The announcement of cancer, from the point of view of caregivers – RoseUp Association

In your medical school, were you taught how to announce the diagnosis of cancer?

Dr. Muriel Hirsch : In 2006, the year I finished my internship, it was not taught. In fact, the human sciences were barely on the curriculum of our medical studies. Today, preparing a student for this test seems essential to me but, based on my experience, I think that simple theory is not enough to face this crucial moment that is the announcement of bad news. These are moments to live.

Dr Mauricette Michallet: In the 1970s, when I did my internship, we did not address this question of the relationship with the patient. At the time, the scientific approach largely took precedence over the humanist approach. However, in my specialty, hematology, we are faced with very serious pathologies, often with an unfavorable prognosis. Knowing how to say is therefore essential. In retrospect, this lack of theoretical training was very painful for me. Today I am campaigning so that young doctors can be tutored by a senior and helped to face difficult moments such as the announcement of a bad diagnosis, a restrictive protocol, a recurrence, or even worse…

Do you remember the first time you had to announce cancer?

M.H. : It seems to me that it was a lady to whom I had to give the results of a sample of a suspicious lump in her breast. My secretary called her to tell her “ that I wanted to see her “. I had him come at the end of the afternoon, after my consultations, in order to be completely available. I remember saying this to him: “ If I called you here, it’s because I have something important to tell you. I received your biopsy result, it is not good “. A preamble that I still use today. I don’t remember having a bad experience with this first experience, or being clumsy. Of course, I certainly had to navigate by sight, cautiously, to manage to tell him the essentials and to pronounce, word after word, the sentences which seal the seriousness of the point.

M.M. : I remember it perfectly – even if we speak more of a “malignant disease” in hematology – because it is a patient that I am still following, some thirty years later. She regularly reminds me how much this first consultation marked her: “ You know, you were a young doctor, we were in an air-conditioned room, completely closed, and fortunately, because otherwise I would have jumped out of the window! “. However, at the time, I was very happy with my interview. I had used all my medical knowledge, that which undoubtedly protects, thinking that this was the most important thing. I realize now that I had completely missed the essential thing: the astonishment that accompanies the announcement of the diagnosis and the sudden shift “into illness”. Forgetting it seems unforgivable to me today.

With experience, have you found the right way to break bad news?

M.H. : Over time, I built a sort of “announcement routine”. Like a kind of Ariadne’s thread, he guides me, step by step. First of all, I attach great importance to being present and available for my patient. I also make sure that I am perfectly familiar with his medical file, his examination results, his biopsy, in order to be precise in the information I provide. I rephrase, if necessary, to be sure that the essential information has been heard and I remain open to any questions. In this difficult moment, I try to keep a positive attitude to give the patient confidence, to show her that I support her. On the other hand, I remain cautious about what will follow, particularly about the therapeutic strategy which is not within my control. With experience, I have refined my know-how which, combined with my interpersonal skills, allows me to better know how to say things. But everything can always be improved.

M.M. : If the recipe existed, I would be the first to grab it! There is indeed an announcement system which ensures that the patient benefits from the best conditions of information, listening and support but, in reality, in view of my long experience, it is difficult to apply it at the foot of the letter.

On the one hand, because there is not just the announcement of the diagnosis but a cascade of announcements during the follow-up of a patient. On the other hand, because at the hospital, consultations follow one another at a frantic pace, we therefore have little time.

Despite these constraints, I always make sure to quickly identify my patient’s profile to adapt my speech and manage to tell them the essentials, in an understandable but also constructive way. I also do not forget that I am dealing with “a sick subject”. So I’m careful not to say certain words too quickly or too early, and to keep a positive attitude, looking to the future. Communicating well is not innate, it is acquired throughout one’s professional life.

What do you find most complicated about this exercise?

M.M. : Like I said, lack of time. This is a source of great frustration for me. Furthermore, it is also not always easy not to be shaken by complex situations. I am thinking, for example, of the cases of women that I have been following for years, with whom I have built a relationship of deep trust, and to whom I have to announce that their treatment is no longer working or that there has been a recurrence. I know in advance that I will have to deal with their emotions, their tears, their anger, sometimes even their aggressiveness, while being fair in my words and empathetic in my attitude. These are moments that are hard and which necessarily affect me.

M.H. : To find the right balance: to be both professional and empathetic, fair in the information provided and reassuring. Leave room for my patient’s emotion without being overwhelmed by it. I think that being a female doctor makes it easier to put myself in the patient’s place, but I must not let this “mirror” effect overwhelm me.