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7 - Between the Big Events

Dealing with the Things That Surface in the Quiet

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
Affiliation:
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
Affiliation:
University of Washington Medical Center
Elise C. Carey
Affiliation:
Mayo Clinic, Minnesota
James A. Tulsky
Affiliation:
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Affiliation:
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Affiliation:
Scripps Health, San Diego, California
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Summary

The times in between significant medical events allow for different conversations with patients about living with uncertainty, the effects of their disease and its treatment, the fear of the next crisis, or figuring out who they are now and what they might hope for their future. Sometimes worry about becoming more ill or dying shows up in conversations in disguise, like being fixated on a particular test that a clinician might consider medically less important or even unnecessary. Sometimes completing cancer therapy brings a mix of emotion, relief that it is done and worry that it may not really be. Other times patients who have recovered from an exacerbation, like in heart failure, realize how much they have changed due to the disease and its treatment, and while glad they survived are simultaneously unhappy about how their life has changed. The roadmap for clinicians in these more calm but uncertain times is to ask your patient’s perspective, respond to their emotion (often exploring to create a deeper understanding), and offer your clinical experience of other patients which might apply to help clarify the issues at hand, provide different perspective, and offer support.

Type
Chapter
Information
Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 101 - 115
Publisher: Cambridge University Press
Print publication year: 2024

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References

Further Reading

Charon, R., Narrative Medicine: Honoring the Stories of Illness. Oxford University Press, New York, 2008.Google Scholar
Frank, A., At the Will of the Body. Mariner Books, Boston, 2002.Google Scholar
Hewitt, M., Greenfield, S., and Stovall, E., eds., From Cancer Patient to Cancer Survivor: Lost in Transition. The National Academies Press, Washington, D.C., 2005.Google Scholar
Jacobson, J., et al., Helping patients with serious illness live well through the promotion of adaptive coping: A report from the Improving Outpatient Palliative Care (IPAL-OP) initiative. J Palliat Med, 2014, 17(4): 463–8.Google Scholar
Kantsiper, M., et al., Transitioning to breast cancer survivorship: Perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med, 2009, 24(Suppl 2): 459–66.CrossRefGoogle ScholarPubMed
Kleinman, A., The Illness Narratives: Suffering, Healing and the Human Condition. Basic Books, New York, 1989.Google Scholar
Rowland, J. H. and Bellizzi, K. M., Cancer survivors and survivorship research: A reflection on today’s successes and tomorrow’s challenges. Hematol Oncol Clin North Am, 2008, 22(2): 181200.CrossRefGoogle ScholarPubMed

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