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Ask, Tell, Ask
Not everyone wants to know everything, but many do. Smith's philosophy is “ask, tell, and ask.” This means ask patients what they want to know, tell them, and then ask follow-up questions to see if they are grasping the information.
Smith also says that bringing hospice and palliative care experts on board early can make a difference in a person’s end-of-life experience. “This is an extra layer of specially trained support that comes out to your house to check on you while you are still well, so they are better able to help you when you become sick.”
David Straker, DO, is often called in when these difficult conversations are had. He is a New York City-based psychiatrist who helps people with cancer cope with their situation. He is also adjunct assistant clinical professor of psychiatry at Columbia University Medical Center in New York City. “A lot of doctors have a difficult time talking about death, and a lot of patients are in denial and just want to be cured,” he says.
It’s no one’s fault, it’s just human nature. “The only way to bridge these gaps is to talk openly and honestly.”
When people hear they have a serious illness like advanced cancer, conversations often go straight to treatment options without discussing quality of life, says Rebecca Kirch. She is the director of Quality of Life and Survivorship for the American Cancer Society.
“There is a clear need to reboot the way we communicate,” she says. “We need to ask what is important to them so they can make decisions about what treatments to pursue and how aggressive they want to be. We need to make sure they know what is involved and what it can do so they don't operate under false assumptions.”
Andrew S. Epstein, MD, agrees. He is an oncologist at Memorial Sloan-Kettering Cancer Center in New York City who also teaches medical residents how to talk to patients about cancer. “The data underscore the need to do a better job about understanding who the person is, their knowledge of their medical situation, and their value system,” he says.