Clinicians should remind themselves that strong emotions often dissipate over time. Furthermore, the ability to retain and process information about a cancer diagnosis increases over time. When possible, clinicians should rely on time as a useful clinical intervention. For example, men with new diagnoses of localized prostate cancer often find out about their diagnosis at the same clinic visit that they decide how to treat the cancer. It is doubtful that these patients have had time to absorb all the information in one sitting, especially given their likely shock at receiving a cancer diagnosis. Perhaps a better goal at such a visit is to communicate their diagnosis and prognosis to patients, and let them know that good treatment options are available, which they can decide about over the next few weeks. When delivering bad news to patients, clinicians should expect that many patients will not be able to process much clinical information during the initial visit, and will usually be more capable on subsequent visits of doing so, when the shock has subsided.
Time may also provide an important context for balancing the need for hope and the need for accurate information. The object of a patient's hope should vary as his or her disease progresses. Initially, most patients focus on long-term survival, whereas later patients may be encouraged to move to short-term goals, and finally many terminal patients will shift to hoping for a good or peaceful death.57,58 Clinicians should understand where a patient is in this timeline and help the patient to reframe his or her object of hope to match their clinical circumstance.59 Realistic information can be focused on what is needed to negotiate the decisions at each step.
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