1. Apsey, Heidi

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In 1998, 178,000 women were diagnosed with breast cancer. My sister, Linda, was one of those statistics. This number grew to 192,200 in 2001, of which 40,600 women will die.1 How do nurses offer supportive communication to patients facing such threatening statistics?

Figure. (from left) ... - Click to enlarge in new windowFigure. (from left) Sisters Linda, Heidi and Nancy

Although I have cared for many cancer patients, supportive communication took on a whole new meaning when cancer struck Linda. As nurses, we are taught to be educators. We learn to give information about patients' diseases so they maybe well-informed and better able to make care decisions. In addition, we are taught never to say things that we do not know to be true, such as "Everything will be okay" or "You will be just fine." I have discovered through Linda, however, that the type of support and communication needed by our patients is very individual. We need to carefully assess each person's emotional state, severity of disease and where they are in that disease process.


Linda's diagnosis was made by routine mammography. She had no palpable lump and no familial history. Linda had lived a healthy lifestyle, never smoking or drinking alcohol. She had her children at an early age. Literally no risk factors existed to indicate that Linda would develop breast cancer.


"Why me?" was the first of many questions that Linda asked. "The greatest emotion I felt initially, and still feel, is fear," Linda confided to me. "Will I lose my breast?" "How will I react to the chemotherapy?" "Am I going to die?" Newly diagnosed cancer patients often ask these questions. This is when they seek concrete information, statistics and probabilities. Through consultations with surgeons, oncologists and radiation oncologists, the list of questions grows longer.


Early in her diagnosis, Linda also sought concrete information, drawing on my knowledge as a nurse. I offered her information about cancer, treatment options, therapy side effects and possible outcomes. I helped her find reputable physicians in her area and sought second opinions from the oncology physicians at the medical facility where I worked. With each new chemotherapy side effect she experienced, Linda would call me first to get information about what might be happening and how to treat it. By taking the time to research answers to these questions and providing specific information about her disease, I was offering the type of support that nurses, as educators and patient advocates, are taught to provide. During the early stage of Linda's disease, this was the support she needed from me. However, that was about to change.


One year later, Linda's cancer returned to the lymph tissue in her axilla. In another year, it metastasized to her bones. Through it all, I continued to offer the same kind of support that I had been offering the past two years: concrete information, probabilities and statistics. After all, this is what she had asked of me early in her disease process.


Linda had started to search for renewed hope by seeking opinions through other medical facilities. One night, as we were talking on the phone about a new cancer center she had discovered, I began telling her what I knew about the facility's reputation. Suddenly, she stopped me. She told me that if I had "nothing positive to say, don't say anything." I was shocked, and my feelings were crushed. What I thought was supportive communication was no longer what my sister needed. She had already heard all the statistics, probabilities, possible outcomes and negative comments she could handle.


Her physicians had stopped offering her hope of a cure, so now Linda's confidence was not in modern medicine but within herself, her faith in God and in the positive support of family and friends. Linda no longer needed the type of support I was taught to give as a nurse. She needed the support I could give as a friend and a sister. Linda wanted to hear that there was hope beyond the statistics. She needed to know that people do win the fight against breast cancer. She wanted to hear that everything was going to be okay, even if the statistics said it wasn't.


Supportive care and effective communication are critical in meeting the health care needs of a client. Since nurses spend more time than other care-givers with the client during hospitalization, they are in a position to assess clients' psychological and spiritual needs, as well as their physical needs.


While communication may be especially difficult with someone facing a life-threatening illness, it is imperative. Often, this client is dealing with much more than a physical illness. Psychologically and emotionally, the client may be experiencing fear, helplessness, anger, frustration and depression. Nurses need to be acutely sensitive to these needs. Communication should involve taking time to listen to the patient. Ask questions that give the client and the family permission to discuss their fears. Most important, only give medical information based on individual need. A client may just need to hear something positive, see a smile or feel a warm, caring touch.


As nurses, our professional experiences can greatly affect our personal lives, and our personal experiences can greatly enhance the care we give as professionals. Because it is deeply ingrained from my nursing education to refrain from giving false hope, I have found other ways to communicate that I care. My sister's battle against breast cancer continues, but I no longer talk about concrete information, statistics and probabilities. I now offer Linda a different kind of support: I listen. I make sure that she is aware that I am always there and that I care.