PALLIATIVE AND SUPPORTIVE CARECommunication at Times of Transitions How to Help Patients Cope with Loss and Re-Define HopeEvans, Wendy G.a; Tulsky, James A.b; Back, Anthony L.c; Arnold, Robert M.dAuthor Information aDepartment of Medicine, Section of Medical Ethics and Palliative Care, Institute for Doctor-Patient Communication, University of Pittsburgh, Pittsburgh, Pennsylvania bDepartment of Medicine, Center for Palliative Care, Duke University and Durham Veterans Affairs Medical Centers, Durham, North Carolina cUniversity of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington dDepartment of Medicine, Section of Medical Ethics and Palliative Care, Institute for Doctor-Patient Communication, University of Pittsburgh, Pittsburgh, Pennsylvania. Reprint requests: Wendy G. Evans, MD, Division of General Internal Medicine, University of Pittsburgh, 200 Lothrop Street, MUH 932W, Pittsburgh, PA 15213. E-mail: [email protected] No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. Received on May 25, 2006; accepted for publication August 15, 2006. The Cancer Journal: September 2006 - Volume 12 - Issue 5 - p 417-424 Buy Abstract Patients undergo multiple transitions during the course of their cancer care. Oncologists are uniquely positioned to help patients through these transitions. When patients' situations change, they must cope with loss and associated negative emotions. They then are able to redefine hope. During transitions, patients want their oncologists to provide biomedical information, show that they care about and understand them as individuals, and balance hope and realism. Eliciting concerns and expressing empathy shows patients that their oncologist cares about and understands them and also helps patients to cope with the loss and negative emotions that transitions create. Oncologists can maintain hope by being sensitive to what patients are ready to hear when, and by helping them discover and identify realistic hopes. This is accomplished with the Ask-Tell-Ask and Hope for the Best, Prepare for the Worst techniques, and most importantly by being curious about patients' hopes and fears. © 2006 Lippincott Williams & Wilkins, Inc.