Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre

Abstract

Purpose

Most people are familiar with the expression ‘laughter is the best medicine’. By enhancing cognitive flexibility and strengthening relationships, laughter can be considered a holistic care-approach. Yet, in medical oncology, especially the palliative phase, using humour can be considered inappropriate or taboo. We aimed to explore the acceptability and functions of humour and laughter in patients with prolonged incurable cancer.

Methods

This study was performed in a Dutch Comprehensive Cancer Centre. We included four short conversations with patients, eighteen in-depth patient-interviews and eleven observational fieldnotes in which humour was a major topic of the conversation. We further administered an online questionnaire to thirty-three oncology clinicians about their experiences with humour. Qualitative data were thematically analysed. We specifically distinguished between humour and laughter.

Results

Nearly all specialists reported using humour (97%), and all reported sometimes laughing during consultations; 83% experienced a positive effect of laughter. These results were in line with patients’ experiences: Patients noted that humour always stayed alive despite medical difficulties. Apart from this human aspect, patients also used humour to broach difficult topics and downplay challenges. Patients and specialists acknowledged that using humour is sometimes inappropriate, partly because they did not always share the same humour. Laughter, in contrast, was regarded as ‘lighter’ than humour, and could, accordingly, more easily be implemented. Specialists cautioned against patients using laughter to avoid broaching difficult topics.

Conclusion

Many conversations were full of laughter. Hierarchy as usually experienced between healthcare professionals and patients/relatives seemed to disappear when using laughter. If applied appropriately, adding shared laughter may help optimize shared decision-making.

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Acknowledgements

The authors first of all gratefully acknowledge all patients and relatives for their participation and openness during the conversations and in-depth interviews. They further would like to thank Dr. S. Doosjes for his helpful comments. Moreover, the authors would like to thank M. Verheul for transcribing part of the conversations. Finally, they would like to thank all nurses at the day-care unit who have been of great assistance.

Funding

This work was supported by an unrestricted grant of Janssen and a grant from Ars Donandi.

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Affiliations

Authors

Contributions

HMB designed the study. HMB carried out the study. HMB, RdB, LB, JWM, and MWM were involved in the interpretation of the study findings. HMB wrote the manuscript which was critically read by all the authors. HMB is guarantor of the study. All authors had full access to all the data in the study and can take responsibility for their integrity and the accuracy of their analysis.

Corresponding author

Correspondence to Hilde M. Buiting.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The study did not require review by a medical ethical committee because the observations and short talks were not considered to be possibly incriminating for patients/relatives.

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Appendix

Appendix

See Table 3

Table 3 Framework humour

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Buiting, H.M., de Bree, R., Brom, L. et al. Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre. Qual Life Res 29, 2425–2434 (2020). https://doi.org/10.1007/s11136-020-02490-w

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Keywords

  • Humour
  • Shared decision-making
  • Oncology
  • Palliative care