Lecture
Chulkova V.A. Informing the Cancer Patient / Study Guide. – St. Petersburg: «Ladoga». – 2nd Edition, revised and expanded. – 2013. – 68 p.
When informing a patient, it is necessary to take their individual characteristics into account. These include the patient's age, sex, social status, marital status, the location of the tumor and the upcoming treatment, and the personality traits of the patient noted above. The principle of competence must be observed: to speak with each patient in a language they can understand, so that they are able to comprehend what is being discussed. As experience shows, this also poses a difficulty for the physician, since they are accustomed to speaking in the language of medical terms.
One should be aware that a physician's conversation with a patient is always of enormous significance to the latter, since it concerns important matters of their life; therefore, care must be taken to arrange a special place and time for the conversation with the patient. The place for this should be where no one could interrupt the discussion, and the privacy of the conversation must be maintained. The time for the conversation is chosen so that it is convenient for both the patient and the physician. If the physician does not have much time, they should warn the patient of this at the beginning of the conversation, so as not to break it off abruptly later.
Delivering unpleasant news causes suffering both to the patient and to the physician. One must be prepared for strong emotional reactions on the part of the patient (anger, tears) and understand that these feelings are appropriate to the situation of the illness. Understanding any of the patient's reactions, giving them the opportunity to express their feelings, and showing them empathy and compassion constitute the essence of emotional support for the patient. It is also important to be aware of one's own feelings in this situation; they may be similar
to the patient's feelings. The suffering experienced is the basis for the patient's realistic attitude toward the illness.
There should be exactly as much information about the illness as the patient can accept. It is necessary to pay attention to the patient's verbal and nonverbal signals that they have already received enough information.
The physician gradually leads the patient to comprehend the serious change in their condition – the transition from health to grave illness. In doing so, as R.J. Twycross and D.R. Frampton note, one must adhere to two parallel principles in the conversation with the patient: never deceive the patient and avoid thoughtless frankness. In other words, one should not misinform the patient by creating a false impression that everything will be fine, since cancer poses a real threat. But at the same time, one should not go into excessive detail about the illness and treatment either, as this may only aggravate the patient's already difficult condition.
At the same time, the physician should take into account that many patients wish to obtain fuller and more detailed information about their illness. They make use of specialized literature and the Internet, and critically evaluate everything their attending physicians tell them (see above regarding locus of control).
In this case, it is appropriate to find out what the patient already knows about the illness, as well as what they want to know. It is recommended that, before conveying unpleasant information to the patient, a «warning signal» be given.
In a candid conversation with the patient about a confirmed diagnosis of a malignant tumor, the physician should not speak about the prognosis of the illness, equate cancer with inevitable death, and so on.
The physician should help ensure that the patient develops hope for a new medication, an advanced treatment method, and the latest scientific discoveries. Hope is an inner resource for the patient to endure the unbearable situation of the illness. However, hope must
be realistic. The most fundamental thing about realistic hope is that the patient will never be left without medical care.
The physician provides the patient with adequate information not only about the diagnosis but also discusses the treatment plan with the patient, informs them of the goals of the examinations and procedures being carried out, and thereby creates in the patient a sense that they themselves are actively participating in the treatment. All of this helps the cancer patient become aware of their motives for recovery, fosters a responsible attitude toward treatment and toward their own life, and allows them to feel their psychological strength and their significance in solving problems that are vital to them.
Such an attitude also reassures the patient's family members, who at such moments often find themselves utterly helpless. The patient's family is sustained by the very thought that everything possible will be done for the patient, and that even if the physician is unable to save the patient's life, they will at least ease their suffering.
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