Have bad news for your patients? Mind your metaphors.

First, the cancer diagnosis. Then, the barrage of trite encouragements: You can beat this! Don’t give up. Keep fighting! It’s not only friends and family members who utter these clichés — usually at a loss of what else to say. Health care providers also attempt to bolster patients’ morale with well-intentioned but well-worn phrases too. Unfortunately, these sentiments frequently fail to have the intended effect. Instead of conveying comfort and support, they can leave patients feeling even more isolated and misunderstood.

Emily McDowell, a cancer survivor herself, created a humorous assortment of greeting cards that help shed light on this. During her treatment, the oncologist used to tell her, “It’s a marathon, not a sprint.” Afterward, she designed a card that reads, “When people say, ‘It’s a marathon, not a sprint,’ I don’t think they get how much you hate running.” Even though the metaphor makes sense, the card poignantly reveals a deeper truth — the fact that “either way, having to run totally sucks.” The direct acknowledgment of this is what resonates with patients, helping them feel not only loved and supported but also seen and understood.

Continually learning how to better cultivate and express empathy is important, but the significance of the metaphors we use also goes beyond this. In a research paper examining two metaphors that are commonly invoked to describe the experience of having cancer, cognitive scientists Dr. Hendricks and Dr. Boroditsky assert that not only is the use of metaphor associated with affecting physical health and decision-making, it may also play a role in influencing patients’ emotional state.

Perhaps the most ubiquitous metaphor that patients with cancer encounter repeatedly is that of the battle. For example, health care providers explain that chemotherapy is attacking the cancer cells. Meanwhile, loved ones do their best to reassure the patient that they won’t have to fight the battle alone. Unfortunately, the practically inescapable battle metaphor has several significant downfalls. For one thing, it implies that if the patient just fights hard enough, they can win. Along the same lines, it can be interpreted to “imply the importance of treatment at all costs.” Furthermore, some suggest that the battle metaphor encourages patients to put on a brave face and suppress natural negative emotions. Despite these problematic aspects of the battle metaphor, some patients still find it to be helpful. Others prefer an alternative way of framing their experience.

Another common metaphor used to describe the experience of having cancer is that of the journey. Some find this metaphor to be more beneficial because instead of the implied oversimplified dichotomy of winning or losing, it suggests that there are a “variety of possibilities.” Dr. Hendricks and Dr. Boroditsky’s research reveals that people who read about an individual’s experience with cancer described in terms of a journey are more likely to agree with the statement that the patient can make peace with their circumstances compared to those who read about the same scenario described in terms of a battle. Another helpful attribute of the journey metaphor is that it places the diagnosis and experience of having cancer in a larger context — it’s “just one part of a larger narrative.”

However, despite these seemingly positive aspects, the journey metaphor doesn’t resonate with everyone. Another one of McDowell’s Empathy Cards states, “I promise never to refer to your illness as a ‘journey.’ Unless someone takes you on a cruise.” While acknowledging that ultimately it’s up to each individual to decide how they conceptualize their own experience, McDowell simultaneously holds space for the complexity of how different patients may hear the journey metaphor. She writes, “if right now it doesn’t feel like a journey, or maybe it feels like a journey to hell, that is totally OK.”

All metaphors have shortcomings, but they are still helpful communication tools. Patients rate health care providers who use more metaphors as being easier to understand. In order to employ metaphors even more effectively though, it helps to be aware of the fact that any metaphor can be used in either an empowering or disempowering way. Ideally, giving patients the option of choosing from a variety of metaphors empowers them with the freedom to decide what resonates most. In turn, contextualizing their own experience in a way that makes sense to them can help improve a patient’s ability to cope with a very difficult situation. We are only beginning to understand the extent to which metaphors matter, but patients would benefit from their health care providers taking these new discoveries and perspectives into account sooner rather than later.

Shannon Casey is a physician assistant.

Image credit: Shutterstock.com

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