Confirmation bias is the tendency to search for, interpret, or recall information in a way that confirms one’s beliefs or hypotheses.1
In this age of racial unrest in Ferguson, New York, Madison, all three locations recently in the news, I have read several newspaper editorials discussing the role of confirmation bias in what has happened. I was unfamiliar with the term but one editorial did an especially good job of explaining its meaning. This column is understandably not a venue for discussing politics or profiling; however, when I read about confirmation bias I immediately thought of how the concept has an interesting application to patient education.
I was discussing the overall goals of symptom management with my patient, Nancy, and her husband Mark before the start of radiation therapy. Nancy had a long history of smoking and was recently told she has an advanced lung cancer. Surprisingly her main symptom was not shortness of breath or a persistent cough. Instead, it was a nagging pain in her lower back that she believed came from lifting a box a few weeks earlier. After several weeks of resting her back, anti-inflammatory meds, and regular use of a heating pad with no improvement in her pain she went to her primary doctor. Two days later she was sitting in a medical oncologist’s office listening as she was told of her new diagnosis of lung cancer, and a few days after her initial diagnosis, she was having a consult for radiation therapy. That was when I first met her. Before she came in, I happened to run into her medical oncologist and he shook his head when he told me about her saying to him, “I don’t know how you can say I have lung cancer. I don’t feel sick. I strained my back, that’s all.” It was perhaps a classic case of denial yet it was more than that: nothing that had happened so far fit her idea of what lung cancer should look like, therefore, it could not be correct.
Many of us working in oncology are familiar with denial. It is a reaction that causes a great deal of consternation for us caregivers. It does not fit into a factual based account of a patient’s illness. It causes a paradoxical comfort and discomfort when we encounter it. Comfortable because we easily recognize it and uncomfortable because it is always a challenge to work with patients we believe are in denial. Though it is not a measurable symptom, it is a word that is easily tossed around. “Nancy is in denial.” Or, “The family in room 652 has a bad case of denial. They keep asking when their mother is going to get better.” Or, a classic patient statement, “Once I get chemo, I’m going to be fine again.” But our willingness to label denial can lull us into thinking we know something about a patient that we do not truly know. It can keep us from looking at what else is causing the reaction. We can have our own confirmation bias, taking patient or family behavior or statements as affirmation that what we are seeing is, in fact, denial. We somehow feel qualified to identify denial. But should we?
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Caring for patients who seem to be in denial is not uncommon. How do you structure your care for a patient in denial?
Is denial something you think you need to “fix”?
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