Doctors are often called upon to deliver bad news to patients, and there isn’t much that’s worse than a diagnosis of an advanced-stage cancer for which there is no cure. But there’s new evidence that a surprisingly large majority of patients who receive this news don’t fully comprehend it, or perhaps willfully choose to ignore it. However, it is a right of a patient to know the reality of the illness and what to expect in the future.
Some patients who believe that their doctors are good communicators were more likely to hold mistaken beliefs of their prognosis. They may be trying to tell their patients what they believe the patient wants to hear, rather than the truth. But the truth of the prognosis has to be revealed gradually to family members and the patient to prepare for what future holds. Patients who do not understand the severity of their diagnosis can’t make plans for their final few months or years.
Some patients believe that Chemotherapy will cure them whereas it only extends the life-span by a few months or years if the cancer is detected at a later stage. If patients think chemo is going to cure them when it cannot be done, they will have unrealistic expectations and are much less open to discussing end-of-life planning.
It is ultimately the doctor’s responsibility to ensure that their patient fully understands what is happening to them.
Reaction of a patient to the news of a cancer diagnosis can vary widely based on several factors, including their personality, previous experiences, mental health status, and the manner in which the news is delivered.
1. Denial: Some patients may go into denial, refusing to accept the diagnosis. They might seek multiple opinions in the hope that the diagnosis is incorrect.
2. Anger: Anger can be directed at the doctor, the healthcare system, or themselves. Patients might express frustration about missed symptoms or perceived delays in diagnosis.
3. Bargaining: Many patients will have a lot of questions and seek detailed information about their diagnosis, prognosis, and treatment options.
4. Depression: Feelings of sadness and hopelessness are common. Some patients may cry or withdraw, displaying signs of depression.
5. Acceptance: Some patients may quickly move to acceptance, focusing on understanding their treatment options and next steps.
Support Strategies
Professional counseling can help patients cope with the emotional impact of the diagnosis. Connecting with others who have similar experiences can provide comfort and practical advice. Providing brochures, websites, and other resources about cancer can help patients understand their condition better. A patient’s reaction to a cancer diagnosis is complex and multifaceted. Thus, medical professionals must approach the situation with empathy, providing not only medical information but also emotional support to help patients navigate this challenging time.
When a patient has a very short period of time left, it is crucial to carefully consider how they spend their remaining time and the type of medical interventions they want to receive.
Decisions regarding medical support, such as cardiac massage (CPR), mechanical ventilation for respiratory depression, or admission to an intensive care unit to sustain heart function, should be thoughtfully discussed and aligned with the patient’s preferences and overall goals for their end-of-life care.
Palliative Care
Palliative Care focuses on providing relief from symptoms and stress. This includes pain management, managing other physical symptoms like nausea or breathlessness, and emotional support.
Palliative care is a specialized medical approach aimed at providing relief from the symptoms and stress of serious illness, focusing on improving quality of life for both the patient and their family. It is appropriate for patients at any stage of a serious illness and can be provided alongside curative treatment. For patients nearing the end of life, palliative care often becomes the primary focus, emphasizing comfort and support.
Terminal Pain Management
Effective pain management is a critical component of palliative care, especially for terminally ill patients. The goal is to alleviate pain and enhance comfort, allowing patients to spend their remaining time with as much quality as possible.
Pharmacological Treatments like providing medications like morphine, oxycodone, and fentanyl are commonly used for severe pain.
Terminal agitation management, Terminal secretion management, oral care and bowel and bladder care, discussing patient’s wishes regarding end-of-life care, including preferred pain management strategies and other treatments, providing emotional support to patients and families during and after the end-of-life journey are some of the other methods that can be given to the patients who are terminally ill.
