How do you console or give encouragement to someone that is very sick?

[nurse3131, RN]

This pt was at the clinic with a complaint of a breast bump. The pt got a mammogram weeks later and came up she has breast cancer. She called me on the phone very stressed, crying and in denial. I tried to give her encouragement but I did not know if I helped her at all. What would you have say to her? I just do not want to promise she is going to be okay because I do not know, and at the same time I do not want her to feel like she is going to die. She is going to get a biopsy soon but it is not known whether the cancer has metastasized... Any suggestions?

[imintrouble, BSN, RN]

I stink at therapeutic communication. Talking about death, dying, or just plain seriously ill, is beyond my capabilities.

That doesn't mean I don't feel sympathy.

A patient I admire enormously was told she had about 3 months left to live.

There was so much I wanted to say and couldn't. I simply said "I hear you received some bad news." Then I listened to her talk.

[nurse3131, RN]

It is very hard to try to give patients words of encouragement without giving them false promises..

[toomuchbaloney]

Many times these frightened people are not looking for words of encouragement or wisdom as much as they are looking for a safe place to verbalize their own fears, angers, and anxieties.

It is important for us to remember that active listening is an important skill in communicating. Just hearing that person and validating their feelings can be very powerful.

[nurse3131, RN]

That makes sense! thank you!

[DosmoRN]

I do not know much about "therapeutic communication" either. But I have had the experience of having bilateral mastectomies, chemo, radiation etc. I've also been sought out by a friend and family member for "advice".

I fully agree with toomuchbalony, that people are usually more in need of being heard than being advised. They will collect tons of advice from various people before this is over...,some advice will be good, some will be bad, but the majority will be useless.

The diagnosis is so overwheming at first, that the patient tries to take in all available information and make sense of it. That cannot be done. And trying, only adds to the helplessness one feels.

But they need to express whatever they are feeling. They need to know that what they feel is understandable (not wrong, weird, cowardly, silly etc.) A newly diagnosed patient is likely to panic and think "Oh, my God, I must be dying!" Then, I usually have to come back again and again to where the patient is now. I may say, "but until the biopsy is done and evaluated, you don't know for sure that you really have cancer". This may sound like assisting denial, but the cancer journey is so long, it's best, I think, to focus on what is coming next...taking one day at a time, one procedure at a time. Of course I have the advantage of having experienced much of what they will. My experiences may not be identical, but they can see that I came through it all OK.

When I was going through chemo, the husband of a good friend of mine said to me, " I don't think I could handle it (the chemo) if it was me." I said, with no prior thought, "oh yes you could...you could if you had to". Irony of ironies, he was diagnosed with colon cancer before my treatments were through. So we had a lot of experiences to share from then on out. That seems to help.

The very best help, I think comes from fellow cancer patients. Because of the schedule of chemo treatments, I usually had mine at the same time as others and came to know them well. They were of different diagnoses and stages, but we became very close and very informal. Sometimes we got to laughing so hard, a nurse had to check and see that we were ok. I actually missed my chemo group when it was all over.

Humor has always been a way I like to relieve stress. So if you have a joking relationship with a cancer patient, by all means, keep it up!

Don't get all solemn and sad, as sympathetic as you may feel. Just be yourself.

Doctors unfortunately, don't always quite see the humor in things. The morning of my surgery, I said to my surgeon, "man, I'm sure glad to see you. I have a couple of things I need to get off my chest!" (I was having bilateral mastectomies, after all.) The only one that got and laughed at my joke was an OR nurse. Bless her.

[NurseAgatha]

When a patient is dying and expressing their feelings, sometimes they just want to be heard. Providing false reassurance can only increase their frustrations. The key is to simply give your listening ear, and one option for an appropriate and therapuetic response is a genuine "I'm sorry." It validates their feelings and struggles, and offers compassion and support, without compromising honesty.

[nurse3131, RN]

Thank you all for the advise! next time I get to talk to her I would try my best to make her feel she is been heard. I have never thought about cancer patients becoming friends like that while chemo, that is awesome!

[ORNurseCOS]

In my opinion you don't need or should not provide encouragement - in this situation this is not what she needs or wants.

Practice compassionate listening and offer yourself to her to listen deeply - be present in the moment with her and actively listen, don't just listen to then put your 2 cents in but a listening in which by doing so you remove the burden of suffering from her.

This compassionate listening will allow her to relieve this suffering, if only for a short time.

Just be present and available, that is all you can do.

Exercise compassion.