The doctor-patient relationship, like any other relationship, depends upon open communication. Expecting complete information from your health care team also requires that you provide them with complete information. This chapter has been written with the breast cancer patient in mind. Feel free to make copies of this material for your patient (or give the Breast Care Coordinator a call if you would like us to send a copy to her).

Information the Health Care Team Needs to Know about a Patient to Develop the Appropriate Treatment Plan*

1. Close relatives who have had cancer and the type of cancer that they have had.

2. Your goals regarding your quality of life during and after treatment and your optimism or pessimism concerning recovery.

3. The degree to which your life style or personal circumstances will affect your treatment choices.

4. Whether you want to have children in the future.

5. How much you want your health care team to share information concerning your treatment, test results and prognosis with others and who those people are.

6. How much or how little you want to be involved in decisions concerning your treatment options and test results.

7. If you have a durable power of attorney for health care and/or advance directives in case you become too sick to make informed decisions and who should make decisions for you.

8. If you want a second opinion.

9. Other therapies you may be using in conjunction with standard treatment and all prescriptions and over-the-counter remedies that you are taking so that you can minimize the chance of one medicine counteracting another.

10. Any symptom(s) that may indicate side effects of a medication(s) you are taking so that they can change the dose or medication and/or treat the symptom(s).

*Source and Suggested Resource: Adapted from: Imagery for Healing and Wholeness © 1995, Arlene Harder, MA, MFCC P. O. Box 6708, Altadena, CA 91003-6708, 818-797-3834, Fax 818-798-5815

How to Communicate Effectively with the Health Care Team

As you know, when patients are first told that they have breast cancer they are overwhelmed with the shock of the diagnosis and with the decisions that need to be made. Under these circumstances it can be difficult to hear, let alone understand, absorb and remember what a doctor is telling them.

Following are a number of suggestions that you can give to your patient. These suggestions will increase her understanding and recollection of what has been said. They will also alert her to the kinds of information that her doctor and the other members of her health care team will need from her. It is important to remind patients that no question is stupid or a waste of time.

Suggestions to Help Patients Keep Up Their End of the Communication*

1. Before each office visit, write down any concerns or questions you want to discuss with your doctor and bring the list with you to the visit.

2. Do not wait until the last minute to ask important questions; let your doctor know at the beginning of your visit that you have them.

3. Bring a friend or family member with you on medical visits; they can help you ask important questions and recall the answers.

4. Bring a tape recorder (with your doctorís permission) with you to your medical visits so that you can review information as needed at a later time.

5. Let the office know in advance if you need to talk with your doctor for an extended period of time.

6. Describe any discomfort or pain as accurately as possible. Do not accept pain as something unavoidable that you must endure.

7. Report any changes that concern you regarding your physical or emotional health.

8. Ask your doctor to repeat instructions or information that you do not remember or do not understand.

9. Ask for written and video patient education resources.

*Source and Suggested Resource: Adapted from: Imagery for Healing and Wholeness © 1995, Arlene Harder, MA, MFCC P. O. Box 6708, Altadena, CA 91003-6708, 818-797-3834, Fax 818-798-5815

Ten Priority Questions for Physicians that will Help Patients Understand Their Breast Cancer Diagnosis and Breast Cancer Treatment Options

1. What does my diagnosis mean?

2. Can I have a copy of my pathology report?

3. How advanced is this (tumor)? / What type and stage of breast cancer do I have?

4. What are my treatment options?

5. What do you expect the treatment to do?

6. What are the short-term and long-term side effects and risks of the suggested treatment?

7. What might happen if I decide not to have this treatment?

8. How long will I be in treatment?

9. How long will this treatment take each time and what does it involve?

10. Are there alternative treatments? (Clinical trials, complementary treatments and other options.)

Listen to Understand - Be sure to get clarification if you do not understand the answers to your questions. If you feel any answer is not complete, ask more questions. This is where alternating open-end and close-end questions might be a technique that will assist you (see "Communication Skills for Breast Buddy Volunteers" page 84).

General Questions to Help Patients Learn More about Follow-up Care and Breast Cancer "Risk Management"

1. After I have completed my treatment, who will be in charge of my medical care and how often will I be seen for follow-up visits?

2. Will I be monitored to see how I am doing? What other kinds of tests will I have and how often?

3. Are there "do's" and "don'ts" that I should follow after treatment and for how long?

4. Are any of my relatives at an increased risk for breast cancer? If so, what is the risk?

5. What are your recommendations for breast cancer screening (breast examinations by a health care professional, mammograms) and how often should I be screened?

6. How often and at what time of the month should breast self-exams be done? Can you teach me how to do a proper breast self-examination (including reconstructed breast(s)/mastectomy scar examination?

7. At what age should breast examinations begin? Do you have instructional materials on breast self-exams and healthy lifestyles (nutrition, etc.) that I can use and give to my relatives and friends?

Summary of General Questions to Ask Your Health Care Team about Breast Cancer Treatment

Answers to the following questions will help your patient get through her treatment(s) as smoothly as possible and on to her recovery and follow-up care.

1. Please explain what this treatment is and what it will do.

2. What are the short-term and long-term benefits of this treatment?

3. What are the short-term and long-term risks of this treatment?

4. What are the side effects of this treatment? Is there anything that I can do to prevent or reduce any side effects?

5. How will this treatment affect me emotionally and/or sexually?

6. Can you refer me to a counselor, a support group or another person who has been through this to help me deal with some of the issues with which I am struggling (such as emotions, sexuality, relationships)?

7. How might this treatment affect my lifestyle and my ability to continue working and doing other activities (work, exercise, diet, etc.)?

8. Will this treatment affect my ability to have children?

9. Is it possible to get pregnant while I am in treatment? If so, what should I be doing about birth control?

10. Are there any precautions ("do's" and "don'ts") that I should know about before I begin my treatment? (such as shaving underarm(s), cosmetics, exposure in the sun, etc.) How about during treatment?

11. Are there "do's" and "don'ts" that I should follow after treatment and for how long?

12. Are there any nutritional and other complementary practices/therapies that I should follow to help reduce any side effects and to keep me healthy and strong while I am in treatment?

13. How can I find out more about this treatment?

Problem-solving Tips for Volunteers and Patients

There are many problems that can surface following a breast cancer diagnosis. Everyday stresses are compounded by the need for patients to rearrange their lives to accommodate doctor appointments and make treatment decisions. The following problem-solving tips have been designed to help break problems down into manageable steps.