything we could do for a younger person would kill you."

He then left us alone to process that for a few minutes, then he came back and answered Dad's questions. He sent Dad off to get an unnecessary X-ray so he could tell me that he had about a month, and that was that. We never saw the doctor again.

Your mom deserves to have her doctor tell her and to be there to answer her questions. You aren't qualified to answer them, and he should be there to do it.

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I'd tell the onc that with this news, a 10-day scrip of Ativan (not Xanax) would help break it and provide her some clear, non-panicked thinking in what her next step should be. It's a legit concern. If it's hospice, then Ativan is part of the normal course, and in my opinion, it should be anyway.

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This is the doctor's job, not yours.

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When i read this I said the same thing. This is the doctor's job. To sit her down and explain the options.

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Not everybody can handle bad news. Some hypersensitive person may even drop dead on the spot. You have to realize that given her the bad news won't accomplish anything positive. I'm not telling you what to do, only what I would do in a similar situation. I would withhold the news a let her fantasize anything she wants. Eventually, her condition will worsen and she herself will gradually realize that something isn't right and will start asking questions.

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I agree, while you and probably your sister if possible should be there, this is something the doctor should be telling her. She knows she had the scan and I assume used to the process of going in for a meeting with the doctor to get the results since she has dealt with Cancer in the past. This should be an appointment with the doctor that includes you and or your sister, it is not your responsibility or job to deliver the news just to pick up the pieces. It will help of course that you know what’s coming, you have digested the news and can just be there as support for your mom rather than in shock as well.

My thoughts are with you.

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We had quite the roller coaster situation with my 75 year old Mother. She is a lifelong smoker and was in a car accident this past summer (which thankfully was the last straw for her independent driving). They did a CT scan which showed a 3 cm tumor in her right lung. The CT report even said it was highly suspicious for lung cancer. We took her to an oncologist who said it’s lung cancer but they needed to do more tests to determine staging. In the meantime, I told mom she has lung cancer (which was soooo hard considering her husband , my father, passed away from this disease last year).

My mother didn’t even look up from her word search after I told her. She just questioned “how do they possibly know that??!?” And “they are wrong!”. Then went right back to circling words in total denial I had just given her bad news. The next day, I asked her what she would want for treatment and she asked “for what??!!!!”. Yup. She forgot. I didn’t mention any of the cancer stuff again until the PET scan. She kept asking what it was for and I would tell her but on the way home, she’d ask again. She is incapable of having bad news sink in.

Fast forward to the call from the doctor with PET scan results. The dr. told me that the suspected cancer was actually a huge 3 cm granuloma!!!!!!!!!! He and his colleagues were shocked and said this was very rare especially in a lifelong 2 pack a day smoker. She does have diffuse emphysema….but the bottom line….we weren’t looking at cancer.

I told mom the incredible news (although in some ways this was mixed news for me). I don’t want her to die a painful cancer death, but I also don’t want her to die a long drawn out death by complications of Alzheimer’s either. Mom reacted with “well of course I don’t have cancer!”. Lol. This is truly a classic story about my Mom….she has unbelievably good luck. She had Covid a year ago along with all 8 of us in our family. She is in several high risk categories, yet she had it the most mild. No fever, no big cough….just felt a bit under the weather for a day.

I’m telling this story because perhaps you don’t need to go into elaborate info or details about her disease if she is not going to be treated anyways. Keeping it simple to understand and telling her things on a “need to know” basis? I’m not sure how with it your mom is in terms of how she will remember anyways. I would wait until after the new year….but that’s just me. Good luck and I hope she takes the news well.

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My mom passed away 3 years ago from Lewy Body Dementia. My dad had already started showing signs of dementia. I brought him here to live with us. I decided not to tell him my mom passed away. I got some resistance from family members but ultimately, since he was living with me, I decided not to let him grieve himself to death. Fast forward almost 4 years and it was the best decision I’ve ever made. He NEVER even asks about her. They had been married 60 years. Sometimes you just have to go with your gut. It seems as if he has totally forgotten about her. It’s such a sad disease to watch. Not sure which is worse…cancer, where you still have your mind to know what’s going on…or dementia where you have no clue. I’m sure you will make the best decision for you and your mom. Best of luck to you

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How does it come about that you - and, it seems, your sister - have been given this information by your mother's doctors and your mother has not?

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I always see test / lab reports before the doctor calls. However, except to tell my husband "You're numbers look great," I wait for the doctor to tell him. I knew my mammo results two days before the doctor got around to notifying me. So, perhaps that is how OP and her sister know about mom's results.

