Tough Talks With Cancer Patients: Dealing With Challenges

Shelly Reese


April 06, 2016

In This Article

Overcoming Common Hurdles

Clinical jargon. Physicians' reliance on medical terminology represents a fundamental stumbling block when they interact with patients, says Dr Robert Arnold, director of palliative care services and director of the Institute for Doctor-Patient Communication at the University of Pittsburgh. "When we talk to other healthcare providers, we talk in details and data, but when we talk with patients, it's confusing. It's a problem of expertise: You forget what it's like when you don't have expertise."

Dr Arnold suggests using a "mental model" to simplify your explanations. "I try to talk like I'm writing for USA Today, or I am talking with someone's grandparents," he says. He also encourages patients to describe what they know about a condition or treatment before telling them about it to gauge their level of understanding. "I have to constantly remember that patients won't ask their doctors about what they don't know, because there is such social desirability to appear smart to your doctor and not take too much of your doctor's time. I have to constantly remind myself to elicit questions from them."

The time crunch. "Doctors feel strapped for time, and they need to deal with a lot of other types of issues in a consultation. They feel they don't have time to be able to address the emotional component of the conversation," says Dr Tulsky. Packed as those brief consultations may be, responding with an empathic remark at the appropriate moment doesn't eat up a lot of time. "It's really more an issue of having the communication skills," Dr Tulsky says, "because when you have the skills, time is not such a barrier."

Information overload. Patients with cancer are faced with an enormous amount of unfamiliar information. "Even the most intelligent person who is not emotionally distressed would have trouble processing it all," Dr Pollak says.

Patients need time to process bad news before they can take in more information. Oncologists need to pause after delivering serious news and recognize that patients may not be able to take in any more information at that time. Dr Pollak also suggests looking for ways to distill the information. Providing handouts and links to webpages that the patient can review repeatedly at their leisure, and perhaps in the company of a loved one, can help.

Dr Pollak notes that some organizations use the OpenNotes initiative, which enables patients to access and download outpatient progress notes via a participating hospital's MyChart patient portal. As a result, patients can go home, read the chart, look up words that they aren't familiar with, and better understand and participate in their care.

Fear of eliminating hope. Doctors may seek to soften bad news because they don't want to rob patients of hope. In trying to be gentle, however, physicians may subvert patients' ability to make well-informed choices and end-of-life plans.

"People can hope for a lot of different things," notes Dr Arnold. Physicians need to work with patients to help them "expand their hope portfolios," so that patients aren't just hoping for a cure that may be highly unlikely but for more attainable goals, such as feeling well enough to attend a family reunion.

According to a study of patients with advanced cancer published in 2008, patients who had end-of-life discussions with their physician did not suffer higher rates of major depressive disorder and enjoyed better quality of life near death.[3] End-of-life discussions were associated with lower rates of ventilation, resuscitation, and intensive care unit admission and with earlier hospice enrollment.


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