Person-centered language in oncology helps people ‘feel genuinely cared for’
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When referring to individuals with cancer, emphasizing the person rather than the condition improves patient morale and refocuses clinicians on the mission of patient-centered care, according to an opinion paper published in JAMA Oncology.
Frederic Ivan L. Ting, MD, medical oncologist in the division of medical oncology at Corazon Locsin Montelibano Memorial Regional Hospital and associate dean of the University of St. La Salle College of Medicine in the Philippines, emphasized the importance of semantics in the context of cancer care.
Ting cited the theory of linguistic relativity, also known as the Sapir-Whorf Hypothesis — a concept that holds that the grammatical and verbal structure of an individual’s language influences their thinking.
In oncology, the phrase “cancer patient” can inadvertently place a clinician’s focus on the malignancy rather than the person under their care. Such language also can cause the person with cancer to feel defined by their disease.
In an interview with Healio, Ting recounted the experience that led him to address this issue. It centered around a woman named Annabelle, who had metastatic lung cancer.
“Annabelle comes into the hospital every 3 weeks to get her treatment and, because our residents and trainees rotate monthly, she is taken care of by different sets of young doctors,” Ting said. “One day, Annabelle shared her discomfort with the fact that she regularly heard doctors describe her using words like ‘Bed 10’ or ‘Case #2’ — or, at one point, ‘the lung cancer lady.’”
In his opinion piece, Ting discussed the ways in which word choice can compromise a clinician’s mindset, how they may affect a patient’s feelings, and the impact language can have on the patient-provider relationship.
Healio: How did Annabelle’s story motivate you to write this paper?
Ting: Annabelle found it painful to be referred to as a ‘living cancer’ rather than a living patient. She asked me, as the attending physician responsible both for her care and for the trainees, to do something about it. She had a very good point, and she is a very strong and active patient advocate.
As a writer, I was familiar with the concept of linguistic relativity, but I had not applied it to clinical conversations. When I realized that Annabelle had a good point, I met with all of my trainees — including the residents and interns — as well as the consultants in the hospital, and I shared Annabelle’s experience with them. We started changing the way we identify patients, calling them “persons with cancer” rather than “cancer patients.” It’s amazing how this small change of words and sequencing shifts our focus to the person instead of the cancer. It’s a very minor change, but it potentially has major impacts on patients and clinicians.
We started this change within the section of oncology, then expanded it to the entire department of medicine, and eventually to the entire hospital. Because of the impact I saw, I realized this was worth sharing to a broader community, and that led to this paper.
Healio: How can changing wording shift a physician’s mindset and help personalize care?
Ting: By using the term “persons with cancer” as opposed to “cancer patients” to identify people living with malignancies, our brains are rewired to maintain focus and give utmost importance to the person, since it is the first word the brain encounters. Also, emphasizing the person rather than the condition is reflective of the physician’s genuine concern for patients and their loved ones, especially during delicate conversations about topics such as a diagnosis of cancer or a poor prognosis. Several studies have shown that the words clinicians use truly affect cognition, behavior and frame of mind.
Healio: In what other ways can this approach be adopted?
Ting: I feel strongly that this change should not be limited to the medical profession. It should be extended to paramedical specialties — social services, family members and essentially everyone who interacts with persons with cancer. I would like to see medical journals consider including this in their guidelines and policies and mandate the use of “persons with cancer” rather than “cancer patients.” I also would like to appeal to professional societies to consider strictly requiring speakers and participants in conferences to not allow the use of the term “cancer patients” in their presentations. I have appealed this to my own society, Philippine Society of Medical Oncology, and I received full support.
Healio: Do you think increased awareness will motivate oncologists to choose their words more carefully?
Ting: Yes. For clinicians starting at a young age in medical school, the first literatures that we read usually are the ones that are imprinted on us. If the first journal a student reads describes persons with cancer as “cancer patients,” that’s probably the term they will use for the rest of their careers. This could change in the future, as long as there is support from senior staff, the institutions and the journals themselves. We definitely can do better and be more intentional in the words we use.
Healio: Is there anything else you would like to mention?
Ting: I wanted to go back to the story of Annabelle, who is the main inspiration for this piece. A few weeks after our conversation, Annabelle was readmitted to the hospital. After another group of residents and interns did rounds with her, she told me she was so glad we now use the phrase “persons with cancer” [and] that it made her feel genuinely cared for. This was very inspiring and encouraging, because Annabelle showed us that a small change truly has the potential to make a big impact in creating a patient-centered perspective in providing cancer care around the world.
Reference:
For more information:
Frederic Ivan L. Ting, MD, can be reached at f.ting@usls.edu.ph.
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