Cancer and the Family: The Silent Words of Truth -- JCO The Art of Oncology series

INCONCLUSIVE THOUGHTS: One of the aims of psycho-oncology is to explore, clarify, and accept different realities that are alluded to in the unspoken words of the family narrative, while also eliciting family stories of survival, adjustment, mutuality, belief, and hope. The psycho-oncologist is trained to understand the language of the patient and family members in their subjective appraisals of health and illness and then to encourage them to share their truths about being understood, heard, supported, and emboldened or discredited and stigmatized.

Learning about culturally sensitive communication and education is a necessary tool to deliver effective cancer care in today's increasingly multiethnic and multicultural societies. Yet, there will be clinical situations, or particular patients and families, where the family traditions will prevail. In such cases, we may try to understand and respect, while never giving up on our medical efforts to help our patients and their families know that there are legitimate alternative ways to interpret cancer and to live with it.

Sima's case, if considered only through the lenses of our Western values, can be seen as a failure of the medical team to educate and communicate the family narrative. Yet, it has awakened awareness and questions in those who cared for her about understanding cultural differences and family dynamics. This task requires reaching a deeper balance of reciprocal responsibility, integrity, commitment, and unquestionable trust in the patient-doctor-family relationship.