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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 2 | Page : 360-361 |
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A twist in the tale: Alternate methods to communicate, or are they great expectations?
Mahati Chittem, Sravannthi Maya
Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India., India
| Date of Submission | 05-Mar-2020 |
| Date of Acceptance | 13-Mar-2020 |
| Date of Web Publication | 19-Jun-2020 |
Correspondence Address:
Mahati Chittem
Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, Sangareddy - 502 285, Telangana
India
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/CRST.CRST_67_20
How to cite this article:
Chittem M, Maya S. A twist in the tale: Alternate methods to communicate, or are they great expectations?. Cancer Res Stat Treat 2020;3:360-1 |
Recently, a moving account of an Indian oncologist's efforts to navigate prognosis (non) disclosure was published.[1] The author brought to light three important aspects of cancer communication which are unique to Indian medical care:[1] pervasive belief that the family knows best,[2] patients' and caregivers' psychological outcomes when the former is (un)aware of their diagnosis/prognosis, and [3] oncologists' everyday communication attempts. In this letter, I will challenge the first point, add to the second, and explore alternative oncologist-led communication opportunities.
In India, there is a common belief that the family knows the individual the best. This is rooted in the collectivistic approach, wherein key decisions (e.g., choosing a marital partner) are made in consultation, and sometimes, by the family. Similarly, our research evidences that families decide whether or not to reveal the cancer diagnosis to patients citing several reasons for and for not informing the patient.[2] Contrasting to this, 'family first' approach, our research shows that patients display agency such that they are able to ascribe clear roles for each of their supportive care providers.[3] Therefore, it is quite possible that the family might not know the patient best, as the author claims.
What happens when a patient is denied the opportunity to know their diagnosis/prognosis? As reflected in the author's description, patients who are unaware report higher levels of anxiety and depression,[4] while families who withhold the diagnosis report increased distress and guilt,[2] than their counterparts. These findings (coupled with what is a common experience for most Indian oncologists) suggest that not knowing is a painful, agonizing journey which, conceivably, haunts the family members much after the patient's death.
Therefore, we argue that the author's “ask and you shall know” approach can be improved on. Why?First, when “badgered” with questions on the reasons for his pain, the oncologist did not, in reality, openly explain the cause to Patient A. Second, the author assumes that patients know how to ask coherent questions which is quite unlikely, especially when they are in extreme pain. Third, it appears that the author is unsettled with this approach as it only helps him to “get by,” which can be problematic for his or any other oncologist's well-being in the long term. Hence, how can we ease cancer communication in the face of nondisclosure? Although our results are yet to be published, we believe two methods can work. First, encouraging and inviting question-asking behaviors in patients and families. Patients and families can be taught the skill of asking questions through a question prompt list (QPL).[5] Second, attending regular communication skills training (CST) led by psychologists and oncologists. These interactive training sessions focus on learning, exercising, and utilizing a range of skills such as responding with empathy, summarizing, categorizing information, and so on.
In conclusion, we echo the author's description of the difficulty of and attempts to handle communication challenges within the medical encounter. However, we suggest there are different methods to effectively address these situations, which include patient empowerment tools (e.g., QPLs) and attending CSTs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Chandrasekharan A. A tale of two patients. Cancer Res Stat Treat 2020;3:1-2.  [Full text] |
| 2. | Chittem M, Norman P, Harris P. Primary Family Caregivers' Reasons for Disclosing Versus Not Disclosing a Cancer Diagnosis in India. Cancer Nurs 2020;43:126-33. |
| 3. | Chawak S, Chittem M, Butow P, Huilgol N. Indian cancer patients' needs, perceptions of, and expectations from their support network: A qualitative study. J Cancer Educ 2019;4:1-8. |
| 4. | Chittem M, Norman P, Harris PR. Illness representations and psychological distress in Indian patients with cancer: Does being aware of one's cancer diagnosis make a difference? Psychooncology 2015;24:1694-700. |
| 5. | Brandes K, Butow PN, Tattersall MH, Clayton JM, Davidson PM, Young J, et al. Advanced cancer patients' and caregivers' use of a question prompt list. Patient Educ Couns 2014;97:30-7. |
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