How to have one of the most difficult cancer conversations

The treatment of any potentially deadly condition carries with it for most people an element of hope – that the treatment will be a success, they’ll regain their good health and that they’ll live for many more years.

Sadly, of course, for some, that’s not the outcome. Instead, they and their family must deal with a barrage of emotions as the patient makes the difficult transition from active treatment to palliative care.

Dr Ralph McConaghy is a palliative care specialist who helps patients and their loved ones navigate this journey, says the end of active treatment is a devastating moment for most people who are fighting cancer.

“They have a conversation with the oncologist, who says there’s no more treatment we can offer you to fix this cancer, so it’s going to progress and it will end your life,” he says. “Quite often the patient feels like ‘you’ve put me in a row boat, untied me from the jetty, pushed me into the ocean and I’m sailing away by myself’.”

In addition to providing emotional support and information, palliative care is about managing any physical impact from the patient’s condition.

“I’ll just say to them, ‘I’m good at helping people with pain and other symptoms, so why don’t we talk about what’s causing your distress and let’s see if it can be improved it’ and usually it can,” Dr McConaghy explains. “I’ll meet them again two weeks later and they’ll say, ‘I feel much less pain, why didn’t I see you six months ago?’ and that’s a common comment.

“We’ll build a relationship and talk about the scary stuff as time goes by.”

Some of that ‘scary stuff’ involves helping patients ready themselves for the end-of-life journey at a time when they’re mentally prepared to have that conversation.

“Hop in bed with the patient and have a hug. Do the things that feel important and valuable for each other.”

“That works well for some families who are pretty touchy-feely, but if you’re a bunch of blokes, you may approach it differently, have a beer and say, ‘how are you going mate?’ but still cover the same important topic.”

Dr McConaghy says that palliative care specialists can advise families how to care for their loved one at home, from the food and exercise they may be able to take to the emergency numbers to call should the patient’s condition suddenly worsen.

“Often they’ll want to know about what if the person they love wants to die at home,” he says. “What would it be like, if it’s scary or awful, how they do it, who would help them, what happens after they die? The truth is, when a person dies the family don’t have to do anything immediately. I’ll say, ‘get the grandkids over, let them hop in and cuddle up with their granddad – he’s died, but he’s not scary’.

“Sometimes that’s a really precious and important time for people, just because they get to say goodbye properly.”