Sometimes, when we talk to patients who have cancer, we say the wrong thing, over and over and over. We tell them they’re in the midst of a battle, or a war. We tell them they can beat it if they fight it, if they’re strong, if they never give up.
But what if all the pain, suffering, and indignity they’ve endured in chemotherapy has left them wanting to close their eyes and rest peacefully in the knowledge that their time has come? Urging them to fight is not going to make them feel better. It might make them feel worse — as if they did not try hard enough and failed.
“There’s better healing language that can be used,” says Katie Deming, MD. “But it’s going to be different for everyone.”
Giving the patient a voice
Dr. Deming is a radiation oncologist and former medical director of cancer services for Kaiser Permanente in Portland, Oregon. She wants to change the way we talk to patients with cancer. Specifically, she wants to give the patients a voice in how we discuss their illness. She recently gave a TEDx talk in Reno, Nevada, titled How to Talk to Someone With Cancer.
About a decade ago, Dr. Deming and her colleagues surveyed 1,400 patients who had breast cancer to share their feelings about the term “cancer survivor.” She wasn’t prepared for the results: 60% of the respondents considered the term “survivor” to be negative. Patients said it didn’t accurately reflect their unique experience of cancer. Others felt as if they were tempting fate to say they’d “survived.” Some expressed anger, saying they had stage 4 cancer and that survival wasn’t likely.
“This made me really pay attention to the language I used,” Dr. Deming said recently. “And when I started looking more closely, I realized we tend to use a lot of battle language, like ‘Win the fight.’ I also noticed that these terms were not helping my patients.”
Emotionally charged language
When it comes to cancer, most of us rely on language that suggests “fighting” means it can be “beaten,” a comforting sentiment that puts off unpleasant thoughts about death and provides a sense that the illness is temporary and soon everything will be back to normal.
But it can mean something else entirely for the patient. Some may feel compelled to give chemotherapy or other treatments another try because they don’t want to “give up the fight” and disappoint their family when they’d really rather accept their mortality and die on their own terms. Using the language of the battlefield doesn’t motivate these patients. In fact, in some cases it may increase cortisol levels and anxiety and weaken the immune system. Rather than being calming and supportive, this language could aggravate their suffering.
So, Deming is trying to start a different conversation and it starts by putting the patients’ needs first. And to find out what exactly the patient needs, the best start is to ask them.
“It’s ok to say, ‘I want you to know I’m here for you and I want to know what’s most supportive for you.’”
When Dr. Deming asked a close family member with breast cancer how she could be most supportive, her relative said she loved to see photos of house pets. So, rather than daily texts that put the onus on the patient – How are you? – Dr. Deming sent along photos of her pets.
They were a big hit — which isn’t surprising. Laughing at a cat chasing its own tail is a nice respite from “fighting for your life.”