HanoiSitting opposite a 39-year-old man with lung cancer that no longer responds to treatment, doctor Viet Anh, 31 years old, was confused and didn’t know how to start the story.
Through visits, Doctor Nguyen Viet Anh, Department of Thoracic Radiology, K Hospital, felt that the patient and his family still held out hope of recovery. While the results of the examination, scans and tests showed that he was in the final stages, his prognosis was conservative, and the plan was to return him to the local area for palliative care. This made doctor Viet Anh torn, not knowing whether to tell the truth that “they were about to die” or continue to let the patient stay for treatment even though it was ineffective.
Finally, the doctor chose to inform the wife in another room, explaining in detail the husband’s condition and why palliative care was needed rather than continuing with chemotherapy or radiotherapy. After that, he returned to the patient’s room and said: “Your illness needs to go home to maximize nourishment, improve your physical condition to stabilize your health, and continue to return for treatment.”
Similarly, Dr. Nguyen Thi Huong, Deputy Director of the Palliative Care Center, K Hospital, is also burdened by very young cancer patients with a strong desire to live. Because the psychological development of this group is complex and not as easy to accept the truth as people in their 80s and 90s, it is very difficult for doctors to inform them of bad news.
“Breaking bad news” – an English term meaning “announcing bad news”, plays an important role in world medicine, to the point that there are hundreds of academic articles and dozens of research works on the topic. This topic, according to Stewart Dunn, professor of Psychological Medicine at Sydney Medical School at Royal North Shore Hospital. Telling someone they are dying is one of the most difficult things a doctor or nurse can do, experts say. This is an emotional aspect that worries many medical staff, including experienced doctors.
One study found that the act of delivering bad news can cause a doctor’s heart rate to double, to 168, when a normal heart rate is about 70. This work also estimates that an oncologist will announce about 20,000 bad news in career. Patient and family reactions can range from sadness, extreme crying, and shock to disbelief and anger. Some doctors talk about patients or relatives punching, running into walls, walking away, or scolding or threatening others in serious situations.
In many countries, some doctors still choose to hide their illness, with the idea that the family, not the patient, should bear the brunt of the shock. Bad news of cancer or a short life expectancy can make people depressed, depressed, further hindering their recovery process or ability to survive. In fact, much evidence shows that severe depression and chronic stress in cancer patients affect the immune system, making the disease more severe.
On the other hand, the announcement “cannot be cured” is similar to admitting failure by doctors, while medicine is increasingly advancing with breakthrough treatments. Medical technology focuses on “defying death” at any cost, thereby instilling hope in patients and their families that they can be cured no matter how serious their illness is. This partly creates psychological tension for doctors when “bombarding” the patient’s emotions.
Therefore, an important part of the job of doctor Viet Anh, as well as the medical staff of K Hospital – the last line of cancer treatment in the North – is to learn how to deliver bad news to patients, especially those with advanced age. In the final stage, it is necessary to return to the family and local hospital for palliative care. This care consists of two parts: pain treatment and psychological care.
In cases where he understands the disease and is mentally prepared, doctor Viet Anh chooses to notify both the patient and family at the same time. Accordingly, experts explain why drug therapy, chemotherapy and radiotherapy are ineffective while palliative care will improve quality and prolong life.
For people with a hopeful mentality, the doctor will talk privately with family members first, then choose a context to inform the patient. In any situation, Viet Anh does not choose to say “you have been returned, your prognosis is only a few months”. He used some announcements to make it easier for listeners to accept, such as: “Your illness now needs maximum nourishment so that you can stabilize and return to treatment.”
Some people are sensitive and can understand the meaning of the word “palliative care”. They will ask the question “how long do I have to live”, wanting the doctor to tell the truth. In this situation, doctor Viet Anh does not give a prognosis because this is not accurate. I’ll cover the best-case scenario and the worst-case scenario. For example, a 42-year-old woman asked, “Can I live to see my daughter go to college or get married?” “Maybe, but I will definitely live to witness other important milestones for my children and family members,” Viet Anh said.
From professional experience, he understands that optimistic news will bring positive emotions to patients, help them live fully in their last days of life, and be able to fulfill their unfinished wishes.
Doctor Nguyen Viet Anh. Image: Phuong Thao
The Department of Thoracic Radiology has 8-10 doctors, currently treating 300-500 patients, mainly cancers in the chest, of which lung cancer accounts for the highest rate. On average, each doctor examines and treats 30-50 patients per day. Most of them feel that delivering bad news has a profound impact on the patient’s spirit, while doctors are busy and only have a few minutes to do this.
“However, the connection between people is really important. Sometimes, medicine cannot help much, but the doctor’s listening, empathy and sincerity can make a difference,” Viet said. He said, adding that this is the reason why every day he always focuses on conversations with patients, learning about the patient’s psychology, thereby finding the most gentle and effective way to communicate.
It is estimated that more than 300,000 Vietnamese people are living with cancer. The number of patients tends to increase. In 2018, 165,000 new cases were recorded, in 2020 this number was 182,000, and the number of deaths was 122,690. Three common types of cancer in Vietnam are lung, liver, and stomach, all of which have high mortality rates. However, today’s medical advances have helped many people cure or prolong their lives, depending on the type of cancer and stage of the disease. For some types of cancer, the cure rate over 5 years exceeds 90% if detected at an early stage and treated promptly.