The Seriously ill patients and their families face intense emotional sufferingso a group of researchers believes that doctors should engage in ‘compassionate communication’ as part of the treatment process and to do so they have identified what they have called “never words”, which should not be said under any circumstances and provide more useful language to use instead.
In the study, published in the journal ‘Mayo Clinic Proceedings’, Dr. Leonard Berry, professor of Marketing at Texas A&M University and co-authors at Henry Ford Health in Detroit, both in the United States, affirm that, despite the rapid advances in the treatment of serious diseases such as cancer, advanced heart failure and end-stage lung disease, certain ‘eternal’ aspects of the patient’s experience, such as fear.
“Communicating the nature, purpose and expected duration of often complex treatments, and setting realistic expectations about what they offer, continues to address timeless patient experiences: fear, intense emotions, lack of medical experience and the sometimes unrealistic hope of being cured,” they write. The “intense and daunting nature of these conversations” may cause physicians to resort to learned communication habits or declarative statements.
Even A single word can scare patients and families, making them feel helpless. and possibly nullify the effectiveness of shared decision-making, they recall.
“Understandably, the Serious patients and their families are scared and ‘hanging’ on every word their doctor says –says Berry, a researcher at the Institute for Healthcare Improvement–. Serious illness is not only a matter of physical suffering, but also emotional. “The physician’s behavior, including his or her verbal and nonverbal communication, can exacerbate or reduce emotional distress.”
Berry points out that, all too often, doctors use insensitive language when communicating critical informationand they commonly do so without realizing the unnecessary alarm or offense they have inflicted.
Patients and their families should feel “psychologically safe” when communicating with healthcare professionalsBerry says, even when expressing concern about the proposed treatment plan or conveying fears.
Words a doctor should not say
Based on surveys of doctors, Researchers identified the ‘never words’:
- “We can’t do anything else.”
- “It won’t get better.”
- “Withdraw attention.”
- “It’s terminal.”
- “Do you want us to do it all?”
- ‘Fight’ or ‘battle’ or ‘combat’ and terms related to war.
- ‘I don’t know why you waited so long to come.’
- “What did your other doctors do/think?”
In another specific study on the oncology caredoctors were asked about words or phrases that they would never use with a patient, and the main results were:
- “Let’s not worry about that now.”
- “You’re lucky it’s only in phase 2.”
- “The chemo failed.”
“‘Let’s not worry about it now’ not only fails to address a legitimate patient concern, but it is derogatory –explain the researchers.– Pointing out that cancer is in an early stage is presumptuous, since it assumes that the patient should feel gratitude, without making room for the patient’s anxiety and fear of having cancer.” And, according to Berry, patients do not fail chemotherapy but chemotherapy fails patients.
What doctors should say
Healthcare professionals can engage in dialogue by inviting patients and families to ask questions and respond honestly and thoughtfully. “They must learn to recognize the words and phrases that unintentionally scare, offend or diminish the ability to act and work to reimagine their own communication,” the researchers say.
Berry says that opportunity can arise when doctors encourage patients to talk. “Something as simple as ‘What questions do you have for me?’, instead of ‘Do you have any questions?’, invites a sincere conversation,” he says.
As for the ‘never words’, the researchers recommend alternative language, as well as the justification for each one. For example, instead of: ‘It won’t get better,’ the doctor might say, ‘I’m worried it won’t get better.’. In this way, the doctor replaces a strong negative prediction with an expression of concern.
The use of words such as ‘fight’ and ‘battle’ may imply that willpower can overcome illness and patients may feel that they are letting their loved ones down by not fighting hard enough. Instead, doctors might say: ‘We will face this difficult disease together’ to make it clear that patients have the support of a team.
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