Responding to difficult emotions

Clinicians must be prepared to allow the expression of a variety of emotions in cancer care. There are times during the illness when emotional responses may be anticipated, such as when a patient is first diagnosed with cancer, when a recurrence occurs, or when the disease is progressing despite anti-cancer treatments. There will be other times when the physician is unaware of the particular stimulus for distress. A seemingly benign discussion can result in an unexpected response due to vulnerabilities in the lives of patients, not directly related to the cancer care. To be supportive, physicians must be skilled in the delivery of empathic responses. There is a substantial body of evidence demonstrating that these are teachable skills (Moore et al. 2004; Lienard et al. 2010; Heyn et al. 2013).

The assessments of physicians and their responses will vary according to the acuity or chronicity of the emotions expressed. We will divide this chapter accordingly. We take the angry patient as one example of an emotionally difficult encounter and offer a model of how the clinician can respond. This approach can be applied to a range of other challenging interactions.