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Cancer patients want a doctor who shows empathy and doesn’t make vague promises

Patients with incurable cancer want their oncologist to be clear but to show empathy too. They find hard and vague communication harmful. These are the results of a study by psychologists from Leiden that has been published in the American journal Cancer.

‘I’m sorry but there’s nothing more we can do for you.’ These are the dreaded words that a doctor can utter when there are no more treatment options available. In a survey of 74 cancer patients, the majority said they found words like these to be harmful, according to a study published on 11 November in the renowned journal Cancer. Health psychologists Liesbeth van Vliet and Janine Westendorp presented the patients with 19 potential situations and asked them which communication they found harmful and which helpful. Like the example of when there are no more treatment options. Van Vliet: ‘Therapies may no longer work, but there are always things that can still be done, to reduce the symptoms, for example. What patients want to hear from their doctor is that they’re still there for them.’

Avoid vague promises and jargon

Nearly all the patients had an aversion to vague promises, such as: ‘I’ll try to call you on Friday.’ Van Vliet: ‘Patients wait nervously all day. If possible, doctors should say they will call between certain times.’ Doctors should also try to avoid jargon to ensure patients understand what they are saying. ‘Use clear language and check that your patient understands you,’ says Van Vliet.

‘Some want to decide together with their doctor, whereas others want to decide for themselves.’

Patients face difficult decisions about whether to have therapies such as immunotherapy or chemotherapy. Many prefer their doctors not to use directive language such as: ‘You have to start chemo within two weeks’. It is better if the doctor first explains why a certain therapy would be the sensible option. And where possible, patients want to hear if there are other alternatives and the advantages and disadvantages of these, says Van Vliet. Patients are divided on who should have the last word on the choice of treatment. Westendorp: ‘Some want to decide together with their doctor, whereas others want to decide for themselves. Ask what they prefer.’ 

Whether to mention the prognosis

Another important question is whether, at an early stage, a doctor should discuss the option of not choosing a treatment: 49 percent of the patients find this harmful whereas 44 percent find it harmful if this option is not discussed. Opinions are also divided on communication about life expectancy. Around half of the patients find it harmful if the doctor explicitly discusses the prognosis. The other half finds this helpful because otherwise they don’t know where they stand, says Van Vliet.

Show empathy

The respondents were unanimous in their need for a doctor with empathy. They find it harmful if an oncologist ignores emotions, doesn’t listen to them or compliments them without giving them room to disagree. Westendorp: ‘A compliment like “you look good” can be hurtful for patients because they may not feel so. It’s good if the doctor follows up the compliment by saying: “But I know this doesn’t always match how you feel. So how are you?”

Research results to doctors and hospitals

The study meets a need because little research has been conducted into potentially harmful communication. The psychologists will bring the results to the attention of doctors and hospitals. They will do so together with patient organisations including The Netherlands Breast Cancer Association and Cooperative Palliative Care The Netherlands. 

‘Mind your words: Oncologists’ communication that potentially harms patients with advanced cancer: A survey on patient perspectives’  

Text: Linda van Putten

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