1. Harpham, Wendy S. MD

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When you order a scan, do you ever wonder what kind of news your patient hopes for? If you assume every patient hopes for "good" news, you'd be right most of the time. But not always. I, for one, don't spend time and energy hoping for good news. To understand why, let's look at hope in the setting of patient evaluations.

WENDY S. HARPHAM, MD... - Click to enlarge in new window

Hope Defined

A good place to start is a definition of hope. Here's one I've found most useful: Hope: a pleasurable feeling associated with your belief that something you want to happen might happen.


I say "might," because a prerequisite for hope is uncertainty about the outcome. So, for example, patients don't hope for tomorrow's sunrise because it's a sure thing. But when having a scan, since nobody can predict the results, patients can experience hope.



Patients' heightened sense of uncertainty about their condition-and their future-makes the entire process of having a scan and waiting for the results an anxiety-rich ordeal. The survivorship community even gave patients' emotions a new name: scanxiety.


During my initial course of chemo and subsequent remission, my bouts of scanxiety prompted me to hope and pray for good news. The mental image of getting good news slowed the cascade of fears. Hearing my friends and family echo my hope for good news helped me feel less alone.


But this reflexive hope was problematic. The tension between hoping for good news and knowing I might get bad news was exhausting. Since I couldn't change how much cancer I had, sometimes I felt waves of helplessness while lying on the scanner's bed. And the longer I waited for the test results, the more helpless I often felt.


False Good News

Just weeks after completing radiation therapy for my first recurrence, I developed the same symptoms that had heralded my original diagnosis. My oncologist ordered a CT. I hoped for good news. After my oncologist called me with the results, I led my friends and family in a collective sigh of relief.


But my symptoms persisted. Weeks later, my oncologist ordered a repeat scan. This time the news was not good. Pulling out the prior "normal" scan, the radiologist re-examined the same areas where the new CT showed obvious abnormalities. Subtle, benign-appearing changes were, in fact, very early signs of recurrence. Through my deep disappointment and flashes of terror, I grasped at the feeble consolation that at least now we knew why I felt sick.


How did I deal with the "missed" diagnosis? I knew that the retrospectoscope offers an unfair advantage. Interpreting scans is an art performed in real time, with the accuracy of test results subject to a variety of factors, only some of which are modifiable. In my case, my oncologist had provided detailed information to a superb radiologist, and I'd held still during the scan. My physicians and I had done the best we could within the limits of technology.


There was a silver lining: A mantra was born that has helped me through every evaluation since: "More than I hope for good news, I hope for accurate news-findings that correctly reflect my condition."


The Healing Power of Hope

In your work as oncologists and oncology nurses, you have a professional obligation to remain objective while evaluating patients. If compassion leads you to hope for good news, the primacy of your hope for accurate news prevents your emotions from clouding your judgment.


Patients can benefit from this hope, too. Unlike hope for good news, hope for accurate news mobilizes patients to contribute to their care.


For instance, patients who hope for accurate news may be more apt to notice changes and volunteer information than patients who, hoping for good news, are less observant or keep symptoms to themselves-consciously or subconsciously.


Hope for accurate news may help patients tolerate discomforts during procedures better than patients who, hoping for good news, feel frightened and helpless.


Hope for accurate news can help patients through the waiting, too. This hope makes it a priority to have scans done using state-of-the-art equipment and read by skilled radiologists, even if it means dealing with added delays when scheduling scans or waiting for results.


Lastly, hope for accurate news helps prepare patients for the possibility of bad news. And it sets the stage for patients to perceive "bad news" as helpful news. After all, you can't address a problem you don't know about.


Guiding Patients' Hope

Patients look to their oncologists and oncology nurses not only for medical advice, but also for guidance regarding hope. By validating patients' hope for good news when ordering tests, you show compassion: "It's okay to hope for good news. I'm certainly hoping for good news for you."


By highlighting hope for accurate news, you empower patients: "While doing these tests, our number one hope should be hope for accurate news-results that correctly reflect what is going on. So let's work as a team to get the most out of the scans. I'll ensure the radiologist knows what we're looking for. You try to lie still during the scan. That will help."


Finally, share with your patients the real good news: "Working together we can obtain the best information about your condition. The best information helps us make the best decisions about your care. In other words, hoping for accurate news now increases our chance of getting good news down the line."