By foregrounding patients’ needs and goals, Dr. Jalid Sehouli and his team help women with metastatic breast cancer (MBC) regain confidence and control over their lives.
Professor Jalid Sehouli has practiced gynecological oncology for 30 years, and since 2011 has directed the Department of Gynecology with Center for Oncological Surgery at the Charité Hospital in Berlin. He talks about his work with women with MBC.
What challenges do clinicians face in communicating with MBC patients?
We are always afraid to communicate bad results. We are human beings, we know that the woman has a family, she has desires. These patients are in a traumatic situation, because they cannot be cured, but it is important to avoid negative undertones.
How do you help patients absorb and move past these first feelings of trauma?
I give each patient space to ingest the information. They need the space to cry — doctors need to tolerate this, instead of jumping in with further comments. I keep the first communication short, but let the patient know that we will continue the conversation about treatment options, but also about how to live in a positive way. We need to recognize that for each patient, we can always find something good.
Why it is important for MBC patients to recognize the positive?
Although the patient cannot be cured, in fact most of her body is healthy. We must define what we can do to maintain this. Many patients can live long, with a good quality of life. MBC is not a homogenous group, and the doctor must avoid "reducing" these patients. The diagnosis does not have to diminish their capacity to participate in life.
How do you guide the patient to focus on the positive?
We try to motivate the patient, to overcome the lack of self-confidence she may feel in learning of her diagnosis, to wake her up. To help patients move in a new direction, it’s important to define the resources and desires they have. What was motivating them before, and how can we reactivate that? What are some external goals or milestones? These can help overcome the trauma.
How can you encourage MBC patients to reconnect with their lives?
When a patient learns about metastases or treatment failure, she may at first feel hopeless. But I ask how her to tell me about positive things in her life during the past six months, say. There is always something. Second, I ask, You want to live — why? I encourage her to identify her priorities. Above all, the patient has to know three things: that she is not responsible for her disease, she is valuable in her family and community, and she is able to influence events in her life and environment.
What can you share about your upcoming book, Breaking Bad News and the Discovery of the Good Message?
It explores sharing bad news from the patient perspective, the family’s, and the doctor’s, and how to find and talk about the good message. We’re all trained to highlight negative results and ignore positive information. Patients must also explain the bad news to others, and the family as well. Everybody is in every role, at the end of the day.