Talking to seriously ill patients, knowing what I know now
In early 2012, aged 53, my father was diagnosed with advanced metastatic prostate carcinoma. At the time I was struck by a multitude of thoughts and feelings, some of which were identical to those I had experienced towards other cancer patients. What do I say? How do I behave? Will the subject be uncomfortable?
Since my father’s diagnosis I have observed a tangible feeling of awkwardness around the subject of cancer; friends are left tongue tied; family members stand back unsure what to do; others want to help but few seem to know how. In my experience most people with cancer do not want to be defined by their disease—they want to be treated normally, but with a degree of sensitivity. There is no right answer or magical formula, no specific things that must or must not be said, each person, cancer, and situation is different and requires thoughtfulness and intuition.
Despite this, my experiences have shown that some of the best questions can seem awkward. Asking how someone is or what they have been doing might seem like a blindingly obvious thing to do. However, to some people the revulsion at the prospect of the answer being “I have cancer” or “I’m dying” is too much to bear, and the question is left unasked, particularly if the patient is bed bound. I believe these are probably the most pertinent questions. They give an idea of the patient’s mindset and, most obviously, how they are. These questions are not confined to the physical but also cover someone’s emotional and mental wellbeing. My father, who can now walk unaided having previously been unable to leave his bed for the past two months, often answers, “fantastic” or “feeling much better.” It’s relative. Each day is different. They’re not awkward questions, but fundamental ones.
Every day with cancer is different. Sometimes the person might want to talk about it, sometimes they might want to discuss what’s in the news, and at other times they want to talk philosophically about life and what it means to them. Most importantly, they might not want to talk: your presence can be all that is needed. Asking an open question allows the person to lead the conversation on to a subject of their choice and lends the dialogue a vital sense of normality. Giving someone condolences, which might feel like the right thing to do, often results in the patient’s thinking that death is around the corner.
Offering to help and giving useful suggestions, however small they seem, can make a huge difference. “Can I do something?” “Would you like anything?” Listen to their answers and be relaxed, calm, and bright. Turn off your mobile phone. Don’t stare out of the window or muse on which question you are going to ask next. Listen. Don’t try and fill the silence by chattering about the intricacies of their treatment or your life. If they feel the silence should be filled, they will fill it. It doesn’t have to be awkward; it can be comfortable.
It is common in today’s healthcare environment to try and develop a prescriptive approach to all facets of care. However, in my opinion, communicating with cancer patients cannot be formatted as a tick box chart. Since my family’s journey began in 2012, I have found that being armed with a few simple questions can allow you and the person with cancer to be comfortable with the subject. Cancer isn’t always a negative thing. Since my father’s diagnosis he has developed an interest in classical music, fulfilled his desire to have a motorbike, and made some close, new friendships with people, all the time still able to joke, laugh, and make plans. Long may it continue.Angus Radford, fourth year medical student
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2014;22:g1692