Every day you order tons of tests. But you're too busy to think about the results-let alone worry about them-until you see the reports.
Meanwhile, some of the patients whose names are on those reports are worrying mightily, stuck in a Sartre-esque hell of uncertainty with no exit from the waiting, day after day after day after day. Plagued by anxiety, they may try to forget about their pending test results. But they can't forget... or sleep... or concentrate.
Anxiety torques their thinking and emotions. It seeps into their relationships and activities, making mountains out of molehills and spoiling good times, day after day until the end of uncertainty.
A few years ago, survivors called attention to this modern affliction by labeling it "scanxiety." Soon enough, websites and counselors devoted to psychosocial oncology began offering useful strategies for managing it. Thank you, thank you. But those efforts service only half the equation. Let's take a few moments to think about the clinicians' role in minimizing scanxiety.
One issue is how to prepare patients for the wait time. At best, waiting is draining. The stress is worse if patients don't know when to expect the results. And it's distressing if patients do know when to expect their results, but then end up having to wait longer. That added stress depletes patients' emotional reserve, handicapping them if they must handle results that are upsetting or ambiguous. And if the test results are normal, patients' relief and gratitude may be tainted by annoyance or anger about the stressful wait. Like parents torn between hugging and scolding a child who darted across a busy street, patients don't like being scared to death.
Another issue is how to prepare patients for their test results. If you are evaluating worrisome symptoms, it's tempting to focus on the best outcome, reassuring patients, "Let's not worry yet. Things may turn out fine." Or you might sidestep the issue, saying you can't know anything until the test results are in.
While certainly true, such reassurances won't reassure patients who, like seasoned poker players, note the subtle change of your tone or involuntary twitch of your jaw. Or your reassurances may help only briefly if your patients go home and consult Dr. Google, an expert at shaking patients' hope for recovery and/or confidence in you.
Conversely, patients who survive the long wait on a raft of reassurances may then feel blown out of the water by upsetting news. How can they make important decisions while stunned, or furious at their fate, or a bit unsure if you're telling them everything?
My experiences as a patient opened my eyes to opportunities for clinicians to help patients. For one thing, many patients try to predict the outcome. Early in my survivorship, I was fascinated by how my scanxiety caused me to poll loved ones' predictions and to search for predictive signs in my symptoms and omens in coincidences. None of that helped, of course. Nobody and nothing could predict the results-and I knew that. Yet I kept trying, because that's what human brains do in situations of uncertainty.
Usually it's an adaptive instinct that enables us to optimize the outcome, such as when we pack an umbrella after checking the forecast. What I learned as a patient was that waiting for test results is a special circumstance of uncertainty. Here, much like the instinct to run if my clothes catch fire, the instinct to predict the results is maladaptive, heightening the sense of vulnerability and powerlessness and thus fanning the flames of scanxiety. Ever since, I've successfully shut down any urge to predict the results.
My next step was managing my expectations. I tried expecting the best results, an approach that seemed to work well for many of the folks in my support group. But as a physician trained to keep all possibilities in mind, my trying to deny the possibility of unwanted outcomes was like pushing a big beach ball underwater. Exhausting.
Then I tried what the curmudgeon in my group did: expect the worst. That lasted five minutes. Why stir fear and sadness while waiting? Expecting the worst wouldn't keep me from being upset by upsetting test results. And what a waste of emotion if the results ended up normal.
I found relief in a triad of expectations: expect any results; expect the results to help; expect to accept and deal with whatever results I get. In other words, accept the uncertainty and focus on the benefit of the test results. That led me to an insight about hope that helped my waiting: More than I hoped for good news, I hoped for accurate news-however long that took. However long I had to wait.
I hate waiting for test results. But life is short, so if I must wait I might as well enjoy it. This probably sounds a bit loopy, but I now encourage patients to embrace the period of waiting as a break from making decisions about their health. While waiting, they can savor the boost of energy from their anxiety, channeling it into productive activity that brings meaning or joy.
A fact of survivorship is that patients have to wait for test results. But waiting doesn't have to be a living hell. To minimize patients' scanxiety:
* Discuss when and how patients will learn their results;
* Voice your expectation that the test results will help;
* Reassure patients that you are ready for anything and hoping for the best; and
* Encourage patients to contact you if they feel anxious, so you can discuss further resources and the role of short-term anxiolytics.
Anxiety is a symptom that needs medical attention, whether it's due to hyperthyroidism, excessive caffeine, or the uncertainty associated with waiting for test results. By addressing anxiety when you hand your patients their requisition slips, you send a message that scanxiety is common and treatable. And that you care.