A friend shared a clip from a movie scene recently with me, in which a businessman flying on an airplane was asked by the female flight attendant, “Do you want the cancer?” Bewildered, the man (actor George Clooney) asks, “The, WHAT?” After a few confusing exchanges, she holds up a soda can, appearing visibly annoyed while she clarifies, “The CAN, sir?”
Despite the intent of some Hollywood humor and levity, this scene had a tremendous impact on helping me realize an important reality, that my communication to patients can have profound implications. Every day, I share important, sometimes life-altering factors with cancer patients about their diagnosis, staging, and treatment plan. Though I do this with support, empathy, and the appropriate medical knowledge tailored to their education level, I take a major leap of faith when I just assume that they understand the information in exactly the same way that I do. Even with good intentions, when revealed in the wrong tone, body language, or even timing, what I say may sound just as confusing to them as it did to George Clooney when the flight attendant asked a seemingly simple question during the beverage service.
In my field, there are two bad words and they are both “C” words: Cancer and Chemotherapy. Even when pronounced correctly or with empathy, these words bring up feelings of overwhelming emotions, fear, and shock. It is difficult to expect a person to absorb technical details, much less the plan of action, during such a phase of bewilderment. I once had a mentor who showed me how to deliver complex information or even bad news to a cancer patient and it typically involved a critical pause. When he was through explaining the clinical circumstances in detail, he always insisted, “Ask me some questions.” Over time, I realized that this allowed the patient to “have the stage” for a moment to “air out” emotions and concerns openly, while allowing him to gauge their level of understanding (or misunderstanding). This method helped to iron out any confusion, misconceptions, or even disagreements.
Some lessons for all clinicians:
· Speak slowly, enunciating words and allowing time for processing.
· Be honest and straightforward, but compassionate.
· Simplify language, especially medical terminology.
· Pause frequently and allow for (or even insist on) questions, giving patients the stage.
· Be comfortable with silence and emotions.
· Hear what is not said, defeating fear with empathy and listening.
· Treat someone like you would a family member going through a tough situation.
· Tailor the conversation to be inclusive and mindful of culture or education level.
· Address the level of understanding of all the people, including caregivers, in the room.
· Introduce and re-introduce key topics over time, evaluating patients’ understanding and grasp of challenging issues or bad news.
· Understand patients’ unique goals of care as they evolve, delivering care that represents their consistent wishes and advocating for shared decision-making.
