Skip to main content

Advertisement

Log in

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

  • Published:
Quality of Life Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Levi, M. (2017). Generalism in modern subspecializing medicine. European Journal of Internal Medicine., 39, 36–38.

    Article  Google Scholar 

  2. Smit, E. F., Wu, Y. L., Gervais, R., et al. (2016). A randomized, double-blind, phase III study comparing two doses of erlotinib for second-line treatment of current smokers with advanced non-small-cell lung cancer (CurrentS). Lung Cancer., 99, 94–101.

    Article  Google Scholar 

  3. Temel, J.S., Gainor, J.F., Sullivan, R.J., Greer, J.A., (2018). Keeping expectations in check with immune checkpoint inhibitors. Journal of Clinical Oncology,Jco2017762146.

  4. Berrino, F., De Angelis, R., Sant, M., et al. (2007). Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study. The lancet Oncology, 8(9), 773–783.

    Article  Google Scholar 

  5. Aaronson, N. K., Mattioli, V., Minton, O., et al. (2014). Beyond treatment—Psychosocial and behavioural issues in cancer survivorship research and practice. EJC supplements : EJC : Official Journal of EORTC, European Organization for Research and Treatment of Cancer [et al. ], 12(1), 54–64.

    Google Scholar 

  6. Stouthard, J., Brom, L., & Buiting, H. M. (2017). Having a conversation with a patient with incurable cancer-just another protocol? JAMA Oncology. https://doi.org/10.1001/jamaoncol.2016.6776.

    Article  PubMed  Google Scholar 

  7. Penson, R. T., Partridge, R. A., Rudd, P., et al. (2005). Laughter: the best medicine? The Oncologist, 10(8), 651–660.

    Article  Google Scholar 

  8. Camus, A. C. (1941). http://www.mon-poeme.fr/citations-rires/. Accessed 2 Apr 2020.

  9. Berk, R. A. (2001). The active ingredients in humor: Psychophysiological benefits and risks for older adults. Educational Gerontology., 27(3–4), 323–339.

    Article  Google Scholar 

  10. Roter, D. L., Yost, K. J., O'Byrne, T., et al. (2016). Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits. Patient Education and Counseling, 99(9), 1519–1525.

    Article  Google Scholar 

  11. Martin, R. (2007). The psychology of humour: An integrative approach. Elsevier.

  12. Candidata, L. (2018). Hooked on humour: Achieving rapport in humorous interactions between men and women who are friends. Western Sydney University Thesis Collection.

  13. Kamath, S. D. (2019). Laughter in oncology is more common than you think. Journal of Clinical Oncology, 37(7), 610–611.

    Article  Google Scholar 

  14. Meyer, J. (2000). Humour as a double-edged sword: Four functions of humour in the communication. Communication theory., 3, 310–331.

    Article  Google Scholar 

  15. Beach, W. A., & Prickett, E. (2017). Laughter, humor, and cancer: Delicate moments and poignant interactional circumstances. Health communication, 32(7), 791–802.

    Article  Google Scholar 

  16. Pinna, M. A. C., Mahtani-Chugani, V., Sanchez Correas, M. A., & Sanz, R. A. (2018). The use of humor in palliative care: A systematic literature review. The American Journal of Hospice & Palliative Medicine Care, 35(10), 1342–1354.

    Article  Google Scholar 

  17. Claxton-Oldfield, S., & Bhatt, A. (2017). Is there a place for humor in hospice palliative care? volunteers say "Yes"! The American Journal of Hospice & Palliative Medicine Care, 34(5), 417–422.

    Article  Google Scholar 

  18. The, A. M., Hak, T., Koeter, G., & van Der Wal, G. (2000). Collusion in doctor-patient communication about imminent death: An ethnographic study. BMJ (Clinical research ed)., 321(7273), 1376–1381.

    Article  CAS  Google Scholar 

  19. Livingstone, J. (2012). Improvising medicine. An African oncology ward in an emerging cancer epidemic. Durham: Duke University Press Books, Duke University.

    Book  Google Scholar 

  20. Buiting, H. M., van Ark, M. A. C., Dethmers, O., Maats, E. P. E., Stoker, J. A., & Sonke, G. S. (2019). Complex challenges for patients with protracted incurable cancer: an ethnographic study in a comprehensive cancer centre in the Netherlands. British Medical Journal Open, 9(3), e024450.

    Google Scholar 

  21. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.

    Article  Google Scholar 

  22. Olsson, H., Backe, H., Sorensen, S., & Kock, M. (2002). The essence of humour and its effects and functions: A qualitative study. Journal of nursing management, 10(1), 21–26.

    Article  Google Scholar 

  23. Schopf, A. C., Martin, G. S., & Keating, M. A. (2017). Humor as a communication strategy in provider-patient communication in a chronic care setting. Qualitative Health Research , 27(3), 374–390. https://doi.org/10.1177/1049732315620773.

    Article  PubMed  Google Scholar 

  24. White, S., & Winzelberg, A. (1992). Laughter and stress. Humor., 5, 343–355.

    Article  Google Scholar 

  25. Oczkowski, S. (2015). Virtuous laughter: We should teach medical learners the art of humor. Critical care (London, England)., 19, 222.

    Article  Google Scholar 

  26. Brands S. (2016) Take care: Clinical futile care. Exploring the role of risk, hope and relationships in the decision-making of terminally ill patients. Amsterdam: Medical Anthropology, University of Amsterdam.

  27. Sonntag, S. (1978). Illness as a metaphor and AIDS and its metaphors. London: Penguin Books.

    Google Scholar 

  28. Hardy, C. (2019). Humor and sympathy in medical practice. Medicine, Health Care and Philosophy. https://doi.org/10.1007/s11019-019-09928-0.

    Article  Google Scholar 

  29. Haakana, M. (2010). Laughter and smiling: Notes on co-occurrences. Journal of Pragmatics, 42(6), 1499–1512.

    Article  Google Scholar 

  30. Gramling, D., & Gramling, R. (2012). Laughing at the dark: Tactical humor for autonomous decision making in serious illness. Journal of Palliative Medicine, 15(11), 1170–1172.

    Article  Google Scholar 

  31. Steinbrook, R., & Redberg, R. F. (2017). Sharing medicine-A JAMA internal medicine series. JAMA Internal Medicine, 177(9), 1256.

    Article  Google Scholar 

  32. Epstein, R. M., & Street, R. L., Jr. (2011). Shared mind: Communication, decision making, and autonomy in serious illness. The Annals of Family Medicine, 9(5), 454–461.

    Article  Google Scholar 

Download references

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.

Author information

Authors and 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.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Table 3

Table 3 Framework humour

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02490-w

Keywords

Navigation