This article originally appeared in the March 2023 edition of the PE GI Journal by PE GI Solutions. PE GI Solutions is now a part of SCA Health. To read the journal in its entirety, including past editions, click here.
No matter if you are a brand-new physician or an experienced practitioner with years under your belt, delivering a colorectal cancer (CRC) diagnosis can be an emotional and stressful process. Managing the emotions of the patient, and others present with them, involves balancing confidence, empathy, and more.
“This was one of the most difficult things I have ever done,” Dr. Erica Cohen of Capital Digestive Care’s Chevy Case Endoscopy Center said when describing her first experience delivering a diagnosis. “I knew the patient’s life was about to change forever because of what I was about to say. I felt an uncomfortable heaviness walking into the room. There’s still that heaviness any time I have to deliver difficult news to a patient.”
A Compassionate Support System
Upon receiving the news, patients can respond in numerous ways. In her years in practice, Cohen explained that responses to this life-changing news can vary depending on the individual. Some react immediately with tears, others were more stoic, wanting next steps, while some simply showed no emotion at all.
“I try to invoke confidence and strength and focus on the next few steps of staging and meeting with the appropriate specialists,” she said. “I enlist family and friends for support and I avoid discussing the variety of treatment options before getting all the data as that can cause more uncertainty and anxiety.”
Erica Cohen, M.D., Chevy Chase Endoscopy Center & Chevy Chase Clinical Research Center
There are always a variety of emotions when you deliver bad news to someone, some people kind of are very stoic and just take it in stride. Some people want to know as much as they can about what you found and the possible prognosis and risks. Everyone handles bad news a different way, and I think that our response to the patients reaction is somewhat based on taking the patients lead.”
Cohen explained that she believes the most important aspect to delivering the news is “to be present.” She advises other physicians to ensure that the patient knows they have their physician’s full attention. Examples of showing you are totally present include turning off your phone to ensure there are no distractions, like texts or calls, and standing or sitting close to them. Cohen also likes to ensure the patient is not in the exam room alone.
“If they have a family member with them in the car or in the waiting room, I like to ask the patient if they would like me to bring them in,” Cohen said. “I never want the patient to go through this alone. It also has the added benefit of having someone else on hand who may pick up things the patient doesn’t as they process the information.”
These small steps will help put your patient at ease. They will know you are dedicated to answering their questions and helping them in planning for the future.
Other Considerations
When delivering a new CRC cancer diagnosis, there are also several other important factors to consider. These include cultural sensitivity, gender sensitivities, sensitivity for the patients support group, and the personality of the patient themselves.
With the reduction in minimum screening age for screening from age 50 to 45 presented by the United States Preventative Services Task Force (USPSTF), a new generation of patients now have access to vital CRC screenings. However, some patients continue to delay or refuse screenings due to fear or misinformation. Cohen explains how she approaches the subject with newly eligible patients.
“I say listen, the guidelines have changed because there’s been an uptick in colon cancer in younger people,” she said. “Any test is better than nothing, and if you are at average risk, you have no family history of colon cancer, you have no history of polyps, and you have no symptoms, doing a non-invasive test is better than nothing. Sometimes that helps kind of get them in the door, at least to getting some screening as opposed to waiting 10 years because they’re too afraid.”
Dr. Erica Cohen works for Capital Digestive Care at the Chevy Chase Endoscopy Center and the Chevy Chase Clinical Research Center in Chevy Chase, MD. Capital Digestive Care is a strategic partner of SCA Health.
