Conversation Peace of Mind

Consultation recording project minimizes confusion, sharpens communications

It’s an image that Dr. Tom Hack didn’t see for himself, yet it is an image that has stayed with him for years. And it’s an image that continues to fuel his passion for improving the lives of cancer patients and their families.

It goes back some years when Hack, Director, Psychosocial Oncology and Cancer Nursing Research, was in his early 20s, in the early days of his interest in clinical psychology.

“I was speaking to my mother about cancer because my grandmother (my mother’s mother) died of breast cancer,” says Hack. “I asked her what that was like for her, having a mother die of breast cancer.  She said, ‘I don’t know much about it, really.’”

“My mother never showed a lot of tears, but did when she told me that story.”

Hack’s mother concluded that her mother was trying to protect her from knowing too much about the cancer. After all, she was only about 11 at the time. But what stuck for Hack’s mother, and for Hack himself upon hearing the story, was her experience stumbling in on her mother once while she was getting dressed.

“She had her top off and I saw her breast and it was black,” says Hack, repeating his mother’s words. The charred skin was the result of the harsh radiation treatments of the day.

“So you can imagine the pain that my grandmother would have had with this burnt breast, but also the horror that my mother experienced, seeing her mom like this,” says Hack. “That image stayed with me greatly as did the impact on my mother. My mother never showed a lot of tears, but did when she told me that story.”

Simple idea, big impact

As a clinical psychologist, Hack has made it his life’s work to ease the burden for cancer patients and their families. To understand and address the emotions that are involved – much like the ones his own mother and grandmother experienced.

Specifically, Hack is at the hub of a consultation recording project that is gaining interest around the world and attracting a great deal of interest from donors. The concept is brilliant in its simplicity, and the evidence base demonstrating its value is growing quickly.

Receiving a cancer diagnosis is an overwhelming experience, and the first consultation with the doctor – when you hear “the news” – produces moments of confusion and anxiety.

The first consultation typically includes discussion about treatment options and prognosis. It is a lot to absorb; a lot to remember. Hack has been advancing an approach to reduce the stress of cancer’s earliest days by recording these initial consultations and providing patients with the recording.

The first 90 days after a diagnosis is a critical time. “It’s a time when the cancer patient has more questions than at any other time, and when important treatment decisions are made,” explains Hack. “If a patient wants to be involved in decision-making, if we want to empower them, how do we do that? We know during the initial treatment consultation patient anxiety levels are very high – so high in fact that patients often tune out and don’t remember what the doctor has told them.”

The recordings, says Hack, allow patients and their families to listen to the conversations at a calmer time so they can better absorb the information. “By listening to the recording, they can be better informed, and be better armed with questions the next time they see their doctor,” says Hack.

Helping patients cope

Hack and his research colleagues are keenly focused on understanding and supporting the cancer patient’s ability to cope with cancer and its treatment. One of the keys, says Hack, is promoting good communication between healthcare providers and patients. The consultation recording practice, already tested with 2,000 patients, is proving itself to be an important vehicle for helping patients cope. As evidence mounts, the greater the likelihood of consultation recording becoming integrated into standard practice.

The idea for the work came years ago from hearing an anecdote about a newly diagnosed patient in British Columbia. The patient attended his first consultation holding a rolled-up copy of Maclean’s Magazine. The magazine slipped and a once-concealed tape recorder fell to the floor.

The patient wanted the tape recorder because he feared he wouldn’t be able to retain what he heard at the appointment; he concealed the recorder because he feared the doctor wouldn’t have allowed a recording if asked. For Hack, hearing this story was a ‘eureka moment’, one that drove a large body research and trials.

The benefit for patients

Hack believes there are five main benefits for patients and their families: “(1) They have better recall of important information about their disease and it’s treatment.; (2) they’re better able to be involved in treatment decision-making; (3) they have less anxiety going into the consultation, knowing that it is going to be recorded, and less anxiety afterwards; (4) improved communication with family members around their cancer because they, as I like to say, can bring the doctor home to the kitchen table and listen to their doctor’s voice with family members and friends present; and (5) improved communication between the patient and the healthcare team, the nurses, and their doctor. Patients just feel better about their cancer treatment experience as a result of having had that recording.”

For more information about Dr. Hack’s research visit: sbrc.ca/hack

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