The manner in which a physician discloses to a patient the diagnosis of cancer can, in and of itself, determine whether the patient will die or survive. The physician can instill hope and the desire to try to fight and be part of a winning team or can cause the patient to want to do nothing and wait for the inevitable end. A telephone call by a nurse or even the doctor stating, “You have cancer” can be totally devastating. The patient assumes the worst, realizing the doctor does not want to tell him or her face-to-face.
In a study by two doctors (note 1) on how disclosure of a cancer diagnosis by a physician is perceived by patients, the conclusion was reached that, “Maximizing hope during the disclosure of a diagnosis is one way clinicians can contribute to psychological adjustment early in the treatment process.” The diagnosis should be in a manner suggesting a high degree of individuality, intimacy and privacy. Patients want to have some prior connection with the physician who presents the diagnosis (e.g. the family doctor). Further, they welcome the participation of an oncologist who can offer additional information about prognosis and treatment.
Most patients truly want all the medical information available. They want to be assured their treatments will be the best available, and what alternatives are possible in case of failure of the initial treatment. It is appropriate to discuss actual cases where individuals have overcome similar ordeals.
Patients favorably view procedures that encourage their participation in the fight. This includes not only the acceptance of the best medical science has to offer but the best resources the patient has to offer. Physicians should nurture and encourage fighting spirit in those patients who demonstrate willingness to take control of their situation and to accept some degree of personal responsibility for their healing. Physicians need not endorse activities or unproven techniques used by a patient. Rather, to the extent that such activities or techniques do not interfere with current treatment, they should be encouraged, if for no other reason than to improve the feeling of participating and the quality of life by and for the patient.
The patient’s normal fear of cancer pain and treatments should be clearly addressed when first diagnosed and disclosed. Increasing the patient’s understanding of what is happening to his or her body and what the likely course of the illness enables the patient to feel in control. A growing body of evidence suggests that this increased understanding actually improves the overall clinical picture for such patients. Assurance that the physician will not abandon the patient is extremely important. Offering to be available to answer all questions is tangible evidence of this commitment. A physician’s appropriate physical contact such as holding a hand, a pat on the shoulder or a hug goes a long way.
Above all, patients needs to have the feeling that they are able to talk with their physician as partners in the fight and as confidants to whom they can relate their feelings.
To many physicians, this is just another patient. Their appointment calendar is full, and they have other things to do and other concerns. For the patient, it is his or her life. The diagnosis of cancer may be one of the most traumatic events in the life of an individual and in the lives of their family members! The way they are told can not only affect the quality of these many lives temporarily, but can actually possibly influence the results!
A friend gave me the following that could help physicians to understand these concepts and be more compassionate with future patients.
note 1: Disclosing the Cancer Diagnosis by Aaron N. Sardell, Psy.D. and Steven J. Trierweiler, Ph.D. published in Cancer, December 1, 1993.
THE ART OF WORDS
The dictionary is full of words. It is how words are used that makes the big difference. Words can lift us into heaven or lower us into hell… Good words anoint a man, ill words kill a man.
Words sung in a lullaby can put a babe to sleep; words of hatred and passion can arouse a mob to violence.
Words have both the explosive power of a nuclear bomb and the soothing effect of oil on troubled waters. They can start a war or they can keep the peace.
The art of words is to use them creatively; to select and arrange them to inspire the mind, stir the heart, lift the spirit…
Words of encouragement fan the spark of genius into the flame of achievement.
Words are the pegs on which we hang creative ideas.
Words of faith, hope and courage lift men upward. Negative words drag men downward.
Choose well your words! They will go marching down the years in the lives you touch!