Fine‐Tuning the Truth

Abstract

Communication has become a major issue in cancer care, and rightly so. Good communication helps patients and their families understand the situation and assists with decision-making, acceptance, adjustment, and coping. It is well known that the way in which a cancer diagnosis is delivered not only affects the person’s understanding of the illness, it can also have an impact on their longer-term psychological adjustment. While these issues are essential to medicine in general, they are particularly important for patients with cancer or other life-threatening conditions. Some unique aspects for breast cancer patients include the effects on women’s sexuality and body image, fertility, and issues around premature menopause induced by adjuvant systemic therapy. Effective communication seems especially important for this latter group in which the high percentage of noncompliance seems to be based on inadequate communication [1]. In the ‘‘Gathering information of adjuvant endocrine therapy (GAEA) study,’’ 41% of participating patients were not included in the decisionmaking process at the beginning of adjuvant treatment [2]. In response to these concerns, a plethora of communication training skill courses has become available and participation in such workshops constitutes part of the core curriculum for the training of cancer specialists in many countries [3]. Good communication skills are also very important tools of the surgeon, and development of these skills should not be reserved for only medical specialists and specialized nursing staff. It is obvious that surgery is not just about cutting! [4, 5]. In this issue of World Journal of Surgery, Mendick et al. [6] have published a study with the pertinent title ‘‘Telling everything, but not too much’’. It highlights the multilayered nature of the encounter between surgeon and patient and the range of functions this serves, in addition to simply conveying objective information. The study is particularly interesting as it contains information from both the doctor’s and the patient’s perspective. It describes through in-depth interviews what seems to be a very successful breast cancer care unit where the clinicians in general are able to meet the communication needs of their patients and target their approach accurately to the individual patient. It is striking how similarly the surgeons and the patients described their communication goals: to give hope, to show surgeon’s expertise (i.e., trust), to sustain a personal clinical relationship, and to support decision-making. Furthermore, the article emphasizes the complexity of the surgeon’s task. Hope needs to be conveyed while maintaining honesty and not withholding any information, and the surgeon is expected to demonstrate authority while building up a personal relationship and to involve the patient in the decision-making process while taking responsibility for important decisions. To achieve this, the surgeons selected and shaped the information and patients relied on them to do so. The necessity of this comes as no surprise to most experienced clinicians. To simply give all available information without taking the individual’s needs and state of mind into consideration can easily lead to information overload and confusion. Although it is clear that contemporary Western ethics emphasize the right of the cancer patient to be fully informed and to participate in decisions about treatment, E. E. Elder (&) Westmead Breast Cancer Institute, Westmead Hospital, P.O. Box 143, Westmead, Sydney, NSW 2145, Australia e-mail: e.elder@bigpond.net.au