Case Report: Family-mediated prognostic non-disclosure and psychological deterioration in terminal cancer

Prognostic non-disclosure is a common practice in Indian palliative care, often driven by family members' intentions to protect patients from emotional distress. However, the psychological consequences of sustained non-disclosure remain insufficiently documented within psycho-oncology literature. This case report, structured according to the CARE guidelines, describes the psychological trajectory of a 34-year-old male police officer with metastatic gastric carcinoma whose terminal prognosis was withheld at his family's request. Initially, the patient remained hopeful following a total gastrectomy and chemotherapy. However, upon readmission with progressive multi-level intestinal obstruction, hepatic dysfunction, and sepsis, he developed escalating anxiety and distress. The growing discrepancy between his lived bodily experience and the "white lies" provided by his family contributed to significant psychological deterioration, culminating in an episode of self-harm (intentional cut injury over the neck and hand) and terminal decline. This case illustrates how well-intentioned family-mediated non-disclosure may inadvertently intensify psychological suffering by undermining trust, autonomy, and emotional regulation. The report underscores the importance of culturally sensitive yet psychologically informed communication practices, early psychosocial assessment, and structured family counseling within palliative oncology care to preserve patient dignity and psychological stability at the end of life.