Monday, September 14, 2015
Communicating to a person that chemotherapy will no longer help doesn’t come naturally to anyone. In a widely read article in the September 2015 issue of the Journal of Clinical Oncology, MSK medical oncologist Martee Hensley shares just how difficult — but vital — the physician’s approach to discussing impending death from cancer can be.
- Cancer doctors struggle, as patients and families do, with conversations about when it is time to stop chemotherapy.
- Both doctors and patients can improve their ability to communicate openly and with sensitivity.
“How do you do what you do?” is a question that medical oncologist Martee Hensley says she’s become accustomed to hearing at school pick-up and dinner parties. In a widely shared article she penned for the Journal of Clinical Oncology, Dr. Hensley shares what she’s learned about communicating to patients when chemotherapy can no longer help, and when the focus should be on making the most of the time that remains.
“Today, I held the hand of a 37-year-old woman who I knew was dying,” she writes. “Yesterday, we had spoken of second-line chemotherapy, weighing the risks against the chance that it might slow the malevolent progression of her sarcoma. Today, I entered her room knowing that I had to change my story, revise the plan, darken the prognosis, look in her eyes, hold her hand, probably cry.”
No easy answers exist on how to tell a patient that she’s dying, Dr. Hensley explains. In the case of her uterine sarcoma patient, she started by sitting down, holding a hand, and inviting conversation about what’s to come. She explains that all this must be done in a way that answers questions “honestly, patiently, truthfully.” Don’t deflect the hard questions, she counsels readers, such as “How long do I have to live?”
“Some days, it is inordinately sad, but, strangely, it is not depressing,” she says of this crucial part of a doctor’s work. “We are willing to have these conversations, witness the suffering, share the journey, again and again, patient by patient, day after day.”
We asked Dr. Hensley to share some of her thoughts and motivations in sharing her story.
What prompted you to write this article?
I have spent a lot of time thinking about that very fragile time when patients go from living with their cancer to beginning to die of it — the time when we begin to see organ function fail and when it no longer makes sense to continue with chemotherapy. I have thought a lot about how to talk about this with patients with honesty and compassion. Although I started writing the piece for myself, as a way to sort through the emotional challenges of this specific patient’s case, the words came together in a way that seemed potentially useful to others.Back to top
What feedback about the article have you received from other doctors?
The morning of the online publication of this article my inbox was filled with responses from doctors as far away as New Zealand, and as close as the office next door. It was clear that it resonated with physicians on both a practical level — really, what do you say? — but also on a deeply emotional level, which we rarely take the time to acknowledge or discuss. I have tried to respond to every email, and one of the things I write is that the response to this piece has been so gratifying for me. Hearing that my words were of value to so many has given me a great sense of connection to others at MSK and around the world who share this good, hard work.Back to top
How does MSK help train its physicians to communicate with patients and caregivers?
How we communicate with patients — and with each other — is such a fundamental element of our work. MSK’s formal communication skills program provides the opportunity for guided practice in how to talk to oncology patients and their families across the spectrum of their experience. Being part of a team, observing and modeling good communicators in the process of caring for patients, and practicing good communication habits with coworkers and colleagues are good ways to develop one’s skills.
I believe if we strive to work from our hearts — if we think for a few moments about how we would want the doctor to talk to us if we were the patient, if we stop for a moment before we go in the room and pause to fully recall that the patient is a person — if we do that before we open our mouths to deliver the information, then our words and our actions are likely to come out right.
If we stop to remember how much we really do care for this fellow human being — which is why we chose this work in the first place — then our communication will reflect that true compassion.