Physician support can also provide hope at a time when patients need it the most. In a 2017 study published in Psycho-Oncology, researchers found that patients receiving higher levels of perceived support, personalized disclosure, and discussion of medical treatment plans from their doctors were more likely to have higher levels of trust in physicians. Furthermore, the perceived emotional support they received from their doctors predicted the patients’ levels of hope. Feelings of trust and hope can help patients continue treatment, even when all seems lost.
These are some of the important ways you can support your patients through a colon cancer diagnosis.
Carefully communicate the diagnosis
Patients often remember with immense clarity the moment they heard the words, “You have colorectal cancer.” Many also recall how the doctor delivered their diagnosis, particularly if the physician does a poor job of communicating the news.
It is never gratifying to hear bad news, of course. However, the way a practitioner delivers it can make the experience more satisfying. Research published in the Annals of Medicine shows that patients were more satisfied with the way a doctor communicated the news when the clinician delivers it in an “unhurried, honest, balanced, and empathic fashion.”
Carefully choose the location for disclosure. The environment should be private, so that the patients can express their feelings freely and without fear of being overheard. Disclosure should never occur in a public place, for example. It is best practice to deliver a cancer diagnosis in person rather than over the phone. However, the pandemic has forced many practitioners to disclose the diagnosis virtually. In these cases, doctors should engage in a face-to-face video conference rather than in a phone call whenever possible. In all cases, physicians should provide enough time for the patient to absorb the implications of the diagnosis and ask questions.
Never bombard the patient with facts, medical jargon, and statistics, particularly when first disclosing the diagnosis. However, be prepared to answer questions and provide the most accurate information possible. Avoid explaining all the details in one appointment. Instead, schedule several interviews to discuss the diagnosis, treatment plan, and available supportive services.
Consider contacting the patient again by telephone on the day of disclosure—this can help reinforce the message of support.
Monitor patients for signs of depression or anxiety
It is normal for cancer patients to experience sadness or distress immediately after disclosure and throughout the course of treatment, as they cope with an uncertain future. Grief and apprehension can evolve into depression and anxiety. This can interfere with the patient’s ability to carry out day-to-day activities and undergo treatment. Depression is common among cancer patients. In fact, one out of four people diagnosed with cancer also suffer from depression.
Physicians should monitor cancer patients for signs and symptoms of depression or anxiety but detecting depression in colon cancer patients can be challenging—the disease and its treatment may mimic certain signs and symptoms of depression, such as major unintended weight loss, extreme fatigue or lethargy, and trouble focusing (chemo brain).
Research published in JAMA found that sleep disturbance, losing interest or pleasure in doing things they once loved (anhedonia), low self-esteem, and decreased appetite were the most common symptoms of major depression in patients. The researchers in that study suggested asking patients if they have been bothered by anhedonia and have been feeling down, depressed, or hopeless (depressed mood) within the past month. Ongoing assessment for these symptoms of depression, as well as insomnia, fatigue, anorexia, nausea, weakness, or palpitations, can help clinicians provide full support for patients with colon cancer.
Develop a personalized approach for each patient
Every patient is an individual, and every person with colon cancer has a unique experience throughout the course of his or her disease. To provide full support, physicians should develop a personalized approach for each patient.
Clinicians can observe the way in which the patient communicates, for example. They can then develop a line of communication that facilitates the patient’s preferred approach. Some patients have trouble expressing their feelings or asking questions, for example, and will simply do as the doctor tells them. Others openly express their thoughts and feelings, and will freely express concerns and questions, both during disclosure and throughout treatment. Many feel more comfortable talking to nurses about their diagnosis. For these patients, create an environment that gives them a few uninterrupted minutes with a trusted nurse before or after meeting with the physician.
Doctors may want to collaborate with families to help find ways to personalize the disclosure. Personalization can also help doctors present individual patients with multiple treatment options and discuss the potential benefits and side effects of each treatment.
Help the patient build a cancer support team.
Depending on their individual needs, people with cancer need a wide variety of support services. Some need the help of a nutritionist to avoid treatment-related nausea and unintentional weight loss, for example. Others benefit from psychiatric care to help them deal with depression and anxiety. Others benefit from joining a cancer support group. They may also need assistance with rides to treatment or lodging when they travel for treatment. The American Cancer Society offers a collection of invaluable resources intended to help cancer patients. Doctors can also provide local information about any supportive care options the patient may need throughout treatment. These include psychiatric care or consultation with a dietician.
Offer continued patient support.
Taking charge of the patient’s care from the initial contact as far into the definitive treatment as possible gives the practitioner more time to develop a supportive relationship with the patient. Offering continuing care also helps the patient calmly explore the available treatment options with someone they know and trust. The doctor should also offer continuing support in cases where the physician in charge changes.
Disclosing a cancer diagnosis is one of the hardest things a clinician will ever have to do. Yet most doctors receive little formal training in being the bearer of bad news. Inexperience and lack of training in delivering a cancer diagnosis can lead to discomfort and uncertainty for both practitioner and patient. Many clinicians improve diagnosis disclosure techniques over the course of their professional careers. However, doctors at every stage in their careers can improve their approach.
Colorectal Cancer Awareness Month provides a great opportunity for clinicians to learn new ways to support their patients. Listening to the personal stories told by cancer patients, survivors, caretakers, and other healthcare professionals can help physicians understand how receiving the diagnosis changes lives. It can also help doctors learn new ways to support their patients.
This article was originally published on March 26, 2021, in the PE GI Journal, published by PE GI Solutions. PE GI Solutions is a strategic service line of SCA Health.
To read more from the PE GI Journal and its past editions, click here.