Word Choice Matters When Caring for Patients With Cancer
Oncology nurses use many tools to help our patients, but one of the most effective is our words. However, our terminology may be overwhelming to patients and feel like medical jargon. We also often use terms to describe how a patient is experiencing cancer, reporting adverse events, noncompliance, failing treatment, and palliative care, which can be confusing and misleading.
When Did Cancer Treatment Become a War?
War terms for facing treatment have been part of the cancer vernacular for decades. In 1971, then-President Richard Nixon signed the National Cancer Act and, in his speech, declared a war on cancer (https://www.cancer.gov/about-nci/overview/history/national-cancer-act-1971).
We find war terminology throughout oncology articles, support groups, and mission statements. Both patients and oncology professionals use the war analogy. We are all part of the team against cancer, and it does feel like coming together to fight a war, but we need to be careful of our words and their impact.
When fighting a war, you need to be more skillful, more cunning, and a better warrior if you’re going to outsmart your opponent. This can put an undo burden on a patient with cancer to have the constant strength or positive mindset to bravely fight to win the war on their cancer. If they don’t win this war, or experience setbacks, then they could feel as though they haven’t fought hard enough.
It may be better to tell patients they are living with cancer (https://powerfulpatients.org/2019/04/24/words-matter-why-cancer-isnt-a-game-of-winners-or-losers/). If cancer leads to death, then the patient would have lived with cancer for a period of time (https://powerfulpatients.org/2019/04/24/words-matter-why-cancer-isnt-a-game-of-winners-or-losers/) rather than have lost because cancer won the war.
This sensitive approach can also lead to conversations with patients on how they want to live with their diagnosis and can help when talking about the patient’s personal goals and wishes. Asking a patient to define their life moving forward is a powerful concept and a positive way to approach the difficult journey ahead.
Some patients will continue to use war analogies during their cancer treatment, and that should be their choice. We can always explore together what words work best for them. It’s about finding a common language to promote greater awareness and more sensitive communication (https://pubmed.ncbi.nlm.nih.gov/22842692/) between the oncology nurse and patient.
Complaining Versus Reporting
As oncology nurses, do we describe the patient as “complaining of” or “reporting” side effects? How we chart a patient’s adverse side effects has an influence.
The patient is part of our team and would report side effects. Complaining has a negative connotation, but reporting denotes that the patient understands the need to communicate side effects so they can be an active part of symptom management.
Noncompliant and Nonadherent Patients
Labeling a patient noncompliant or nonadherent also has a negative connotation (https://journals.lww.com/homehealthcarenurseonline/Citation/2016/01000/Noncompliant_and_Nonadherent__Time_to_Retire_These.12.aspx).
Patients have autonomy and can choose not to follow a plan of care. When discussing a patient who is not following a plan of care, we need to ask why they’re choosing to do so before going directly to labeling. For instance, health literacy and social determinates of health (https://voice.ons.org/news-and-views/not-all-barriers-to-care-are-created-equal) are factors that can lead to noncompliant or nonadherent behaviors.
Exploring a patient’s reasons for not following the plan of care is part of the clinician’s therapeutic relationship. Look at this as an opportunity for discussion with the patient and possibility to adapt the plan of care for successful implementation.
Failing Isn’t Personal
Our patients do not fail treatment; the treatment fails the patient. The burden is on the treatment, not the patient, and we shouldn’t leave patients feeling as though they are the cause of treatment failure.
We must be up front and transparent when a treatment approach is deemed palliative or curative. Those difficult conversations should be approached early in the patient-medical team relationship.
The Centers for Medicare and Medicaid Services’ Oncology Care Model (https://www.cms.gov/newsroom/fact-sheets/oncology-care-model) encourages defining the goal of treatment to allow patients to make informed decisions.
Palliative Care Is Still Treatment
Expressing to a patient that the oncology team is now stopping all treatment and “just using palliative care” diminishes palliative care down to a last resort. Patients with cancer become accustomed to hearing about treatment options, so approaching palliative care as another treatment option can help decrease any unnecessary anxiety.
We can explain to patients that palliative care provides supportive treatment. This treatment approach can be used in collaboration with the oncology team’s plan of care.
When a patient is diagnosed with cancer, they turn to oncology professionals to help them understand what they are facing and what will happen next. Strong communication skills are critical to influencing satisfaction, adherence to plans of care, and overall clinical outcomes (https://cjon.ons.org/cjon/17/3/improving-oncology-nurses-communication-skills-difficult-conversations/html/full) for our patients. We can provide needed support by being conscious of our word choices and how they can affect a patient’s perception. Making sure our words place the burden on the disease and not the patient is a gift we can provide to both our patients and our oncology colleagues.