Being Open While Avoiding Talk about Lung Cancer
This study examines how people cope with a family member having lung cancer. Although experts and people who have experienced this situation generally recommend “being open and honest” about the situation, new evidence suggests that even families who cope relatively well do not always follow that advice.
Knowing how people cope with deaths due to lung cancer is important, in part, because it is a challenge that many families face. Every year, approximately 1.4 million people worldwide die from lung cancer. There is a lot of medical information available about the causes, diagnosis, and treatment of lung cancer, but much less about how to best cope with a family member having lung cancer.
Generally speaking, scholars and medical authorities suggest that patients and caregivers do best if they get their thoughts and feelings about cancer out in the open. Nevertheless, sometimes families avoid rather than engage in communication, and avoiding is not always bad for relationships. For example, one study showed that breast cancer survivors tended to be happy with their marriages even when they avoided a lot—so long as they thought their partner was receptive to talking. Given the evidence that sometimes avoidance is okay when families cope with cancer, we were interested in understanding whether avoiding communication played a role after a lung cancer diagnosis.
We interviewed 29 adults who had lost a parent to lung cancer. We asked them to tell us about their communication with their ill parent and other family members after the diagnosis. Results revealed several important findings regarding family communication.
First, some of the participants initially said that their family was completely open about everything, but when they thought about specific topics, most of them mentioned things their family avoided. Across all the specific topics that families avoided, there were two general types of avoidance: informational and emotional. Informational avoidanceinvolved fact-based topics, such as the ill parent’s prognosis, decisions about treatments, or the logistics of their parent’s inevitable death. For example, some families did not mention the terminal nature of their parents’ cancer until hospice nurses came to the house; others changed the subject whenever their ill parent attempted to discuss end-of-life issues. Emotional avoidance refers to feelings-based topics, such as frank discussions about the ill parent’s thoughts and fears or the adult child’s feelings about his/her parent.
Second, the participants in our study noted several different reasons why they and other family members avoided. Usually, they thought the avoidance was intended to help themselves or other family members effectively cope with the lung cancer diagnosis. For instance, one reason adult children avoided communicating about their parents’ lung cancer was to maintain hope and optimism. Many of the adult children we interviewed thought it was important to stay hopeful, even in the face of a terminal prognosis. In addition, some adult children avoided communication for protective reasons. They often wanted to protect others, including their ill parent or siblings, from becoming upset or hearing undesirable news. Several participants avoided discussing the lung cancer diagnosis with their ill parent because the ill parent was embarrassed that the illness was “self-inflicted” through years of smoking. Adult children also avoided discussing certain topics because being open about these issues was not considered “good” communication within their family. For instance, some participants noted that prior to the lung cancer diagnosis talking openly about emotions was not considered a constructive behavior within their family. Thus, these families tended to uphold their family’s standard and continued to avoid emotional expressions, even after the lung cancer diagnosis. Finally, some participants reported that they did not have the ability or skills to competently talk about certain topics. For instance, one participant did not think she could talk about her fears with her ill mother without breaking down into tears.
Third, adult children avoided in different ways. One strategy, segmentation, allowed participants to talk openly about some issues, while refraining from discussions regarding other issues. Many of our participants, for example, noted that they could talk to their parents about informational topics, such as treatment decisions, but they could not engage in emotional discussions, such as telling other family members they were afraid of losing their parent. Other participants used denial, a strategy that allowed them to avoid talking about informational and/or emotional issues by changing the topic or ignoring their parents’ or other family members’ desire for openness. A final strategy involvedbeing open while avoiding, which refers to situations in which people reported on topics they and other family members avoided while simultaneously believing that their family was completely open. When asked, some participants claimed their family was completely open, yet they would go on to report several issues their family did not discuss.
Although our study did not explicitly examine the link between avoiding communication and successful coping, participants’ responses suggested that certain ways of avoiding communication may be more satisfying than others. Despite the fact that avoidance can be beneficial to relationships, most participants noted that open communication was the key to coping with an illness. As a result, participants seemed to prefer avoidance that was subtle, allowing them to engage in avoidance without undermining their relational goal of having an open and satisfying relationship. Thus, a strategy like being open while avoiding, which does not draw attention to avoidance, allowed individuals to engage in avoidance, while simultaneously cultivating relatively satisfying family relationships. Conversely, the strategy of denial involves obvious avoidance of a topic that anyone can recognize as such. Not surprisingly, people who reported denial in their family generally seemed dissatisfied with their family’s communication.
In sum, cancer is not an individual illness, but a family one. Our study sheds light onto the consequences of a cancer diagnosis on the family system. Anyone who has experienced cancer within their family knows firsthand that cancer raises numerous questions, including how to talk about sensitive and undesirable news, such as the patient’s prognosis and the subsequent emotional ramifications. Despite the widespread ideology that complete openness is the hallmark of “good” family communication, our results suggest that avoidance can also be considered “good” communication in some situations. In fact, avoidance strategies that are aimed at good intentions, such as protecting others or maintaining hope, can be valuable so long as they do not undermine a family’s sense that they are generally open and can talk about topics if they need to. In other words, sometimes not talking about the issue may be just what the doctor ordered.