In the last section, we discussed the first five conversation guidelines.  The first five guidelines were ask first, if they don’t want to talk, knowing what to say, giving advice, and saying cancer. 

In this sectio, we will continue to discuss the conversation guidelines.  The six guidelines for communication in this section are sometimes it’s best to begin with the facts, say how you feel first, don’t cover up your feelings, avoid judgment, and offer acceptance and support, validation, and cry.  As with section 4, you might consider playing this section for your client if he or she could use help regarding conversation with a loved one who has cancer.

6 Conversation Guidelines

♦ Guideline #1: Sometimes It’s Best to Begin With the Facts:  Rick and Cathy from the last section were experiencing difficulty talking to Cathy’s mother Paula who had breast cancer.  Rick stated, "I don’t even know how to start a conversation with her about cancer.  And neither does Paula."  I stated, "In the early stages, cancer patients like Paula may not wish to talk about feelings.  Her feelings are new and strange.  You may find it easier to talk about medical facts.  If you can speak to her comfortably regarding the medical facts, she may find it easier to start talking about feelings."

♦ Guideline #2: Say How You Feel First:  Cathy asked, "How can we get her to open up about her feelings when it is time?"  How might you have responded to Cathy?  I explained, "Stating your own feelings may be a good way to open up a conversation.  Your mother may not want to talk about her feelings for fear that she may be burdening you with them.  When you stated how you feel, you may want to express the pain you are experiencing as a result of not understanding what is going on.  Consider saying something like, ‘I love you.  I’m really upset.  I need to know what you are feeling."

♦ Guideline #3:  Don’t Cover Up Your Feelings :  In addition to saying how you feel first and beginning with the facts, let’s discuss not covering up feelings.  In a later session, Cathy mentioned her mother’s upcoming mastectomy.  Cathy stated, "I’m just trying to be strong for her."  I responded, "I’m sure that Paula can draw strength from you, but don’t say, ‘I’m not worried,’ or ‘I know everything will be fine.’  Instead say, ‘I’m scared, too.  This is a serious operation.  But I’m going to be here for you.  We’ll get through this together.’"  What are the benefits to this type of openness for your client?

♦ Guideline #4: Avoid Judgment, Offer Acceptance and Support:  A fourth communication guideline for Cathy and Rick was to avoid judgment, and offer acceptance and support. 

I stated, "Unless you have been through it yourself, you can never know how you would react if you were in this situation.  Reactions to cancer are often very individualized.  No single reaction is the right reaction.  Paula may not react as you would, but her reaction is affected by her unique experiences, attitudes and expectations.  For example, if Paula says, ‘This really scares me,’ don’t say, ‘You have nothing to fear,’  Instead offer acceptance and support by saying something like, ‘This must not seem fair at all, especially now, but I’m going to do everything I can to help you through this.’" 

Think of your client with a loved one who has cancer.  How can a focus on acceptance and support help shape communication?

♦ Guideline #5: Validation:  Fifth, let’s discuss validation.  Dr. Peter Maguire documented a common way in which health care professionals and family members often invalidate a patient’s feelings by unwittingly changing the subject.  When explained to Rick and Cathy, Rick stated, "I know.  I don’t mean to do it.  But the other day Paula said, ‘I am really scared.’  And then I said, ‘Yes, but how is your leg today?’  As soon as I said it, I realized that Paula perceived me as trivializing her emotions." 

Rick realized that he was talking Paula out of her feelings rather than through them.  How might your client’s communications with a loved one who has cancer benfit from staying on the topic and validating the person’s feelings?  Would playing this section be beneficial.

♦ Guideline #6: Cry:  The final guideline for communication that was implemented by Rick and Cathy was simply to cry.  I stated, "Gentle tears can show Paula that you care for her.  They also convey the message, ‘I am comfortable with your expression of sadness, with your tears."  Cathy asked, "What can I say when my mom cries and then apologizes for it?"  How might you have responded to Cathy? 

I stated, "Let her know she doesn’t have to say she is sorry.  You might say something like, ‘Please don’t apologize for crying.  I’d worry if you weren’t upset.  I know I am.  It’s a natural reaction.’  Or you can say, ‘Sometimes tears are the best way to express your emotions.’" 

Think of your Cathy.  If your client’s mother or loved one is diagnosed with cancer, how might he or she communicate effectively with him or her?  Could the guidelines in the last two sections help foster productive communication?  Would playing these sections for your client help?

In this section, we finished discussing conversation guidelines.  The six guidelines for communication in this section were sometimes it’s best to begin with the facts, say how you feel first, don’t cover up your feelings, avoid judgment, and offer acceptance and support, validation, and cry.

In the next section, we will discuss what to do.  In my practice, I find that when a client experiences a loved one diagnosed with cancer, one of the first things he or she asks is, ‘What can I do?’  If you have a client with similar concerns, perhaps the information in this section will spark ideas to help generate a list for your client.  The actions in this section include bringing food, getting the patient involved, helping with chores, helping with out of town guests, calling and visiting, and creating laughter.  
Reviewed 2023

Peer-Reviewed Journal Article References:
Hesse, B. W., Beckjord, E., Rutten, L. J. F., Fagerlin, A., & Cameron, L. D. (2015). Cancer communication and informatics research across the cancer continuum. American Psychologist, 70(2), 198–210.

Mróz, L. W., Oliffe, J. L., & Davison, B. J. (2013). Masculinities and patient perspectives of communication about active surveillance for prostate cancer. Health Psychology, 32(1), 83–90.

Müller, F., Tuinman, M. A., Stephenson, E., Smink, A., DeLongis, A., & Hagedoorn, M. (2018). Associations of daily partner responses with fatigue interference and relationship satisfaction in colorectal cancer patients. Health Psychology, 37(11), 1015–1024.

Müller, F., Hagedoorn, M., Soriano, E. C., Stephenson, E., Smink, A., Hoff, C., DeLongis, A., Laurenceau, J.-P., & Tuinman, M. A. (2019). Couples’ catastrophizing and co-rumination: Dyadic diary study of patient fatigue after cancer. Health Psychology, 38(12), 1096–1106.

Oberoi, A. R., Cardona, N. D., Davis, K. A., Pariseau, E. M., Berk, D., Muriel, A. C., & Long, K. A. (2020). Parent decision-making about support for siblings of children with cancer: Sociodemographic influences. Clinical Practice in Pediatric Psychology, 8(2), 115–125.

Robinson, L., Kocum, L., Loughlin, C., Bryson, L., & Dimoff, J. K. (2015). I wanted you to know: Breast cancer survivors’ control of workplace communication about cancer. Journal of Occupational Health Psychology, 20(4), 446–456. 

QUESTION 5
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