Information for Nurses and Physicians
Weighing Your Words: Instilling Hope
Doesn't Have to Mean Holding Out
The manner in which a healthcare professional
discloses a patient's cancer diagnosis can,
in and of itself, help determine whether the
patient will die or survive. The health care
professional can instill hope and the desire
to try to fight and be part of a winning team
or can help encourage the patient to do nothing
and wait for the inevitable end.
In a study by two doctors
on how physician disclosure of a cancer
diagnosis 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" (Sardell & Trierweiler,
1993).
The diagnosis should be
made in a manner suggesting a high degree
of individuality, intimacy, and privacy.
Often, patients will want to have had
some prior contact with the healthcare
professional who presents the diagnosis
and 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 that their treatments
will be the best available and want to
know what alternatives are possible in
case the initial treatment fails. It may
sometimes be appropriate to discuss the
cases of other patients who have overcome
similar ordeals.
Procedures that encourage
participation are viewed favorably by
most patients. This includes not only
the acceptance of the best medical science
has to offer but also 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 responsibility
for their healing.
Physicians need not endorse
activities or unproven techniques used
by a patient. Rather, to the extent that
they do not interfere with current treatment,
such alternative techniques should be
tolerated if they improve the patient's
feeling of participation and quality of
life.
The patient's normal fear
of cancer pain and treatments should be
clearly addressed at inception. Increased
understanding of what is happening to
their bodies and the likely course of
the illness allows patients to feel in
control. A growing body of evidence indicates
that giving patients clear information
can improve the overall clinical picture.
Assurance that the physician
will not abandon the patient is extremely
important. Offering to be available to
answer 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. Patients need to have a feeling
that they are able to talk with their
physicians as partners and as confidants
to whom they can relate their feelings.
Above all, keep in mind
the great impact a cancer diagnosis can
have upon a patient. This is the patient's
life. This may be the most important thing
that has ever happened to them and their
family members. The way they are told
can not only affect the quality of these
many lives temporarily but may actually
influence the results.
Note:
Cancer
survivor Richard Bloch is the co-founder
of H&R Block and creator of the RA
Bloch Cancer Foundation. He and his wife
Annette are the founding co-chairs of
National Cancer Survivors Day.
Sources:
Bloch, R. (1994).
Weighing your words: Instilling hope doesn't
have to mean holding out. Cope (May/June),
48.
