Telling Your Family About a Serious Illness: Who, When and How?

You have had a serious diagnosis and are unsure about telling your family. How do you tell a partner, children or elderly parents? Example phrases and tips.

You have just come out of the doctor's office with an envelope in your hand, or a test result on your phone. You are sitting in the car in the hospital car park, and before heading home, a single thought keeps circling in your mind: "How am I going to tell them?" When you receive a serious diagnosis, it is very common to start thinking about how your loved ones will react before you have even had a chance to understand your own feelings. Telling your family about a serious illness is, for many people, a step that feels as heavy as the diagnosis itself. Some want to confide in their partner first, others in a sibling; some stay silent for weeks so as not to upset an elderly mother, while others have no idea what to say to their children. In this article I look at whom you might tell, when and how, how to prepare for the reactions of family members of different ages, and how to protect yourself during this process.

Why Is Telling Your Family About a Serious Illness So Hard?

What makes sharing the news of a diagnosis difficult is often not the news itself so much as fears about the effect it will have on the other person.

• Fear of upsetting loved ones. Thoughts such as "Mum already has a heart condition; she won't be able to cope with this" or "It's my children's exam year; if I tell them now they'll fall apart" push many people into silence.
• Fear of losing control. You may predict that, the moment you share the news, others will start interfering in your decisions, the phone will never stop ringing and you will be showered with suggestions.
• Worry about appearing "weak". If you are the strong one in the family, the one who holds everyone together, being the one who needs help for the first time may make you uncomfortable.
• Not yet understanding your own feelings. Answering other people's questions before you have even taken in the diagnosis yourself can feel like a confrontation you are not ready for.

Sometimes worries linked to age are added to these fears. A young adult diagnosed in their twenties may worry that their family will start treating them like a child again; someone in middle age thinks about both their children and their elderly parents; and an older person fears becoming a burden to their adult children. All of these worries are understandable. You do not have to share the news straight away; but carrying it alone for a long time usually makes the load heavier.

Who Should You Tell First? Setting an Order for Telling Your Family About a Serious Illness

There is no need to tell everyone at the same time and in the same way. It can help to draw yourself a small set of "circles".

The first circle: one or two people who will be by your side

This is usually your spouse, your partner or the sibling you feel closest to. This is the person who will come to check-ups with you, receive information alongside you and be with you in later conversations. If possible, going to appointments about the diagnosis with this person makes it easier to remember together what you heard.

The second circle: children and those living in the home

The people you share a home with notice very quickly that something has changed. Keeping things from children for a long time can lead them to create their own frightening explanations. I will come back to how to tell children separately below.

The third circle: parents, siblings and in-laws

When and how much to tell the wider family depends on the family's structure. In some families, news spreads quickly and everyone voices an opinion. In this case, deciding in advance who will pass on the news protects you from having to give the same explanation over and over again. If you are married, agreeing together whether you or your spouse will tell your spouse's family also reduces the hurt feelings that can arise with in-laws. You can find the general principles of setting boundaries in the wider family in the article on the wider family and boundaries.

The outer circle: relatives, neighbours and acquaintances

You are not obliged to tell people in this circle. You decide how much detail to share. Saying "I have a health problem and I'm having treatment; I'd rather not go into the details for now" is entirely legitimate.

When Should You Tell Them?

The "right time" is often not a moment you wait for but a moment you prepare for. Still, a few pointers can help:

• You may want to wait for the diagnosis to become clear. For some people, sharing once the information is a little clearer is more reassuring than alarming everyone while tests are still going on. However, if this waiting is isolating you, it is good to tell at least the person in your first circle.
• Choose a calm setting. A holiday family meal, wedding preparations or a crowded family dinner are not suitable moments for news like this. A short conversation in a setting with few distractions makes things easier.
• Set aside time. Rather than delivering the news and heading straight off to work or somewhere else, leave a window of time in which the other person can ask questions and show their feelings.
• Just before an important exam or event. It is understandable to wait a little rather than giving the news the day before a child's LGS or YKS exam (Turkey's national high-school and university entrance exams); however, if the exam period lasts for months, keeping it hidden for a long time can increase tension.

Telling Your Family About a Serious Illness: How Should You Say It?

How the news is delivered also affects how the other person receives it. A few basic principles:

• Open briefly and clearly. An opening such as "There's something important I need to tell you. I've come from the doctor and I've had a diagnosis" prepares the other person.
• Say as much as you know. Do not speculate about things you don't know. Saying "We'll discuss the treatment plan next week; this is all I know for now" is an honest answer.
• Say what you need. Clear requests such as "What would help me most right now is for you to come to my check-ups with me" or "I don't want you to tell anyone about this for now" let the other person know what to do.
• Leave room for their reaction. The other person may cry, stay silent, deny it or immediately start looking for solutions. All of these are different faces of shock.

Fictional example sentences

Sentences you might use when opening the conversation:

• "Shall we sit down for a bit? There's something important I want to share with you."
• "This isn't easy for me to tell you, but I want you to know."
• "I don't know what you'll feel, and whatever you feel, I'll understand."

Sentences you might use to protect yourself:

• "I'm not ready to talk about the details right now. Let's talk later."
• "Thank you for the suggestion; I'll be making decisions together with my doctor."
• "Today I just wanted to share this; I'm not expecting you to find a solution."

By Age: Telling Children, Teenagers and Elderly Parents

Telling your family about a serious illness calls for a different language depending on the age of the person in front of you.

