Denial and communication

Linda Sheahan, David W. Kissane

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Patients who appear not to acknowledge the diagnosis of an illness, or its gravity, are said to be 'in denial'. A patient's history readily illustrates this in Box 16.1.

Denial is considered a common reaction, especially when an illness is life-threatening. After being told of the diagnosis of terminal cancer, approximately 20% of patients deny they have cancer, 26% partially suppress awareness of impending death, and 8% demonstrate complete denial (Greer 1992). A meta-analysis suggested that the prevalence of denial of the cancer diagnosis ranged from 4 to 47%, and denial of negative affect from 18 to 42% (Vos and De Haes 2007).

Although the term 'denial' is an accepted part of the medical vernacular, it is used in a variety of clinical circumstances, with varying definitions and little consensus. Furthermore, as with all of the body's defences - physiological, immunological, psychological - denial can become maladaptive.

This chapter will establish a pragmatic view of denial, explore how it functions within the clinician-patient relationship, and then demonstrate when intervention is appropriate and how that intervention is best undertaken. Specific attention will be given to the communication skills required for an effective clinical response to denial.
Original languageEnglish
Title of host publicationOxford Textbook of Communcation in Oncology and Palliative Care
EditorsDavid W. Kissane, Barry D. Bultz, Phyllis N. Butow, Carma L. Bylund, Simon Noble, Susie Wilkinson
Place of PublicationOxford UK
PublisherOxford University Press
Number of pages6
ISBN (Print)978-0-19-873613-4
Publication statusPublished - 2017


  • denial; oncology; communication skills training, palliative care

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