"We use "mortal time" in our work to mean the experience of human beings confronting the prospect of death. This confrontation can stimulate intense feelings, a flurry of thoughts, and erratic or unusual behavior. In the broadest sense, mortal time is entered whenever death comes near, and that can happen either directly or vicariously. Hearing the words, "you have cancer," and signing a medical consent form where death is a possible medical "complication," are direct experiences of mortal time. Learning of a loved one's cancer diagnosis, losing a family member in an automobile accident, or reading about a missing child are vicarious experiences of mortal time. The power of tragedy in the theatre can brings us into the experience of mortality. King Lear's madness in the face of betrayal propels him toward an untimely death. The focus in this book is on the particular and powerful experience of entering mortal time when someone receives a diagnosis of cancer, a life-threatening illness. As we noted in our introduction to this second edition, the experience of mortal time in cancer medicine has changed with new treatments. A cancer diagnosis could mean an illness where rapid progression toward death is looming, or where there is only the distant possibility of death. Now there is a third option: the prospect of longer survival with metastatic disease due to the promise of additional therapies, facilitated by next generation genome sequencing. This means, a lengthier period of mortal time and uncertainty for many cancer patients. MORTAL TIME: HOW LONG DOES IT LAST? There are, of course, many instances in which people far exceed their statistically predicted life span. This holds true whether it be the prediction of a physician in the midst of treating an illness or the projected life span of an insurance life-expectancy table. In Part II we give an example of how misleading statistics can be when we discuss the idea of false hope. When mortal time looms with the diagnosis of cancer, it may stretch from days to years, with patients encountering both helpful treatments that lead to periods of remission and recurrences of disease requiring additional treatment. Some patients may never experience a time when it is apparent that they are dying until the last days. The interval between living and dying that we are concerned with here is not primarily chronological time, measured in days, weeks, and months. The hallmark of mortal time is the person's unique biological, psychological, social, and spiritual experience of the prospect and meaning of death, a prospect that confronts their caregivers as well. Mortal time is "kairos" time, the ancient Greek word meaning the time of decisions. When someone enters mortal time directly, their caregivers enter the same time zone vicariously. What they do together in mortal time, especially how they speak and listen to each other, affects the quality and meaning of life for all involved, in the moment and beyond"--

Every day, thousands of people receive a diagnosis of serious, life-threatening illness, and their families and friends suddenly become caregivers. Despite the best of intentions it is not always easy to communicate well under these circumstances, or find deep empathy for something one has never before experienced. When is it best to speak, and when to be silent? How can someone provide real comfort, and how can relationships with loved ones facing serious illness be enhanced in this most difficult time? This book is about how to be an encouraging caregiver and friend under the most difficult circumstances, when the possibility of death is all too real The authors believe that open dialogue must not be avoided until the last minute when opportunities will be limited, but that caregivers and loved ones can embrace this time, mortal time, honestly as a way to sensitively and compassionately engage with those for whom a central fact of life is realized--that all of our lives are time-limited. In The Art of Conversation Through Serious Illness, the authors consider how to best listen to and speak with one facing life-threatening illness, with lessons on being a primary conversation partner, becoming properly empathic and receiving empathy, maintaining everyday conversation, using platitudes appropriately, understanding healthy denial, and talking about dying. Offering bedside guidance usually only available to professionals and peppered with insightful anecdotes from the authors' own experiences, this gentle, succinct book is appropriate for anyone going through this uniquely difficult yet universal life experience.

The Handbook of Communication and Cancer Care is a major newcompendium of state-of-the-art readings concerning the powerfulinfluences of human and mediated communication to enable healthcare consumers and providers to get the most out of cancer care. Anextraordinary number of communication issues must be considered inthe conduct of cancer care, including gathering and interpreting relevanthealth information, eliciting coordination among interdependentpatients, providers, and family members, and/or caregivers, andproviding social support and promoting psychosocial adjustment.