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Deciding on treatment or not is a personal, family decision and I have no way to recommend for or against. My brother passed 25 years ago, age 51, with lung cancer. He wanted treatment and lived nine months after diagnosis. It was not a good nine months of quality time. Usually unable to eat much, stand without help, lucidity was bad. But, he wanted treatment right up to the point that the doctors said there was nothing more they could do and recommended hospice, the last two months of his life. Outside looking in even as his brother, I had to wonder why he wanted such harsh radiation/chemo treatments. If the cancer has metastasized beyond the lungs, treatment can only extend life a few months and the quality of time is not good at all. But still the patients decision. I dont know with certainty but I wouldn't bring up the subject of dying. If she asks when it becomes obvious to her, there is no reason to lie. If she wants treatment and they are willing to give it, then go with it. My brother didn't think he was dying until the doctors cancelled any further treatments and hospice came into the picture. I asked the medical team nurse why he even got treatment after hospice. She was very clear yet understanding. She said first, my brother wanted treatment, my sister in law was also wanting it even though the doctors knew it was terminal. In just 3-4 months before diagnosis, the cancer had metastasized into his spine and brain. She said radiation treatment was like trying to put out a grass fire with your foot as it spread into his abdomen. You put out the fire in one spot, it pops up in half a dozen other spots. In short the patient wanted it and the hospital was connected to Catholic services, we aren't Catholic, and she said they believe in miracles and its not their place to decide life or death until death is imminent. I hope that makes sense to you. Let her make her plans, the truth will make itself known in time when you can be truthful with her.

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My husband had lung cancer and died of it six months after diagnosis. He accepted some treatments to deal with immediate symptoms, but declined chemo which would have added a few months, but would have made him much sicker during thosemonths. Instead, he did what he could still do during his remaining months. Is your mother asking for her diagnosis? Why is her doctor not the one to deliver the diagnosis or to help you decide what to tell your mother?

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If she has Dementia, you do not need to tell her. It will upset her, and then she will forget. Then, when you remind her, she will just get upset again.

Why upset her, especially considering that she stated that she did not want treatment (I'm assuming she was in a coherent state of mind when she stated that)?

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I expect your mom will not be happy - nobody is happy to hear about bad results. Best is to tell her, "CT revealed bad results. (Tell her if she wants details - "You have advanced lung cancer.") Do you want to treat it or just enjoy life and let nature take its course?" If she opts for "enjoy life", then help her to do all those things she really wants to - like travel. She may end up needing portable oxygen and some pain medications eventually, but that shouldn't limit the life she has. If she opts for treatment, then take her to the doctor who can outline her options.

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Lisa
I am sorry that your family has to deal with cancer. It’s the leading cause of death in my family. My mother dreaded it and was on guard against it but thankfully never had it. But of course, she died.
I don’t see where you mention any dementia for your mom.
How did she manage her thyroid cancer? Was that long ago?
We are all “slowly dying”. Your mom might handle this as well as those around her.

I agree that the doctor is the proper source of medical information for mom. You and sister should make an appointment with mom to go for the results and any next steps that involve the oncologist. This for you and sister as well as mom. It is shocking to hear. sometimes we aren’t ready with questions the first time we visit with the doctor.

I do think it’s good to have meds on hand and an understanding of how and when to give. (I took a 1/2 Low dosage xanax once and it knocked me out.)
Does your mom live alone? Is she still driving, cooking? taking care of her ADLs? Using a mobility aid? I would be very watchful for the side affects of the news and the meds.
Denial is not always a bad thing. It sometimes allows a situation to slowly be absorbed. It is part of processing a loss. The point is, mom is an adult who has the right to receive and process this news in a calm informative setting.
In our 80s (well, really all through life) we should be doing any and all of the things we have been putting off that are important or on our bucket list.
When my mom turned 90 she had a big birthday party with many in attendance. Years later when looking through photos of the event, we would marvel at how many people passed before she did. Much younger friends and family.
So, make an appointment with the oncologist.
Call the primary for medication and a next appointment if necessary.
Plan the day with support available for that day and the next few with mild activities that mom would enjoy.
If she has a relationship with a faith based group, see what programs or visits are available.
Decide how you and sister will help mom and manage your own lives.
Make a pact with sister to be there for each other.
Take your direction from mom.

Atul Gawande’s book “Being Mortal, Medicine and what matters in the end” is a great informative read with good questions to cover with mom.

Let us know how it goes. Hugs.

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Why do you have to tell her?

What purpose would it have to make your mom sad and worried?

Don't tell her.

Let mom enjoy what time she has left doing whatever she's wants and able to do.

Start a Bucket List and let mom do as much as she's able to do.

Of course she doesn't need the harsh Cancer Treatments for her end of life.

