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KENYA SOCIETY OF HAEMATOLOGY

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AND ONCOLOGY

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5th INTERNATIONAL CANCER CONFERENCE 2018

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Title: COMMUNICATING WITH THE CANCER PATIENT
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Andrew Odhiambo
MBChB, MMed, MRCP(UK)(Medical Oncology), FCP(ECSA)
Medical Oncologist & Lecturer – University of Nairobi
KESHO Secretary
Disclosures

None

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HOWEVER, I had asked for a half day symposium but

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was given ¼ of an hour.

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So I may not cover everything but I will try and focus on

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what is practical for day to day scenarios
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Outline
I have no outline. I want you to remain eager to see

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what is coming next so that you don’t sleep

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A cancer patient is ………
• Scared – staring death at its face !!!!

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• Stressed

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• Lonely

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• Worried

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•
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Doubtful
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• Self blaming
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• Suffers from severe information deficiency

A cancer patient’s relatives are ………

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• Scared

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• Stressed

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• Lonely

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• Worried

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Doubtful

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• Self blaming

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Suffers from severe
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information
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deficiency
A cancer patient + relatives will spend hours
googling ……

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PCC (Patient Centered Communication)

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Barriers to effective communication
• HCW

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– Fears

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– Beliefs

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– Inadequate skills

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– Lack of support

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• Patient

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– Fears ig
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– Beliefs
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– Difficulties
Who is usually involved
• PCP

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• Nurse

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• Psychologist/Counselor

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• Oncologist

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• Other specialties

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• Other health workers
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– Lab/Radiology
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• Other family members

A good communicator
• Listens

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• Empathizes

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• Focused

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• Appropriateness

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• Simple words/efficient

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• Is flexible
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• Gives feedback
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• Non-verbal guru
A bad communicator
• Mixed signals

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• Lots of jargon

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• Stereotyped phrases

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• Bad-mouthing

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• Unshared decision- maker
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• Makes assumptions
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• Imposes their beliefs

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Illustration by Kimberly Carney / Fred Hutch News Service 15

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BREAKING BAD NEWS
Introduce yourself well….
• Be careful incase the

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patient has no idea

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that they patient has

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cancer.

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• You need to have

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and prepared yourself

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 The setting (My actual office)
• No barriers

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• Non intimidating

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• Open arms

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• Eye contact

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• Tissues & water , some
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sweets or mints
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• Empathy
How much do they know ??
• Patients will

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always

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read their

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results !!!

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• Sets the

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depth of
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discussion
FISH is recommended !! Which FISH ??

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Clarify …..clarify…clarify…….
• “Correct me if I’m

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wrong…….The

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surgeon told you that

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you have a growth in

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the colon right ???”
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• Minimized
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assumptions
WARNING SHOT
• I'm sorry the CT scan

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report is not what we all

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expected …according to

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the experts ….. The

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conclusion isn’t good !!!!!!
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Allow time to CRY, VENT & ABSORB
• If you suspect its going

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to be heavy…… get

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adequate company

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After the crying and “asking why Lord”
• Test understanding

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• Offer realistic hope when plausible

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• Summarize

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• Establish family support

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• Don’t rub it in

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• Set future appointments
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• Help patient & family to make decisions
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• Exchange contacts
Should you tell patients how long they have to live
???

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Advanced level BBN
• Unexpected cancer diagnosis
• Relapse after curative adjuvant

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• Double tragedy

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– Cancer & HIV

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– 2 or more sites of metastatic at diagnosis

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• Progressing while on chemo

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• Progressing < 3 months from previous line

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• Failing 3rd/4th line chemos
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• Your loved one is dying ……..there’s nothing left to offer

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• Insurance limits.
• AYA’s, Geriatric, Language barrier
All a cancer patient wants is to be loved and cared
for.

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All relatives of cancer patients want is:
• To understand why their loves one has cancer

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• How they got to where there are

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• What is the plan of action at every instance

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• What to anticipate

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• To be given hope (realistic hope)

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Regular family conferences are crucial

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Take home message
• Take your time

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• Understand

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• Empathize

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• Educate

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• Reassure

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• Give hope ig
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Thank you...

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