Physicians who care for patients with life-threatening illnesses face daunting communication challenges. Patients and family members can react to difficult news with sadness, distress, anger, or denial. This book defines the specific communication tasks involved in talking with patients with life-threatening illnesses and their families. Topics include delivering bad news, transition to palliative care, discussing goals of advance-care planning and do-not-resuscitate orders, existential and spiritual issues, family conferences, medical futility, and other conflicts at the end of life. Drs Anthony Back, Robert Arnold, and James Tulsky bring together empirical research as well as their own experience to provide a roadmap through difficult conversations about life-threatening issues. The book offers both a theoretical framework and practical conversational tools that the practising physician and clinician can use to improve communication skills, increase satisfaction, and protect themselves from burnout.

This book covers all the relevant aspects of communication in cancer care, such as communication in cancer prevention and genetic counseling, communication at different stages of disease and communication with the family and children. In addition, more general topics are discussed, such as the benefits and evidence of communication skills training and the challenges of interdisciplinary and cross-cultural communication.

This comprehensive text provides clinicians with practical and evidence-based guidelines to achieve effective, patient-centered communication in the areas of cancer and palliative care. Written by an outstanding panel of international experts, it integrates empirical findings with clinical wisdom, draws on historical approaches and presents a state-of-the-art curriculum for applied communication skills training for the specialist oncologist, surgeon, nurse and other multi-disciplinary team members involved in cancer care today. In this book communication is broken down into key modules that cover the life-cycle of cancer care. They include coverage of diagnosis and treatment including clinical trials, empathic support in response to distress, transition to survivorship or palliative therapies, discussion of prognosis, conduct of family meetings, and care of the dying. Complementary training of patients in their communication with the doctor completes the interactive dyad. The art of teaching, impact of gender and power in the consultation and the ethical context are carefully considered. Special communication challenges include discussion of genetic risk, rehabilitative and salvage surgery, promotion of treatment adherence, unanticipated adverse outcomes, intercultural issues, fertility and sexuality. The value of decision aides, question prompt lists, audio-recording of consultations and use of the internet is illustrated. By looking across the full spectrum of disciplines involved in the multidisciplinary team, discipline-specific issues are considered by experts in each field. In this manner, the needs of patients and their relatives are evaluated, including paediatric and geriatric populations. To achieve all of this, theoretical models are examined from the medical school to the highly specialized practice, facilitation training and actor training are made explicit, and international approaches to communication skills training are compared and contrasted. Finally, research tools that assist in coding cancer consultations, evaluating training courses, and employing mixed methods in studies aid the reader in providing clear and sensitive communication when handling challenging situations whilst treating cancer sufferers and palliative care patients.

A handy guide to tackling difficult patient and professional interactions with confidence and compassion In this age of increasing reliance on technology, it is essential that the fundamentals of compassion and good communication—the art of patient care—remain at the heart of health care. This clear, concise guide to professional communication strategies helps nurses and other health care clinicians to build effective patient relationships and navigate a wide variety of difficult patient and professional interactions. Written by a practicing psychotherapist who has devoted nearly 30 years of study to clinician—patient relationships, the book tackles such complex issues as dealing with demanding patients, maintaining professional boundaries, overcoming biases and stereotypes, managing clinician emotions, communicating bad news, challenging a colleague’s clinical opinion, and other common scenarios. The book guides the reader through a conceptual framework for building effective relationships that is based on the principles of mindfulness. These principles are embedded in discussions of the fundamental elements of interpersonal effectiveness, such as hope, empathy, and listening. Chapters apply mindfulness principles to specific challenging situations with concrete examples that describe effective clinical behaviors as well as situations depicting pitfalls that may impede compassionate care. From a focus on everyday manners in difficult situations to beneficial approaches with challenging populations, the guide helps health care professionals confidently resolve common problems. Brief, to-the-point chapters help clinicians channel their clinical knowledge and good intentions into caring behaviors that allow the patient to more fully experience empathy and compassion. With the guiding theme of “using words as precision instruments,” this is a resource that will be referred to again and again. Key Features: • Helps health care professionals and nurses communicate effectively in challenging clinical and professional situations • Uses the principles of mindfulness to build satisfying relationships and resolve problems • Addresses such difficult issues as demanding patients, maintaining boundaries, overcoming biases, managing clinician emotions, and much more • Provides special tips for communicating with family members and caregivers • Authored by a practicing psychotherapist specializing in clinician—patient relationships for nearly 30 years