All she needs is her family and being able to do anything and everything that she feels like doing.

She doesn't have long. So make every day count.

Don't make her think every day is her last by telling her about the stage 4 cancer.

Prayers.

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Very few people 'enjoy what time they have left' when dying of terminal cancer. Many if not most want to know what is going wrong.

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My father had a terminal brain tumor that started growing and was going to kill him in short order. When I took him to the ER, the doctor gave me the news that it was growing, and that he had 3 months to live (in her opinion) and there was nothing they could do for him medically; surgery was not an option at 91 years old. The doctor didn't know him from Adam, so it was up to ME to tell him what was going on. Why would I want a stranger to tell him anyway? Although I surely did not WANT to break this news to him, who better to tell him than his daughter and only child who loved him dearly and who would tell him in a loving, compassionate way?

I never worried for a moment that he would 'drop dead on the spot' TChamp.

I broke the news to him that his brain tumor had grown and was causing him the droopiness on one side that he was experiencing lately. I also told him that there was no treatment available for him due to his age, and that surgery was way too invasive a thing for him to endure. He said, "Are you sure?" I said yes. I told him that hospice would be on call for him but that people were known to live for 2 years or more under hospice care, and that he had me and mom to help him and care for him, too. He thanked me for everything, we both cried a bit, and he accepted the news with grace and dignity.

He had every right to know what was happening to him. Why should he have been prevented from knowing what was happening to his own body? I totally disagree with hiding the truth from your mother b/c the news may upset her.

My dad died 19 days after he went to the ER for an MRI. The brain tumor was very aggressive. He died peacefully and with no pain and I'm grateful for that.

I'm sorry you are faced with this situation and the sad fact of losing your mom to lung cancer. If you feel the doctor should tell her, then have him do it. If you feel she'd take the news better coming from you, then you should tell her. But she is entitled to know her fate. Ask the doctor to prescribe some Ativan for her as well.

Wishing you the best of luck with a difficult situation.

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Let the doctor deliver the news, with perhaps a social worker or palliative nurse in attendance, and of course you/family.
Sometimes older people are more closely bonded with a long time friend closer to their own age. If she's got a dear, strong and loyal friend you may want them to be on standby.
If she does not have dementia, perhaps she'd like the respect of being told and control what little she can.
If she has dementia, in my oppinion, I wouldn't say a thing.
My mother did not have dementia. She insisted on fighting with chemo for her pancreatic cancer knowing that w/o it she'd have 3 fairly gentler months to a certain end and only 4 cruel months with chemo. It was a nightmare.

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Yes. I told my father who had always denied he had serious lung cancer. Scared me to tell him. I just said the doctor had suggested hospice. He replied “I think that’s a good idea, honey.”Amazed me as he was a very difficult person. He shined at managing death. Well, an idiot hospice worker took away his vodka bottle ( glass is dangerous) and didn’t give him a plastic one. He had a hissy fit. They gave him a major tranquilizer. He died. Would have anyway, fit may have been part of it, but he was sweet as pie otherwise I would suggest telling your Mom there were some problems in her tests. See how much she wants to know. Don’t make definite prediction. Tell her to tell you if she is uncomfortable, needs something, wants to do something. Let her determine how much she wants to know and do. The staff may be able to help you prepare and handle this. They have done it many times.

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She has serious physical issues and I am sure she knows she has some bad problems. Why would you add fuel to the fire and tell her more than she needs to know. Just give her medication but don't say anything. Just let her talk and support her but don't be cruel and tell her more than she needs to know or can handle. Leave her be in peace to pass when it is time.

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Absolutely not your job, nor should it be.

This is the Doctor’s job. He needs to be able to answer any questions she has, which you will not be able to do. You should go to the appointment with her, to be her support system. But you will just cause chaos and grief if you tell her before she can talk to het Doctor. Don’t Do It.

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What if you asked the doctor to tell her? She's perhaps more able to believe him. And actually that's his responsibility. You can be with her when he delivers the news. Let HER ask him whatever she wants. And when she's done that, you may have more questions, too.

But if she's feeling well enough to plan for the future...well maybe you don't have to entirely rain on her parade. Nobody, even the doctor, can always predict how long someone will live. If she enjoys planning things ahead, let her. It will give her something pleasant to think about, but eventually she won't feel up to it. She will feel less like traveling as time goes on. If that's the case, then that will probably be the time for you to discourage her trip.

So sorry you have to go through this. There comes a time when all of us have to prepare for the "goodbyes". Take care of yourself. It's a tough time!

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She may have some unfinished business - emotional or otherwise. If it were me, even though I'm a highly anxious person who needs Xanax at times, I would want to know. But I do think it's the doctor's responsibility to tell her while discussing treatment options. She may yet have time for that trip, if it's fast-tracked.

