“Tough Love”? Creating a Safe Emotional Space in Cancer Rehab 

Recently, I evaluated a new patient who’s coming in to see me about her stubborn lymphedema.  During our initial interview, this patient mentioned how frustrated & saddened she was since her previous therapist told her she could never get her nails done ever again.

For this patient, this news was devastating on top of already knowing that lymphedema is a chronic condition.  

I firmly believe there is a need for transparency & honesty in our patient care.  There is a time & place for telling hard truths in cancer rehab.  

But there is also a tremendous need for kindness & compassion in cancer rehab.  Cancer is taxing in every realm of a patient’s existence; the last thing they need is for their rehab professional to be cruel in the name of blunt honesty or “just telling it like it is.”

When I trained at my CLT program, we learned that nail salons are basically walk-in cellulitis appointments.  But after practicing for a few months, I realized just how many of my patients got their nails done because it was the one link they had to their femininity, their old selves.  Who am I to take that away from them?

So today, I always discuss nail care & safety with each of my patients, including how to ensure their nail technician is using clean equipment, things to avoid in the nail salon, & all about cellulitis signs & symptoms, appropriate management, & more.

While some therapists would say I’ve gone soft, this is in fact a more compassionate & patient-centered approach to my care.  It doesn’t mean I’m slacking off with my patients – in fact, I’m probably more of a stickler on certain things like exercise prescription, dosing, & intensity than I used to be – but I’m trying to focus more on big picture, what’s truly best for my patients in the long-term.

And if that means getting your nails done, then I’m fine with that.

As a cancer rehab physical therapist, it’s essential to maintain a compassionate and patient-centered approach while still ensuring the best care for your clients. Here are five things to consider softening your stance on or being less rigid about:

Emotional Expression

Dealing with cancer is not only physically challenging but emotionally taxing as well. Patients may experience a range of emotions, including fear, anxiety, frustration, and sadness. Encouraging emotional expression during therapy sessions creates a safe space for patients to share their feelings and concerns. 

As a cancer rehab professional, actively listening and validating your patients’ emotions can be therapeutic in itself, helping to reduce stress and improve overall well-being. Acknowledging their emotional struggles can also foster trust and strengthen the therapist-patient relationship, which is crucial for effective rehabilitation.

This may mean telling patients outright this is a safe space to cry, say 4- & 5-letter words, or whatever that looks like for y’all.

Likewise, this emotional expression may also be needed from YOU.  No patient likes a robot therapist, especially when they are physically &/or emotionally vulnerable with you.  

Treatment Goals

Cancer treatment can be unpredictable, and your patient’s response to therapy can vary. Being open to adjusting treatment goals based on your patient’s changing needs and progress is essential. Some patients may experience setbacks or delays due to treatment side effects or other factors. 

By setting realistic short-term goals that are achievable, your patients can experience a sense of accomplishment, which boosts motivation and adherence to the rehabilitation program. Additionally, revisiting and revising goals periodically helps track progress and adapt the treatment plan accordingly.

Not only should your treatment goals be feasible & achievable, they should also be PERTINENT to your patient.  Having explicit conversations with your patients about why they’re doing “x” exercise & how it ties into improved ability to do “y” is critical in cancer rehab.  While you as the therapist have a big picture in mind, your patients don’t have that same insight.  Share the plan, share the process, find common ground to make sure you’re both working towards the ultimate goal.  

Personal Preferences

Taking into account your patient’s personal preferences when designing exercise routines can significantly impact their engagement and compliance with the program. For example, some individuals might prefer outdoor activities like walking or hiking, while others may enjoy more structured exercises in a gym setting. 

One of my go-to home programs for patients is a graded walking program (download your copy here).  It’s relatively simple for patients to incorporate into their daily routines, even during the throes of cancer treatment.  However, not everybody likes walking.  

So what we’ll do is take the principles of the walking program (frequency, intensity, duration, gradual progression, etc.) & marry them to an activity the patient will actually participate in, such as biking.

Tailoring the program to align with their interests and preferences makes the therapy sessions more enjoyable, increasing the likelihood of sustained participation and better outcomes. 

It also shows your patient that their therapist respects their autonomy and preferences in their cancer rehab journey.

Accommodating Bad Days

Cancer treatment often comes with a rollercoaster of good and bad days. On bad days, the patient may be dealing with intense side effects, fatigue, or emotional distress, making it challenging to engage fully in therapy. During such times, it’s crucial for you to demonstrate empathy and support, letting your patient know that it’s okay to take it easy when needed. 

Offering encouragement and understanding instead of pushing your patient too hard can prevent feelings of guilt or failure, and it shows that you prioritize your patient’s well-being above all else.

Lifestyle Adjustments

After a cancer diagnosis, some patients may feel overwhelmed by the prospect of making significant lifestyle changes to improve their health. As a cancer rehab pro, it’s essential to offer guidance on lifestyle adjustments with a patient-centered and realistic approach. 

Rather than imposing drastic changes, encourage gradual and sustainable modifications that align with the patient’s capabilities and preferences. This might involve providing advice on incorporating healthy habits like regular physical activity, balanced nutrition, and stress management techniques into their daily routine. Supporting the patient throughout their efforts to adopt a healthier lifestyle can positively influence their physical and emotional recovery.

For example: I previously worked with a patient with metastatic breast cancer.  Due to her diagnosis, she experienced a lot of pain, leading to a lot of sedentary time.  After nearly 3 months together, she was finally walking independently around her apartment complex in the mornings.  This was incredible progress from the frightened, anxious, & in-pain woman I started working with.  

Offer guidance on lifestyle adjustments but be mindful not to impose drastic changes that might overwhelm the patient. Encourage gradual and sustainable changes.

Compassion & kindness are not the same as “going soft.”

Remember, being compassionate and understanding can positively impact your patient’s mental and emotional well-being, which can play a significant role in their overall recovery and rehabilitation journey.

Recall the patient I mentioned previously: metastatic breast cancer, cancer-related pain leading to lots of sedentary time, months of working together to get her walking independently around her apartment complex, starting to finally feel some semblance of confidence…

This is where we were at when I went on a weekend getaway, & a substitute therapist came to cover my patients.  By the time I came back, my patient had canceled her therapy sessions, swore to never return, & had stopped walking altogether.

In the 1-2 visits my patient had with this therapist, this sub therapist tore into my patient about how she was always going to be fat, how her lymphedema & cancer were because she was fat, & that walking was not going to do anything to help her.  

In 1-2 visits, all my patient’s progress was ripped away & belittled to nothing.  And it took the remaining 4 weeks I was at that job to build my patient back to even being interested in walking around her apartment complex again.

This happened several years ago, & it still upsets me to this day.  But I believe it truly demonstrates my point today: there is a time & place for telling hard truths in cancer rehab.  But there is also a tremendous need for kindness & compassion in cancer rehab.  

By approaching each patient, each visit with intentional kindness & compassion, you can create a more supportive and compassionate environment, fostering an enhanced sense of trust, motivation, and overall well-being for their patients.

Until next time, this is Elise with TheOncoPT. And remember: you are exactly the physical therapist that your patients with cancer need. So let’s get to work.

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