Navigating Difficult Questions in Breast Cancer Care

From: medpagetoday.com

In “Beyond Diagnosis: Breast Cancer,” Cleveland Clinic oncologist Tiffany Onger, MD, and host John Mangels continue their conversations on communicating effectively and empathetically with patients across the breast cancer care journey.

Each monthly installment examines an individual aspect of these crucial discussions, including establishing trust, reviewing treatment options, and supporting patients through complex or emotionally charged decisions.

This fourth of six episodes focuses on answering difficult questions, addressing fear and uncertainty, and balancing factual clarity with compassionate guidance when delivering challenging news.

The following is a transcript of their remarks:

Mangels: Welcome to “Beyond Diagnosis.” I’m your host, John Mangels. Newly diagnosed breast cancer patients need information and support. As a physician, how should you prepare for that conversation? For expert advice, I’m joined by Cleveland Clinic oncologist and breast cancer specialist, Dr. Tiffany Onger. Dr. Onger, thanks so much for your time today.

Onger: Thank you for having me.

Mangels: We’re talking today about how to answer patients’ difficult questions. Tell me, how do you balance empathy and honesty when you’re talking to a patient about their disease?

Onger: I think it’s an incredibly important skill as an oncologist. We’re going to be dealing with patients who are going to sometimes get bad news. Sometimes the scan is going to show progression, and so what I like to do is first focus on the facts. What are we seeing? Are we seeing a stage IV diagnosis that’s just the bones or are we seeing stage IV diagnosis with brain and liver and lots of lung involvement?

So two really different conversations, and so I like to help frame our conversation around what we’re actually seeing, what our opportunities are for treatment, and what I expect and anticipate for them going forward on that treatment.

Mangels: How do you help patients deal with the fear and uncertainty that, of course, goes with a cancer diagnosis?

Onger: Fear and uncertainty go hand in hand in oncology. I find that if I’m able to reassure the patient about what the plan is going forward, that fear really comes down. So I like to let them know what we know. Maybe we have a new PET scan that’s showing a new spot someplace. I might mention we’re going to gather some information. We might need to get an MRI or a biopsy, and then we’ll come up with a plan of what we’re going to do based upon the results of the information.

Mangels: So feeling like they have that roadmap and they kind of know where they’re headed is important.

Onger: It’s incredibly important, yes.

Mangels: What’s the most difficult question a patient has ever asked you and how have you answered it?

Onger: One of the questions that patients ask me that is more challenging for me to answer is, “What would you do if this was your mother?” And I can appreciate that what they’re asking for is they want reassurance that, as their oncologist, that I am bringing empathy and heart to their particular case.

But what I as a medical oncologist want to do is I want to make sure that I am bringing recommendations for the patient in front of me, not for my mother if she’s 99 years old. It’s going to be a very different recommendation for maybe a 40-year-old woman with twins at home. And so what I generally tell them is I ask my mother, “What are your hopes and goals for now and for the future, and how can we accomplish that with the medical team?”

Mangels: That’s a really nice way to frame that answer for what’s relevant to the patient.

Onger: Thank you.

Mangels: Thanks so much for your insights, Dr. Onger, and thank you all for watching. Please join us again for another episode of “Beyond Diagnosis.”