I recently read an article by Dr. Wendy Harpham in the December 25, 2012 issue of Oncology Times.
Dr. Harpham is an internist who has personally battled with lymphoma for many years. Her mission is to help others through the synergy of science and caring.
One definition of hope is "a pleasurable feeling associated with a belief that a future good can happen." Both the feeling and the belief are positive and offer the ability to comfort today, and in essence, create a more stable tomorrow. She notes that patients who anchor their belief in facts nurture healthy hope whereas those who base their belief on inaccurate information or wishful thinking foster false hope. Those who insist on the hope of a miracle say it is able to lift their spirits. But these arguments miss the point.
The truth is that false hope can lead patients away from treatment decisions that reflect their values and priorities. False hope can strip them of dignity, meaningfulness, comfort, and joy that are possible at the end of life. Patients who choose treatments with little benefit must endure less than desirable medical procedures along with hospitalizations, which may disrupt and distract the patient from loving relationships and joyful moments. This may also cause a delay in discussions surrounding end-of-life, a conversation that should take place early on for patients, especially those with a poor prognosis.
Patients may often exaggerate the efficacy of salvage treatments. They may be told a treatment only works in one out of 10,000 patients, but what they hear is "this treatment works." Clinicians can help protect patients from the lure of false hope by helping them make informed decisions, even if that means repeating information over and over until the patient has a clear understanding.
Dr. Harpam offers some tips on how clinicians can help patients address their hopes and fears regarding their cancer prognosis:
- Reassure patients of continued commitment to help them live as long and well as possible.
- Reaffirm the goal of making wise treatment decisions that honor their values and priorities.
- Acknowledge obstacles to choosing well, including the instinct to survive and the appeal of more therapy.
- Share the prognosis in a way that opens the door to hope -- the focus of hope changes from cure to comfort and quality of life.
- Acknowledge their grief.
- Provide the foundation for reality-based beliefs, such as the fact that hospice care focuses on living, comfort, dignity, and often lengthens life. Making end-of-life decisions can lower stress for patients and their loved ones.
An important takeaway Dr. Harpham notes is that it matters less what you say and more about what patients hear. Take time to help patients understand the truth about their condition. She states that modern medicine has no place for false hope, which always disappoints in the end.
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