Patients' experience of cancer: evidence of the role of 'fighting' in collusive clinical communication.

Clinical communication with patients with cancer should be based on an accurate understanding of psychological responses to cancer, but existing assumptions about these responses may not be accurate. Male and female ambulant patients (N = 30) provided a sample that varied in type, stage and prognosis of cancer. Interviews about their experience of cancer were audio-recorded and analysed qualitatively. The predominant response was a desire to conceal emotional distress, often to protect others including family and clinicians. Patients perceived clinicians as promoting 'fighting' and a 'positive attitude'. However, for patients, these responses meant resisting the expression of emotional distress rather than the disease. By encouragement to 'fight' and 'be positive', clinicians may therefore collude with patients' emotional suppression. For some patients, cancer led to re-evaluation of life; future research should examine whether and how clinical communication influences this form of adjustment.