A Communication Approach for Oncologists: Understanding Patient Coping and Communicating About Bad News, Palliative Care, and Hospice

Abstract

Oncologists frequently approach patients to discuss difficult topics, such as bad news about cancer progression and referrals to palliative care and hospice. To communicate effectively in these difficult situations, it is helpful to assess what the patient knows and wants to know about their disease in general and, specifically, their prognosis. Although some patients fully accept the diagnosis of cancer and cope well, most patients struggle with how best to cope. This struggle often manifests itself with the patient vacillating between unrealistic hopes for longevity while also indicating prognostic awareness by talking about funeral plans. Although this coping is normal, it is difficult for most clinicians to interpret. This article presents a framework for understanding normal patient coping and gives specific examples of how to talk with these patients during difficult transitions, such as times of disease progression, and about referral to hospice and palliative care.

Helping Patients with Serious Illness Live Well through the Promotion of Adaptive Coping: A Report from the Improving Outpatient Palliative Care (IPAL-OP) Initiative

“…2). [11][12][13] Clinicians may interpret seemingly unreasonable hopes (e.g., ''I will beat the cancer'' or ''I believe in miracles'') as denial, which clinicians often mistakenly diagnose as unhealthy coping. By understanding that these statements do not reflect a dense denial but rather an effective coping strategy that defends against a painful reality, clinicians can better support the patient.…”

Misunderstandings about Prognosis: An Approach for Palliative Care Consultants When the Patient Does Not Seem To Understand What Was Said

“…This struggle with acceptance is usually neither a failure by the clinician who discussed prognosis nor is it maladaptive patient coping, but rather an adaptive and healthy way to cope with life-changing information. 15,16 In order to defend against the anxiety and fear that accompany a terminal diagnosis, patients move their awareness between places of more and less realistic hope (see Figure 1). 16 For example, a patient who understands the prognosis can discuss funeral plans in one conversation, and in another conversation, say that when his cancer is better he plans to return to his job.…”

Stronger together: how to implement oncology and palliative care co-management

“…e essential idea is that patients develop prognostic awareness by swinging, like a pendulum, between moments of realism, when they can acknowledge the prognosis, and moments of optimistic hope, when they seem to not understand the prognosis (see diagram). 21,[31][32][33] Swinging toward optimistic hope is healthy and normal and helps patients modulate the strong emotions that accompany a serious prognosis. 34 Swinging toward a realistic perspective helps patients plan for the future and set expectations for treatment.…”