Receiving a cancer diagnosis and going through treatment can have unexpected twists and turns. For some, it can be difficult to talk about hard information especially during times of transition, such as during an initial diagnosis or when treatment does not go as planned.

Planning how to approach a difficult discussion can help with feelings of dread or worry.

Start by reflecting on why the conversation will be difficult. It is normal if there is more than one reason why discussing a certain topic feels challenging.

Potential reasons include:

• Upsetting the person with your news and/or fear of their emotional reaction

• Disappointing someone with your choice(s)

• Being afraid of any emotionally-charged questions you may be asked

• Discussing the topic makes it feel more “real” for you

• Discussing the topic drains you emotionally

• Having an emotionally complex relationship with the person

• Feeling that you may need to emotionally care for the person’s reaction once you share

There are several techniques to assist you in having these hard conversations.

Starting the Conversation

It can feel daunting and emotional to start a difficult conversation. While there is no “right way” to approach these discussions, a thoughtful opening statement can help.

Examples of the types of opening statements:

• “I want to share some important information about my cancer. When can we set up a time to meet this week?”

• “I’d like to share something with you that makes me feel vulnerable.”

• “I don’t mean to take you by surprise, but I have some important information to share with you.”

Disclosure

Consider what information you know, what information you want to discuss with the person, and when and why you want to discuss it. This can help you decide how much you would like to share at a given time.

Boundaries

For some people boundaries can project the idea of taking a hardline “all or nothing” approach. Boundaries are a method of self-care and can also be subtle and provide a place to find control in your situation. As you reflect on what and how much you want to communicate to certain people in your life, these choices can help to establish potential needed boundaries.

If being asked further questions about the treatment plan, why your doctor made the recommendations they made, or your other treatment decisions feels overwhelming to discuss, be upfront when these topics are not what you want to discuss at this time.

Examples of setting the tone for the conversation:

• “I want to discuss X and Y, but I’m not yet ready to discuss Z.”

• “I don’t want to focus on the details of treatment or the disease today, I want to discuss how I am feeling.”

• "In this conversation it would be helpful to discuss what I need to get done before the surgery.”

• “There is information about the plan we don’t know at this time, but I’ll tell you what I know.”

• “I want to discuss my treatment options, but I’m not ready to make any decisions.”

• “This is hard for me to talk about, but I’ll discuss what I feel comfortable sharing. Can you hold off on asking any questions today?”

Your support system is often looking for how best to support you. Guidance around what you find most helpful in a conversation is often a welcome way for someone to feel like they are meeting your needs.

Timing

Once you determine what is important to discuss, establish the setting and the amount of time you need. Decide who should be there, if privacy is needed, and/or if face-to-face is best.

If you anticipate the news will be difficult for a loved one to hear, consider having someone else present to help you offer them support. For example, if you would like to share news about your cancer with your elderly parents but are anxious about their concerns, coordinate with your sibling(s) so they can offer support. If they can’t be present, have them schedule a follow-up support call with your parents.

If you need to discuss news of your cancer with a person with whom you have a complex relationship and you know regardless of how much you prepare the conversation will drain you, plan to support yourself after the conversation. Let someone you trust know you will need to lean on them for support following the conversation or plan time alone with an activity you enjoy and that provides you with a mental break.

Self–Reflection

If you are avoiding speaking to a loved one about an aspect of your cancer, it may feel counterintuitive to further reflect on the situation before discussing it with them. For some, the idea of discussing the situation makes it more “real." Exploring supportive techniques related to acceptance can be a helpful place to reflect before you have an important conversation with someone else. To explore acceptance further, see the Iris Article: Acceptance: Reimagining Your Relationship with Control.

While you never have to justify your choices to another person, you often want the people closest to you to understand why you have made certain decisions. Consider what values and goals have led to your decision. It can be helpful for both you and others if you articulate what is most important to you and how your choice reflects your values. While you set the boundaries of what you want to discuss, it is thoughtful to check in to see how the other person is coping with the news.

Support

After sharing the difficult news, expect a question like “How can I support you?” It can be helpful to prepare your answer to this question before having the conversation. If you are uncertain, you can always respond, “Your support by listening to this news is helpful in itself. I will let you know when I need your help.”

For support when speaking with your children or grandchildren, consider resources based on the age of your child and the situation. Ask an Iris mental health therapist for specific resources and support. 

If revealing your initial cancer diagnosis is what you are finding difficult, see Iris Mini: Disclosure as a helpful guide to navigating that first conversation.  

You don’t have to have all the answers when starting these difficult conversations. Preparing for them and setting aside the time needed to have them is a helpful starting place.

Discussing what worries you about having hard conversations can help offer clarity and is an opportunity to think about how you want to approach them. Iris mental health therapists have extensive training in supporting those facing cancer and its various emotional issues. Consider making an appointment to further explore how we can help.