No matter if you are a brand-new physician or an experienced practitioner with years under your belt, delivering a colorectal cancer diagnosis can be an emotional and stressful process. Managing the emotions of the patient, and others present with them, involves balancing confidence, empathy, understanding and more.
“This was one of the most difficult things I have ever done,” Dr. Erica Cohen of Capital Digestive Care’s Chevy Chase Endoscopy Center said when describing her first experience delivering a diagnosis. “I knew the patient’s life was about to change forever because of what I was about to say. I felt an uncomfortable heaviness walking into the room. This heaviness comes any time I deliver difficult news to a patient.”
Upon receiving the news, patients can respond in numerous ways. Cohen said that she had experienced the full range of reactions, from those who immediately broke down in tears, to those who wanted to quickly move forward with next steps, to patients who showed little external emotion at all.
“I try to invoke confidence and strength and focus on the next few steps of staging and meeting with the appropriate specialists,” she said. “I enlist family and friends for support. I avoid discussing the variety of treatment options before getting all the data as that can cause more uncertainty and anxiety.
I know there are always a variety of emotions when you deliver bad news to someone, some people kind of are very stoic and just take it in stride. Some people want to know as much as they can about what you found and the possible prognosis and risks. Everyone handles bad news a different way, and I think some of that (the physician’s response) is somewhat based on taking the patients lead.”
Delivering the News
Cohen explained that she believes the most important aspect to delivering a colorectal cancer diagnosis is “to be present.” She advises other physicians to ensure that the patient knows they have their physician’s full attention. This includes turning off your phone to ensure there are no distractions, like texts or calls. It also includes standing or sitting close to them. Cohen also likes to ensure the patient is not in the exam room alone.
“If they have a family member with them in the car or in the waiting room, I like to ask the patient if they would like me to bring them in,” Cohen said. “I never want the patient to go through this alone. It also has the added benefit of having someone else on hand who may pick up things the patient doesn’t as they process the information.”
These small steps will help put your patient at ease. This is because they know you are dedicated to answering their questions and helping plan for the future.
When delivering a new CRC cancer diagnosis, there are also several other important factors to consider. These include cultural sensitivity, gender sensitivities, sensitivity for the patients support group, and the personality of the patient themselves.
With the reduction in minimum screening age for screening from age 50 to 45 presented by the United States Preventative Services Task Force (USPSTF), a new generation of patients now have access to vital CRC screenings. However, some patients continue to delay or refuse screenings due to fear or misinformation. Cohen explains how she approaches the subject with newly eligible patients.
“I say listen, the guidelines have changed because there’s been an uptick in colon cancer in younger people,” she said. “Any test is better than nothing, and if you are at average risk, you have no family history of colon cancer, you have no history of polyps, and you have no symptoms, doing a non-invasive test is better than nothing. Sometimes that helps kind of get them in the door, at least to getting some screening as opposed to waiting 10 years because they’re too afraid.”
Dr. Erica Cohen works for Capital Digestive Care at the Chevy Chase Endoscopy Center and the Chevy Chase Clinical Research Center in Chevy Chase, MD. Capital Digestive Care is a strategic partner of PE GI Solutions leveraging the PE Practice Solutions platform. PE Practice Solutions is a physician-oriented management services organization (MSO). To learn more about PE GI Solutions and our solutions platforms click here. To learn more about Capital Digestive Care, click here.