After diagnosis people with cancer need to be able to speak openly

Nurses have a vital role in helping patients with cancer express and cope with their fears and anxieties

For patients and their families, a diagnosis of cancer can prompt episodes of deep fear and disbelief.

Early detection of cancer can mean long periods of managing uncertainty and dependency on others, including professional services.

In addition to these difficulties, patients and families may be unable to speak openly about their concerns in case they are misunderstood or seem ungrateful for the care they have received.

They may be troubled by their feelings, yet unable to make sense of what is worrying them or embrace change.

In such circumstances, it is necessary to be sensitive to the many ways distress is communicated.  

Feelings of vulnerability

A need to control events, and feelings of anger or withdrawal can mask people’s true feelings of vulnerability.

Feelings of distress and grief can be expressed – and sometimes encouraged by others – as positive thinking or as periods of silence.

Serious illnesses, such as cancer, can also challenge healthcare professionals’ abilities to cope, and they may avoid raising difficult topics. In such circumstances, patients’ distress and anguish can be overlooked.

By listening closely to patients’ concerns, however, professionals can encourage patients to grasp the seriousness of their situation while appreciating life for what it is. Decisions can be made, life events reviewed and relationships respected.

Emotional language

As a young psychotherapist working in psychological medicine, I undertook a consultation with a dying man who was coming to terms with his diagnosis and wished to share his concerns. 

Our first conversations proved difficult because he was highly anxious, but we soon settled into the consultation and he began to explain his dilemma.

He was more concerned by how he would die than with death itself. He described how he had tried to teach his son to be stoical so that he could cope with future misfortune, but was now concerned they would have to say goodbye without the necessary emotional language to express their feelings for each other.

I later spoke with his wife and son. His son explained that they were a family who did not share emotions and he feared his father would die with neither of them able to speak about their feelings for one another.

I asked if I could help by being present when they next met and both agreed.

Restorative conversations

I met the father and son just outside a side room of the hospital ward. As they entered, I saw each greeting the other with warmth and affection.

I held back and allowed their conversations to continue without me. Later on, the son contacted me to explain that he, his father and mother shared their feelings for the first time, and that all were comforted at a time of family sorrow.

Restorative conversations such as this and the ability to listen carefully have roles to play in helping people with cancer discover their needs and raise their concerns.

However, the requirement for throughput in general hospitals limits the time and resources of nurses.

For these reasons, counterbalances are required so that professional encounters with cancer, death and bereavement do not consume nurses’ time, and their sense of personal well-being can be sustained.

About the author

Alun Charles Jones is a consultant psychotherapist at Spire Yale Hospital, Wrexham, and visiting professor in psychotherapy, University of Chester