Dr. McQuellon

The Mesothelioma Cancer Alliance recently spoke to Dr. Richard McQuellon, the Director of the Psychosocial Oncology and Cancer Patient Support Programs at Wake Forest Baptist Medical Center, to hear his expert advice on how to be the most encouraging and empathetic caregiver. In part one of a two part piece, Dr. McQuellon explains why open communication and empathy can be some of a cancer patient's strongest medicine when it comes from their caregiver.

Each day thousands of people become caregivers. For most, this new role is neither easy nor comfortable. While it may sound cliché, most find one of the biggest challenges to be effective communication between the person providing care and the one receiving it. 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.

I 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. My book, The Art of Conversation Through Serious Illness, discusses how to be an encouraging caregiver and friend under the most difficult circumstances, when the possibility of death is all too real.

For caregivers and recipients, everyday conversation can become both more important and more complicated, especially when one of the partners has been diagnosed with cancer and has entered what we refer to as mortal time— the emotional experience when one becomes aware of their own mortality. The personal assumptions and histories of patients and caregivers set in motion a rhythm of conversation between them that has the power to generate consolation and hope for both. Healing conversation has two basic requirements. The more deeply we accept both, the richer the communication that will result.

The first is to listen carefully to grasp our partner’s take on things; let him or her know that we “get” what’s happening as he or she feels and sees it. Understanding another means seeing a situation from his or her point of view. Empathy is one word for such understanding. To empathize is to grasp both the events and the feelings conveyed through another’s story, to make a disciplined effort to set aside our thoughts and feelings and walk in the other’s shoes for a time.

The events are the facts of the conversation, as delivered in words. Feelings signal emotional tone and intensity. Feelings are usually expressed by how words are spoken, including nonverbal signals, and are much more complex than any transcript of words can capture. Empathy requires both attentive listening and appropriate eye contact to fathom the content and feelings of a patient’s communication. Caregivers who are empathetic invite the possibility of hope-creating conversations.

Empathy is a quality and specific behavior that allows one to enter the world of another. The experience of receiving empathy can put people in touch with their own voices, in touch with themselves. It is a skill to put feelings of compassion into action. First, we must grasp what the other is going through and how they feel about it. Then, we must convey understanding; let them know that we “get it.” Sometimes we can simply reflect back what we have heard in the simplest language possible; sometimes words are unnecessary and a compassionate nod of the head or touch of the hand is sufficient.

Empathy can be powerful medicine for several reasons.

  1. Caregivers who are good listeners can gain new insight by hearing themselves (and others) talk about a situation. Often, caregivers who listen empathetically can clarify their own assumptions.
  2. Clarity of a situation can lead to problem-solving, either through complex existential questions (why is this happening to me?) or practical decisions (whether to wear a wig or a scarf for a head covering). Putting experience into words can open up new understandings and possibilities.
  3. Extending empathy allows the speaker to confide. Before rushing to speak or resolve an issue, pause. This isn’t easy. Most of us have a natural tendency to relieve the suffering of another by responding quickly, but this can shut off or interrupt feelings just at the moment they need to be expressed.
  4. Allow the speaker to name his or her fear; this is the first step toward mastering that fear. Mastery can bring relief, even if only temporarily.
  5. We are human. While we cannot directly experience the life of another, we can do so indirectly through the quality of our empathy.

Listening deeply and responding with empathy brings us as close as we can get to forms of suffering that we have not experienced ourselves. With a rare cancer such as mesothelioma, vicarious experience is limited, but real.

Richard McQuellon, PhD, is professor in the Department of Medicine, Section of Hematology and Oncology and Director of the Psychosocial Oncology and Cancer Patient Support Programs at Wake Forest Baptist Medical Center. He received a BS in Psychology from the University of Washington, Ph.D. in Counseling Psychology from Michigan State University and has over 20 years of clinical experience working with cancer patients and their families. His clinical work involves survivorship planning from diagnosis though end of life and the psychosocial care of patients undergoing extreme cancer treatments including stem cell transplantation. He has served on the editorial boards of the Journal of Clinical Oncology and Bone Marrow Transplantation and has published over 125 abstracts, journal articles and textbook chapters. He is currently on the editorial board of the Journal of Hospice and Palliative Medicine.