Building trust.

In the most recent edition of Oncology Times e-newsletter there is an article by Dr. Paul R Teft MD
Dr Teft is Associate Professor of Medicine in the Dept of Hematology/Oncology at Indiana University, he is also a practicing Oncologist who has built a system for building trust with his patients while allowing them to know the truth about their condition, prognosis, care and treatment options. This is a seven part system he has developed and shares with the fellowship physicians whom he mentors. He states that there are many other effective ways of approaching patients and those interested should study the writings of others. This is not a verbatim copy of Dr Telft's article but the points that I gleaned I felt would be helpful to see in the Drs treating caregivers loved ones and when approaching the same subjects with their own loved ones. After a Dr visit it is often necessary to interpret what has been said and iron out any misconceptions and filter things you don't want or don't feel your elder is ready to hear.

It must be remembered that an Oncologist's sole practice is the treatment of cancer.

1 Building trust.

The main aspect of this is for the Dr to take time and really listen to the patient and remember him/her from one visit to the next and show empathy for their condition

2. Non verbal communication

This includes body language and showing respect for the patient as a person not a disease.

3.Listening.

Spend more time listening than talking. Ask about emotional wellbeing, fears and show the patient the Dr really cares about this individual.

4.Understanding of patient

They should be asked what they already know about their condition so that any misconceptions can be rectified and a summary of the visit can be given based on the patient's knowledge, fears and expectations.

5.Dr anxiety.

It is a difficult task for a Dr to have to break bad news so it is important he/she does not convey their own anxieties. The patient should be warned that there is something important about their condition that needs to be to discussed and asked if they feel strong enough to hear it at this time. The information should be totally honest but can be brief. If the patient becomes emotional all conversation should stop until the patient is ready to continue. The Dr should move closer to show support but remain silent till the patient speaks. This will allow patient to know the Dr understand their fears but will continue to offer strength and support. Glib platitudes should be avoided.

6. Prognosis.

If the disease is potentially curable the patient will be hopeful but still have anxiety about the treatment options. He/he can focus on the options and the best choices to make.
Incurable disease will be much more emotional especially if there is the element of shock at a new diagnosis. Most patient's first question will be "How long have I got" While it can only be a rough estimate it is crucial that it be totally honest. Everyone is different so three months can stretch into six or shrink to weeks. Experience is the Dr's only guide and that estimate will change as the disease progresses or interventions are started.

7. Choices.

The patient must be involved in the choices of therapy, understand the side effects and what they will have on the quality of their remaining time. Quality v quantity, even if no treatment is chosen something like palliative radiation may be ordered to relieve pain or shrink a tumor. As the caregiver of an elderly loved one especially one with dementia the caregiver may have to make the decisions for the patient.

What I take from these suggestions which may apply equally to caregivers when they are in the position of explaining to their loved ones just what the Dr said. The goal is to be truthful but not promote anxiety and know that their feelings are respected and they can trust the caregiver to act in their best interests