Re: Don’t torment me with hope
In defence of hope
Alexandra Filby’s painful experience illustrates the need for more open and upfront, albeit difficult, conversations about prognosis and death. . The society, as a whole, doesn’t embrace death in a rational manner and oncologists are no exception. . As observed in an ethnographic study, doctors and patients do sometimes collude in avoiding discussions about death..
Nevertheless, honest conversations about death don’t mean extinguishing hope when discussing treatments for incurable disease.. This is because hope helps to dissipate anger and frustration. Hope keeps the cloud of despair at bay as the painful journey progresses towards acceptance of death.
Along with discussions about prognosis, many patients do prefer “cup half-full” type of hopeful honesty rather than “cup half-empty” type of dark pessimism. Many cancer patients go through palliative chemotherapy for small survival benefits even after an open honest conversation about benefits and risks..
Furthermore, Oncologists are not terribly good at accurate prognostication.. Not all cancers behave in the same manner. Some cancers are quite aggressive. Some can be indolent. Some respond well to treatment. Prognosis of advanced cancers is actually quite dependent on response to treatment. An incurable cancer diagnosis doesn’t always spell doom and gloom as exemplified by advanced prostate cancer patients having a prognosis typically measured in years. So when there are significant uncertainties about anticipated treatment outcome, hoping for an optimistic outcome is the default coping mechanism of many patients as well as their oncologists.
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Competing interests: No competing interests