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What to Say to Patients When Palliation Is the Best Option

What to Say to Patients When Palliation Is the Best Option

SAN FRANCISCO—There is no shortage of educational programs on
terminal care, advance directives, and breaking bad news to cancer patients.
However, an equally challenging task is often overlooked in these training
sessions: what to say when treatment fails to cure or control the disease.

At this difficult transition from therapy to palliation, physicians need to
strike a delicate balance between "providing honest disclosure and
maintaining realistic hope," said Geoffrey H. Gordon, MD, an associate
director at the Bayer Institute for Health Care Communication. That way,
"when the treatment fails the patient, you don’t feel like a failure
yourself," he said.

Dr. Gordon described Bayer Institute’s workshop designed to address these
issues in a special session held before the 37th American Society of Clinical
Oncology meeting.

Effectively communicating at the transition may be easier than many
oncologists think. One study showed that patients who hear just 40 seconds of
empathy will be less anxious and will see their physician as more pleasant,
helpful, and caring.

"There is a tremendous amount of empathy among clinicians, but you
would never know it by watching their behavior," Dr. Gordon said. "It
does not get expressed. However, it does not cost you time and does not turn
the consultation into a psychotherapy session."

The 4-hour "Care Not Cure" workshop consists of brief lectures
interspersed with case-based exercises, a video/discussion section, and a
conclusion/evaluation. Tapes of patient-physician dialogues are used to trigger
discussions among participants and generate ideas.

Participants receive an annotated bibliography of published articles that
clarify important aspects of communication when patients transition from cancer
treatment to symptom control.


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