When I read the Peter Rabbit story to Jake, he did not question the part about the Mrs. McGregor’s pie story. I moved on. I think the same thing can happen in our conversations with patients and families. When we talk about their loved one’s illness, do we give information without confirming that they understand? We know the disease process and place a high value on being straightforward in our explanations. Just as the oncologist was gentle and concrete at the same time, we do the same, conveying information and assuming a certain level of understanding. After all, if they don’t ask for clarification then it must be clear. They nod their heads and ask no questions, understanding is implicit. But what if they hear the news without realizing they don’t understand? Not asking questions does not necessarily indicate understanding. It’s like turning the page to continue reading; and because they don’t ask for details or because they seem to understand, we keep reading with an assumption of understanding.

The middle part, Cindy’s physical condition, was explained in clear detail. It wasn’t exactly an a ha moment as much as it was a resignation, a subtle shift on their part. The family wanted what was best for her. Labeling a family as difficult or in denial is easy; but in this case, they were just lost. Not that no one had told them these things, but they hadn’t heard. We had to work to open their ears. The communication challenge was to uncover the gaps and fill the family with the correct information. Henry didn’t know that Cindy’s hypercalcemia was an ominous sign, and that her poor performance status could not be reversed. Understanding the middle helped him put the end in context.

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Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.   


1. Potter B. The Tale of Peter Rabbit. © Frederick Warne & Co, 1902. London, England: Penguin Group; 2002.