All 4 situations presented a challenge in communication. How do we help our patients and families make sense of the bigger picture? It is easy to get caught in details and miss the bottom line.

There is a church near my home that I pass on my way to work. Each week they post a new inspirational saying.  A couple of weeks ago the saying was, “What is The Point?” I drove the rest of the way to work thinking of patients like these 4. My focus in situations such as these is to help patients and their families and the caregivers clarify the goals of care. Also to stay objective and remain supportive if they struggle with difficult choices.

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What do you think you might say when a family pushes for XRT when a patient is confused, as Walter was?

Do you think having a definitive biopsy and diagnosis is essential for patients like Sheila?

What do you say to a patient like Phyllis who continues with care you know is not curative?

When you have a patient like Steven, with waxing and waning confusion, does that impact the choices he may be offered?

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