How to tell cancer patients: A contribution to a theory of communicating the diagnosis

How to tell patients they have cancer is an important question in cancer ca re. The question provokes distress in physicians, and a failure in relating the diagnosis may arrest patients' process of coping with anxiety and redu ce their subjective well-being. This contribution to a theory of communicat ing about the diagnosis is empirically based on an earlier study in which p atients with malignant brain tumors were interviewed and is theoretically b ased on contemporary object-relational psychoanalysis. The authors propose that a beneficial physician-patient encounter can be viewed as characterize d by the acknowledgement of the physician as an unconscious protection agai nst death and as a facilitating environment for the patient's reconstructiv e process. The implications of these propositions are discussed. The author s also propose that the transference from the child-parent relationship to the patient-physician relationship enables physicians to use introspection as a means to improve their skillfulness regarding "How to tell." Thus, int rospection may provide physicians with guiding knowledge grounded in themse lves.