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If she asks, tell her. If she doesn't, she may not want to know. And why damper her spirits or will to survive? It's possible she may end up with some treatment if a tumor gets large or causes discomfort even though it may not really prolong life. At this point it's more about comfort and a positive attitude (versus grief) for her. You already know she's emotional - try to avoid it. Let her live with the perspective of planning for future. If she's well enough right now to travel - take her somewhere. Do as much as you can before she gets too weak to do things. All of you can enjoy this time spent with her.

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If your mother is still in her right mind, telling her will be a respectful thing because we all need to trust our loved ones to be honest with us; yes, it could get 'emotional' because it's a scary diagnosis and most everyone knows lung cancer is often a rapid decline toward death. By telling your mother, in simple terms, as "your recent test shows new illness" she can then use her own sense of how to proceed: getting more information from her doctor, etc. It's often a relief to find out what is the cause of not feeling well; a polite person will often report "I feel fine" when it's obvious there is discomfort/debility. Just give her support every step of the way.

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So sorry for your situation. Like a few of the answers here, I didn't think twice about having to deliver the news to my Dad that his cancer had returned after 20 years and he didn't have much time. The doctor, who didn't know Dad (an associate of his regular doctor who assumed Dad would only want pallative care given he was 95) seemed so blunt about telling me, I think it was better that I delivered the news to Dad. I was definitely nervous about it and my husband was beside me when I delivered the news. I wasn't exact when I told Dad how little time (doctors said 3 -6 months without treatment, but it only took about 7 weeks after he found out why he wasn't feeling so good. He was very clear he didn't want treatment.) While he was in the hospital getting tests for having nearly fainted, there was an opening in our conversation and the topic came up quite naturally. (The Lord has his ways is all I could think.) I was lucky enough to be able to take time off from work and spend most of those last 7 weeks with him, and be by his side when he passed.
Your Mom has the right to know as much as she can handle.

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When a beloved aunt was almost 92 they found small cell lung cancer. She had never been a smoker. My mother (her younger sister) was POA and elected not to tell her. There wasn't really a treatment option, it was too advanced and she was medically frail. She got weaker but was otherwise fine until she passed away a fw months later. She took pain meds when needed and had a hospice nurse monitoring her. She was happy to the end, and that was what she would have wanted.

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hauzrlisa: Imho, your mother's physician should have told her of the dx. Ergo, it is not your task.

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To make a long story bareable, I sat my Daddy down and told him what the doctor had told me. She had offered to do it, but I told her I would. When I told my daddy he was terminal, he said he would like to keep on fighting. I said OK, I would help him. We did make all the legal provisions, and started his retirement, if we hadn't done that my mom wouldn't have received any retirement after he died. In about 4 weeks he was gone. Hospice hadn't come to our area in 1974,

Why don't you let the doctor do it? When my mom was terminal, the doctor sat us down, said she had 2 weeks to 2 months, and offered to help us set up Hospice.

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If it doesn't help to tell her, and she only has a few months (probability is less than a year without treatment) then why spoil it for her. A lot of people will say she has a right to know and so she does if she asks and would accept treatment. But if you are sure she would not accept treatment, and treatment won't be pleasant, then perhaps a few good (in her opinion) months, and then palliative care may be more what she would want. We can answer the theoretical question but we don't know your mother - you do. Make a decision on whether you even tell her or what you tell her knowing her as you do. It doesn't matter if she goes into denial if that is her way of dealing with things she doesn't want to know - but it does matter if you make the rest of her life something she wouldn't want. Perhaps a chat with local hospice and even a visit by them - to see how she is feeling (or something) - would help you make a decision.

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You have some very good thoughts. My concern is;

1. If she has legal things that need to be addressed, now is the time to do it. If she isn't aware, she may put it off until it is too late. For example, if she wants Judy to have her antique cabinet, she had better make it known or give it to her now.

2. If there are any fences to mend with family, now is the time to mend them.

3. I have had two family members that wanted to confess something. Knowing they only had a short time, allowed them to make the confession. In my Sister-in-Law's case, she decided to confess that it was her and her cousin Marlene who has driven the Model T through Grandpa's barn wall. She didn't know that everyone had figured that out 65 years ago. May not seem much to us, but as a Catholic, it weighed heavy on her mind.

4. As she gets worse, it might help her to understand what is going on. My husband felt better when he learned he had Alzheimer's. As he said, it gave a name to what was going on in his head.

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How do you deliver bad news to your elderly mother? She "feels fine" although she coughs & is short of breath. She has stage 4 lung cancer.

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