Hard times

A friend or family member has a serious diagnosis

Someone you love has just told you they have cancer or another serious illness. They're frightened, and you're desperate to say something that helps. What helps most is letting them lead.

What they need from you, and why

A serious diagnosis takes away more than health. The Illness & Health Challenges module describes a kind of grief for the plans and the sense of safety the person had before, and the strain of not knowing what comes next. The feelings come in waves and double back: shock, anger, a search for options, sometimes all in the same afternoon.

What they need from you is to be allowed to lead: how much they want to talk about the medical side, how they want to cope, what they want to decide. They need their fear acknowledged before anyone tries to brighten it, and specific help rather than vague offers that put the work back on them.

When Gayle Dakof and Shelley Taylor asked 55 people with cancer which responses had helped and which hadn't, minimising, forced cheerfulness, being told not to worry and being avoided were among the unhelpful ones. Peter Maguire's 1996 study of cancer consultations found that early advice and reassurance shut patients down, while open questions and empathic comments helped them say what was worrying them. And in 2002, Mark Petticrew and colleagues reviewed 26 studies and found most showed no significant link between "fighting spirit" and survival, so nobody should be pressed to stay positive as if their life depended on it.

Understand it properly

First

Take three slow breaths before you respond, and let the urge to reassure them pass.

You could say

I'm so sorry. That's a lot to take in.
It meets the news without rushing past it, which is what early reassurance does.
It makes complete sense that you'd be scared.
Validation before positivity: their fear is reasonable, and saying so lets them admit to it.
How much do you want to talk about the medical side, and how much about everything else?
It lets them set the depth, which is the first principle of supporting someone who is ill.
I'm hoping for the best with you, and I'll be here whatever happens.
Real hope that doesn't promise an outcome, so they don't have to perform optimism for you.
I'm free Saturday morning. I can drive you to the appointment or do the shopping, whichever helps.
A specific offer doesn't ask them to think of something, or to feel like a burden.
I'll ring on Thursday to hear how it went.
It promises continuing contact, which is exactly what people who avoid them fail to give.

If it goes badly

Three ways this can turn. Read the one that happens; the others can wait.

You've said something like

I'm so sorry. That's a lot to take in.

If they get angry, maybe at you
You've every right to be angry. I can take it.
Anger is a normal response to an unfair diagnosis and may land on the nearest safe person; don't try to calm it away.
If they don't want to talk about it at all
Then let's not. Want to watch something, or go for a walk?
Following their lead includes their silence; ordinary company is support too.
If they ask you whether they'll be okay
I don't know, and I'm not going to pretend I do. Whatever happens, you won't be doing it alone.
Honest connection beats forced optimism, and the promise you can keep is presence.

Send them to yourself, or to someone helping you.

Try not to say

"You'll beat this. Just stay positive."
A 2002 review found most studies showed no link between fighting spirit and survival, and the pressure leaves people alone with their fear.
"My aunt had the same thing and it was nothing."
Early reassurance closes the conversation before they've said what's worrying them.
Unsolicited medical advice or miracle cures
It says you know better than their doctors, when what they need from you is a friend.
Staying away because you don't know what to say
People with cancer have described being avoided as one of the most hurtful responses.

Afterwards

Keep turning up. People with serious illnesses describe being avoided as one of the most hurtful responses, and it usually happens because friends don't know what to say. Ask about their whole life, not just the illness, and keep including them in plans even if they say no. Make a note of appointment dates and ask how they went. If they have a partner or carer, ask how that person is doing too; carers are often overlooked and carry their own fear.

Understand it properly

The words above come from these. A section is about ten minutes; the whole module is there when you have longer.

Where this comes from

Deeper Dialogues, Illness & Health Challenges: what people with cancer found unhelpful (Dakof & Taylor, 1990), early reassurance (Maguire et al., 1996), and specific offers of help
Deeper Dialogues, Emotional Intelligence in Conversation: validation first, the HEART method, and staying steady when someone cries

We gather and pass on what researchers and support organisations have found. This isn't a replacement for a doctor, counsellor or support service.

What they need from you, and why

You could say

If it goes badly

Share these words

Try not to say

Afterwards

Understand it properly