Cancer is a terrifying word. Here's how to let the patient know the news is bad.
'Cancer' is a terrifying word. The first time I heard the word directed at me was in 1996. I was 32 years old. I had just had a colposcopy after an irregular pap smear. The call from my gynecologist was forwarded to me at the library reference desk where I was working.
"The pathology report showed cancerous cells. We need to remove them. I'd like to do a LEEP procedure so we can get clean margins."
It was stage I cervical cancer. I was at work. I will never forget that feeling of shocked confusion as I finished my shift.
The phone would continue to be a part of my cancer journey.
In 2011, there was a suspicious mammogram, followed by a biopsy. I was informed by phone that the biopsy showed cancer. After the next test, an MRI, I was told by phone that the scan showed two distinct tumors in my breast. I was also told by phone that the HER2-positive breast cancer had spread to my bone and liver. This call was made by my oncologist's nurse practitioner as I was sitting down in the chair to receive my first chemo. The bone and CT scans had just been returned to my oncologist, and they were trying to stop the previously planned chemo so that we could change treatment direction in light of the new diagnosis. The nurse practitioner pronounced that the scans showed lesions on my bones and spots on my liver. In my mind, spots on the liver meant I was going to die and die soon. I had taken the call at the nurse's station. When I heard the nurse’s words, I began to sob and I began to hate the phone.
But as time went on, and I received more test results, I realized I didn’t hate the phone. I hated the way in which news was being delivered over the phone. The radiologist who called to confirm that the breast biopsy showed cancer was kind, measured and detailed in her report. I was grateful for this approach, even calmed. My gynecologist who called to tell me that the breast MRI showed two tumors had not even bothered to have the scan report in her hand during the call and was dismissive of my questions. The nurse practitioner who informed me of my stage 4 metastatic breast cancer turned out to be someone who lacked social skills and should not have been informing patients of any test results. It's all in how the informing is handled.
Certainly the topic of how patients prefer to be informed of test results is of great interest. The Breast Cancer Social Media (BCSM) Community, a group of doctors, researchers, patients and advocates is asking just this question in a survey How Do You Prefer to Receive Test Results (the survey is open until Oct 23). I have my own preferences in how I want to be informed of test results.
We all know that delivering bad news is horrible for the giver and the receiver. The key is to deliver the news with kindness, provide details of the findings and give a plan for going forward. Here are some do’s and don’ts (from my perspective) of informing a patient that they have cancer:
Although everyone has their preference in how they want to receive test results, I thought it would be helpful to give some basic guidelines, based on my experience of receiving test results. To all the patients out there: Chime in about your preference via comments. Here’s a chance to let the incredible medical teams who are helping us know about how you’d like to be informed.