Telling young children

For children of preschool and primary school age, short, concrete and honest explanations are enough: "Mummy has an illness in her body. The doctors are working to treat it. Sometimes I might be tired, but I always love you." Children often think the illness might be their fault; it is important to say, "This is nobody's fault, and it isn't yours either." Keeping school, play and sleep routines going gives them security. I have covered this topic in more detail in the article on telling a child about a parent's illness.

Telling teenagers

Teenagers usually want more information and quickly notice when adults are hiding something. It is important to be honest with them, make room for their questions and talk together about changes in responsibilities at home. A teenager may have their own preferences about whom to share this news with; they may want to tell a friend, or not want to talk at all. It is important to avoid placing excessive responsibility on them and not to push them into an adult role with sentences such as "You're the man of the house now" or "You'll be the one looking after your little sister."

Telling adult children

If you are older, giving the news to your adult children also brings its own difficulties. One child may want to take control immediately; another may feel guilty because they live far away. Gently reminding them that the decisions are yours, and telling your children clearly what you need from them, protects the relationship.

Telling elderly parents

As an adult child, telling your elderly parents is often the most postponed conversation. The thought "I don't want to upset them" is a very human form of protection; but elderly parents may also want to know what their children are going through and to offer support. Hearing hidden news from someone else can cause much deeper hurt. If their health allows, telling them in a calm setting, ideally with a sibling beside you, and without exaggeration, is usually healthier.

Deciding whom to tell about your illness, when and how much, is one of the most important rights that remains in your hands during this time.

Coping With Reactions

The reactions that follow the news can sometimes be as tiring as the news itself.

• Tears and intense sadness. Sometimes, even though you are the one who is ill, you end up comforting the other person. This happens very often; but if you get stuck in this role, it is your right to say, "I know you're upset too, but right now I need support as well."
• Denial. Reactions such as "It must be a misdiagnosis; let's see another doctor" are often an expression of shock. Getting a second opinion is your decision; it should be considered together with your doctor, not under pressure from anyone.
• Blame. Sentences such as "I told you so; you didn't look after yourself" hurt. They usually come from the other person's helplessness, but you do not have to accept them.
• A flood of suggestions. Herbal remedies, other hospitals, doctors someone knows… You can find suggestions on coping with this pressure in the article on pressure from relatives during illness.

Your spouse's or partner's reaction

The person in your first circle is often your spouse, and their reaction may be the one that affects you most. Some partners immediately switch into "manager" mode; they arrange appointments, do research and call everyone. Others freeze, avoid raising the subject and act as if nothing has happened. Neither reaction comes from a lack of love; both come from fear. Telling each other what kind of closeness you need reduces misunderstandings: for example, "I don't need you to do research for me; I need you to sit with me in the evenings."

Make room for your own feelings too

While giving the news, your attention may be constantly on the people in front of you: who will react how, who will be hurt, whose heart won't be able to take it? Meanwhile your own fear, anger or grief has to wait its turn. Yet you are the first person affected by this news, and the most affected. Giving yourself a short break after each conversation, going for a walk or writing down what is going through your mind in a notebook helps you not to lose yourself while carrying other people's feelings.

A family member receiving the news very differently from what you expected does not mean your relationship is over. Time can help the first reactions give way to a calmer closeness.

When Should You Seek Professional Support?

After a diagnosis, it is natural to feel anxiety, sadness and anger. However, support from a mental health professional may be helpful in the following situations:

• Feeling so stuck that you cannot tell anyone, and becoming completely isolated as a result
• Reactions within the family hurting you deeply, with relationships reaching breaking point
• Sleep and appetite being disrupted for a long time, and being unable to enjoy anything
• Struggling to make or keep to treatment decisions

If you are having thoughts of ending your life, or feelings such as "I wish I never woke up", do not carry this alone; in an emergency call 112 (emergency services) or go to the nearest emergency department. For all medical questions about your diagnosis and treatment, consult the doctor overseeing your treatment.

How Is Sharing a Diagnosis Addressed in Therapy?

Psychological support can help you take in the diagnosis and prepare to share the news. In individual therapy, you can first make room for your own feelings and then plan together whom to tell and how. Rehearsing difficult conversations in advance, preparing your own sentences for possible reactions and defining your boundaries are frequently worked-on topics.

Within a cognitive behavioural therapy framework, examining thoughts such as "If I tell them, everything will fall apart" or "I'm letting my family down" can make anxiety more manageable. Where needed, joint sessions with a partner or family can support a healthier conversation about the news within the family. For people who find it hard to leave home during treatment, sessions can also be held online.

Frequently Asked Questions

Is it right to hide my illness from my family completely?

This is your decision, and in some situations you may have valid reasons for keeping it private. However, in a long course of treatment, hiding an illness often increases the burden and leaves you without support. Telling at least one person you trust can ease your loneliness.

Can I ask the doctor to give the news to my family?

Some doctors may agree, with the patient's consent, to hold a meeting that the family also attends. This ensures that medical questions are answered by the right person. You can ask your treatment team whether such a meeting is possible.

Everyone is hearing it from one another. How can I stop this?

You can explicitly ask the first people you share the news with to keep it confidential, and appoint one family member as a "spokesperson". Stating your boundaries clearly helps people come to respect them over time.

I regretted telling them after I gave the news. What should I do?

Regret often stems from unexpected reactions. You cannot take back what you have shared, but you can decide again how much detail to share from now on. Saying "I'd like to take a break from talking about this for now" is also an option.

• #sharing a diagnosis
• #family communication
• #patient psychology
• #difficult conversations

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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