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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References
Levi, M. (2017). Generalism in modern subspecializing medicine. European Journal of Internal Medicine., 39, 36–38.
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.
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.
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.
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.
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.
Penson, R. T., Partridge, R. A., Rudd, P., et al. (2005). Laughter: the best medicine? The Oncologist, 10(8), 651–660.
Camus, A. C. (1941). http://www.mon-poeme.fr/citations-rires/. Accessed 2 Apr 2020.
Berk, R. A. (2001). The active ingredients in humor: Psychophysiological benefits and risks for older adults. Educational Gerontology., 27(3–4), 323–339.
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.
Martin, R. (2007). The psychology of humour: An integrative approach. Elsevier.
Candidata, L. (2018). Hooked on humour: Achieving rapport in humorous interactions between men and women who are friends. Western Sydney University Thesis Collection.
Kamath, S. D. (2019). Laughter in oncology is more common than you think. Journal of Clinical Oncology, 37(7), 610–611.
Meyer, J. (2000). Humour as a double-edged sword: Four functions of humour in the communication. Communication theory., 3, 310–331.
Beach, W. A., & Prickett, E. (2017). Laughter, humor, and cancer: Delicate moments and poignant interactional circumstances. Health communication, 32(7), 791–802.
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.
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.
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.
Livingstone, J. (2012). Improvising medicine. An African oncology ward in an emerging cancer epidemic. Durham: Duke University Press Books, Duke University.
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.
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.
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.
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.
White, S., & Winzelberg, A. (1992). Laughter and stress. Humor., 5, 343–355.
Oczkowski, S. (2015). Virtuous laughter: We should teach medical learners the art of humor. Critical care (London, England)., 19, 222.
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.
Sonntag, S. (1978). Illness as a metaphor and AIDS and its metaphors. London: Penguin Books.
Hardy, C. (2019). Humor and sympathy in medical practice. Medicine, Health Care and Philosophy. https://doi.org/10.1007/s11019-019-09928-0.
Haakana, M. (2010). Laughter and smiling: Notes on co-occurrences. Journal of Pragmatics, 42(6), 1499–1512.
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.
Steinbrook, R., & Redberg, R. F. (2017). Sharing medicine-A JAMA internal medicine series. JAMA Internal Medicine, 177(9), 1256.
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.
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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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.
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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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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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DOI: https://doi.org/10.1007/s11136-020-02490-w