Delivering the Diagnosis

Delivering the Diagnosis

Delivering a colorectal cancer diagnosis can be difficult for physicians and involves a wide range of emotions and empathy

No matter if you are a brand-new physician or an experienced practitioner with years under your belt, delivering a colorectal cancer (CRC) diagnosis can be an emotional and stressful process. Managing the emotions of the patient and others present with them involves balancing confidence, empathy, and more.

“This was one of the most difficult things I have ever done,” Erica Cohen, MD, of Capital Digestive Care’s Chevy Chase Endoscopy Center says when describing her first experience delivering a diagnosis. “I knew the patient’s life was about to change forever because of what I was about to say. I felt an uncomfortable heaviness walking into the room. I still feel that heaviness any time I have to deliver difficult news to a patient.”

Upon receiving the news, patients can respond in numerous ways. In her years in practice, Dr. Cohen explains that responses to this life-changing news can vary depending on the individual. Some react immediately with tears; others are more stoic, wanting the next steps; while some simply show no emotion at all.

“I try to invoke confidence and strength and focus on the next few steps of staging and meeting with the appropriate specialists,” she says. “I enlist family and friends for support. I avoid discussing the variety of treatment options before getting all the data, as that can cause more uncertainty and anxiety.”

Dr. Cohen adds, “I know there are always a variety of emotions when you deliver bad news to someone. Some people are very stoic and just take it in stride. Some people want to know as much as they can about what you found and the possible prognosis and risks. Everyone handles bad news differently, and I think that our response to the patient’s reaction is somewhat based on taking the patient’s lead.”

Being Present for Patients

Dr. Cohen believes the most important aspect of delivering the news is “to be present.” She advises other physicians to ensure that the patient knows they have their physician’s full attention. Examples of showing you are totally present include turning off your phone to ensure there are no distractions, and standing or sitting close to them. Dr. Cohen also likes to ensure the patient is not in the exam room alone.

“If they have a family member with them in the car or in the waiting room, I ask the patient if they would like me to bring them in,” Dr. Cohen says. “I never want the patient to go through this alone. It also has the added benefit of having someone else on hand who may pick up things the patient doesn’t as they process the information.”

These small steps will help put your patient at ease, knowing you are dedicated to answering their questions and helping them plan for the future.

Other Factors to Consider

When delivering a new CRC diagnosis, there are several other important factors to consider. These include cultural sensitivity, gender sensitivity, sensitivity for the patient’s support group, and the personality of the patient themselves.

With the reduction in the minimum screening age from age 50 to 45 presented by the United States Preventative Services Task Force, a new generation of patients now have access to vital CRC screenings. However, some patients continue to delay or refuse screenings due to fear or misinformation. Cohen explains how she approaches the subject with newly eligible patients.

“I say, ‘Listen, the guidelines have changed because there’s been an uptick in colon cancer in younger people’,” she says. “Any test is better than nothing, and if you are at average risk, you have no family history of colon cancer, you have no history of polyps, and you have no symptoms, doing a noninvasive test is better than nothing. Sometimes that helps get them in the door, at least to get some screening as opposed to waiting 10 years because they’re too afraid.”

Erica Cohen, MD, works for Capital Digestive Care at the Chevy Chase Endoscopy Center and the Chevy Chase Clinical Research Center in Chevy Chase, MD. Capital Digestive Care is a strategic partner of PE GI Solutions.

For more patient tips and stories, the latest GI industry news, and more, check out our blog at pegijournal.com.