The aftermath
That interval between initial diagnosis and specialist consultation is extraordinarily difficult and a high anxiety time. It is not unreasonable, in such cases, to recommend the patient to reputable online information sources, such as the Society of Gynecologic Oncology or American Cancer Society websites so that she and her family can do some research prior to that visit in order to prepare them better and give them a sense of understanding in their disease.
It is a particularly compassionate touch to reach out to the patient in the days following her cancer diagnosis, even if she has moved on to a specialist. Patients often tell me that they felt enormous reassurance and appreciation when their ob.gyn. reached out to them to “check on how they are doing.” This can usually reasonably be done by phone. This second contact serves another critical purpose: it allows for repetition of the diagnosis and initial plan, and the ability to fill in the blanks of what the patient may have missed during the prior visit, if her mind was, naturally, elsewhere. It also, quite simply, shows that you care.
Dr. Emma C. Rossi
Ultimately, none of us can break bad news perfectly every time. We all need to be insightful with each of these encounters as to what we did well, what we did not, and how we can adjust in the future. With respect to the SPIKES approach, patients report that physicians struggle most with the “perception,” “invitation,” and “strategy and summary” components.5 Our objective should be keeping the patient’s needs in mind, rather than our own, to maximize the chance of doing a good job. If this task is done well, not only are patients more likely to have positive emotional adjustments to their diagnosis but also more adherence with future therapies.4 In the end, it is the patient who has the final say on whether it was done well or not.
Dr. Rossi is an assistant professor in the division of gynecologic oncology at the University of North Carolina at Chapel Hill. She reports no relevant financial disclosures.
References
1. Baile WF et al. Oncologist. 2000;5(4):302-11.
2. Girgis A et al. Behav Med. 1999 Summer;25(2):69-77.
3. Schmid MM et al. Patient Educ Couns. 2005 Sep;58(3):244-51.
4. Girgis A et al. J Clin Oncol. 1995 Sep;13(9):2449-56.
5. Marscholiek P et al. J Cancer Educ. 2018 Feb 5. doi: 10.1007/s13187-017-1315-3.