Looking after people with cancer

In uganda People dying from cancer /yr: is 21,300 people (source:

Ugandan Cancer Organisations and Resources

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While many may not appreciate the poor prognosis attached to diagnoses such as liver failure or heart failure, ‘cancer’ has a widespread association with suffering and death.

Communication is the first step on a cancer pathway and underpins whatever that diagnosis may subsequently entail for the individual. A range of overwhelming feelings can surface upon receiving a cancer diagnosis: shock, numbness, denial, panic, anger, resignation (‘I knew all along…’). Preconceptions, possibly derived vicariously from friends and family, may be deeply embedded leading to despair or inappropriate optimism. Without an understanding of your patient’s starting point, you may fail to be effective in your guidance and support.

doctor delivering the news to the patient

Tips for the discussion of a cancer diagnosis 

1 Set the environment up carefully. Choose a quiet place where you will not be disturbed. Make sure family or friends are present according to your patient’s wishes. Anticipate likely questions and be sure of your facts.
2 Find out what the patient already knows and believes (often a great deal). ‘What are you worried about today?’
3 Give some warning: ‘There is some bad news for us to address’.
 4 Ascertain how much the person wants to know. ‘Are you someone who likes to know all the details about your condition?’ Although information is a priority for the majority of cancer patients, this may change with the individual, and the course of the disease. ‘Monitors’ will seek information, ‘blunters’ will distract themselves.
 5 Share information about diagnosis and treatments. Specifically list supporting people (oncology multidisciplinary team) and institutions (hospices). Break information down into manageable chunks and check understanding for each. 6 Invite questions patients may feel they cannot ask. ‘Is there anything else you want me to explain?’ Do not hesitate to go over the same ground repeatedly. Allow denial, don’t force the pace, give time. Listen to any concerns raised, encourage the airing of feelings. Empathize.
 7 Address prognosis. Be honest. Doctors are often too optimistic. Encourage an appropriate level of hope, refer to an expert.
8 Make a plan. The desire to be involved in decisions about treatment is variable: your patient’s locus of control can be internal (desire control of their own destiny) or external (passive acceptance). Decision-making can be immediate, deferred, panicked, or rationally deliberated. Time may be required to facilitate any style of decision-making: your plan may be simply to come back and talk again.
 9 Summarize, and offer availability. Record details of your conversation including the language used. 10 Follow through.
       Leave your patient with the knowledge that you are with them, and that your unwritten contract will not be broken. No rules guarantee success. Use whatever your patient gives you—closely observe both verbal and non-verbal cues. Getting to know your patient, seeking out the right expert for each stage of treatment, and making an agreed management plan, are all required.

For any situation which involves the communication of bad news, consider SPIKES 

• Setting up the interview. 

• Assess the patient’s Perception of the situation. 

• Obtain an Invitation (asking the patient’s permission to explain).

 • Give Knowledge and information to the patient.

 • Address the Emotional response with Empathy.

 • Strategy and Summary: aim for consensus with patient and family