Managing Family Collusion
Collusion is generally an act of love and protection for a loved one, where the patient is not made aware of the bad news with regards to his/her illness by the caregiver(s). As a physician, managing collusion among patients and family members is one of the biggest challenges you may face while practicing palliative care in India, where the family is closely knit and involved in decision-making.
Why collusion should be discouraged?
It is necessary to discourage collusion from the beginning of palliative care for the following reasons:
- Collusion causes tension, and holding back information can create problems.
- Instead of protecting patients, it separates them from their loved ones and prevents the family from extending the loving support the patient needs.
- Bereaved family members often feel regret after the patient has passed away.
- Collusion can rob the patient from making important decisions and to take care of unfinished business.
Steps to deal with collusion
- Acknowledge the presence of collusion and the difficulty of the situation for the relative/caregiver.
- Assess the relative’s understanding of the disease and its impact on the family.
- Review and acknowledge the reasons for not telling the patient.
- Consider the consequences and potential harms of not telling.
- Suggest that research evidence indicates that most patients would like to know the truth and that they are already aware that something serious is happening.
- Seek permission to speak to the patient alone.
- Indicate that you have no intention of revealing the truth to the patient but only to assess how much he knows and how much he wants to know.
- Seek permission to convey his/her awareness to his relative.
- Initiate discussion with patient and family to offer support and follow-up, and to start setting realistic goals for the future.
- Beng KS. Collusion in palliative care. Malaysian Family Physician: the Official Journal of the Academy of Family Physicians of Malaysia. 2006; 1(2-3):62.
- Chaturvedi SK, Loiselle CG, Chandra PS. Communication with relatives and collusion in palliative care: A cross-cultural perspective. Indian journal of palliative care. 2009 Jan 1; 15(1):2.
- Kyriacos DS, Mtshali K, van Heerden D. Fresh Perspectives: Fundamentals of Nursing. Pearson South Africa; 2008.