Someone you care about is coping with a chronic or terminal diagnosis

Questions and strategies to help you have a supportive conversation when someone you care about is coping with a chronic or terminal diagnosis.

This is one of a series of topics in the Supportive conversation library. Review the guidelines including what to do if you are concerned for another’s safety before engaging in the conversation.

What do you notice?

You notice someone you care about is finding it hard to navigate a chronic or terminal diagnosis. Maybe they withdraw from life and their regular activities. They might express feelings of guilt over past decisions they think contributed to the onset of the diagnosis. Maybe they’re grappling with reasons for why they got sick or injured. They might appear overwhelmed by thinking about their and their loved ones’ future. You might also notice them feeling hopeless or even in denial about the chronic or terminal diagnosis.

What do you need to understand?

Chronic or terminal illness or injuries typically come without warning. Unexpected events are upsetting as they drastically change our plans for life. Individuals often go through a drastic transition as they come to terms with their mortality and adjust to a new way of functioning either physically or mentally. Imagine if your life were turned upside down and you were asked to reconsider how you would navigate life with reduced abilities and prospects for the future. A chronic or terminal diagnosis means someone will have additional stress as they navigate their new circumstances and grieve their old life and health. Go here for more information about having a supportive conversation with someone who’s grieving.

What do you need to consider?

When someone has a chronic or terminal diagnosis, the condition often takes centre stage in their life. This means they no longer feel others know them as they were before, but as the condition that’s affected them. Those with chronic or terminal conditions also exhibit intense unregulated emotions at times as they process the massive changes and losses in their life – this is a normal response to potentially life-changing events. These intense emotions can be overwhelming and make it hard for that individual to function every day. Be sure to check in frequently with someone who’s navigating these types of changes in their life as it can be a confusing time.

Engaging in a supportive conversation

Have the right mindset

Come into the conversation from a supportive place. Watch out for your hidden agenda, such as wanting to fix or influence the individual. Avoid “you” statements, such as “you always do…”. They often make the person feel judged or invalidated. Be curious and have the mindset that you don’t know anything about their experiences.

Questions to check your mindset:

  • What are my assumptions about this situation?
  • How will I keep my assumptions out of the conversation and be supportive?
  • What do I hope to achieve by having this conversation?
  • How can I keep my desires for an outcome from interfering with my ability to be supportive?

Notice

Notice changes in behaviour that aren’t typical for the person and ask about them. Don’t add your assumptions or opinions about why those changes may be happening. If you’re wrong, the person may be discouraged from continuing the conversation.

Examples of “noticing” conversation starters:

  • “How are you feeling today?”
  • “I noticed that in conversation you’re questioning decisions made prior to your diagnosis. Did you want to share your concerns with me?”
  • “I’ve heard you say you’re feeling tremendous stress thinking about you and your loved ones’ future with this diagnosis. Can you tell me how you’re feeling?”

Preparing for the response

Not all supportive conversations lead to an understanding of how you can help. Remember, the goal of a supportive conversation is to understand the individual’s needs and wants and whether they’re open to assistance. The guidelines below can help prepare you to respond when the person is open or not to a discussion.

When the individual doesn’t appear open to discussion – a closed-door response:

Not everyone’s comfortable being asked how they feel or exploring reasons why they’re behaving differently. You might get avoidant responses, like “I’m fine” or “It’s none of your business.” If this is the case, you can reiterate your concern and leave an opening for them to walk into when they’re ready.

  • “I was concerned about you and wanted to ask. If you say you’re okay, I’ll trust you. If that changes, I’m here to support you if you need me.”

If the supportive conversation ends here, you should feel good that you noticed and asked about their well-being. Try not to take the response or tone personally despite the conversation not going anywhere. It takes courage to initiate these types of conversations, and it’s not your responsibility to force another to notice or change their behaviour.

When the individual appears to be open to discussion – an open-door response:

If the person confirms they feel differently or that life circumstances have changed for them, you’ve opened the door to having a supportive conversation.

The next statement might be:

  • “Tell me more. I want to better understand what you’re going through.”

Continue to follow the guidelines below for having a supportive conversation.

Continuing the conversation

Listen

Listen for where the individual feels unsupported or doesn’t have their needs met. When they’re finished speaking, confirm what you heard by rephrasing it and asking if you understand it correctly.

Examples of “listening” in the conversation include:

  • “I’m hearing that you feel hopeless and it’s hard to participate in your regular activities.”
  • “You’ve shared that you’re asking a lot of questions about certain life decisions prior to your diagnosis. Is that what I’m hearing?”
  • “I’m hearing that you’re feeling a lot of stress from all the changes you have to make in because of the diagnosis. Is that right?”

Highlight strengths

Highlight strengths you see in the person. Some examples could be courage or persistence in dealing with the situation they just shared with you.

Here’s an examples of “calling out strengths” in the conversation:

  • “Thank you for sharing your concerns and worries. This takes courage. It’s understandable to have the concerns that you have. It’s a lot to process.”

Identify

Identify what support the individual wants and connect them with relevant resources. Don’t insist on support or resources they don’t want or aren’t ready to accept.

Examples of “identifying support” in the conversation include:

  • “You’ve identified the need to address the additional stressors [questioning thoughts, thoughts about the future, feeling a sense of hopelessness] that you have in life, so how can I best support you at this time?”*
  • “I can support you with finding resources that might help to address this – would that help?”

*Note: If there’s a limit on how you can be supportive, be specific about how you can help. The offer of support needs to be realistic and in line with your own abilities and available time. Otherwise, talk about what’s realistic for both of you to do to create change in the other’s life.

Create

Create an action plan with the individual to leverage their strengths and follow up on a regular basis, adding additional resources when they’re ready. Give a clear timeline or understanding of how you’ll be supportive.

Here’s an example of “creating an action plan” in the conversation:

  • “I’m so glad we had this conversation. You mentioned a few things you wanted to address as soon as possible. I’ll follow through with my offer of support in the next week.”

Thank you for being supportive! You’ve taken the time to learn to have a conversation that lets your loved one or friend know you notice and care about them. By showing concern, you can help them evaluate whether they should continue as is or address certain elements in their life. For some, this may be the beginning of a journey that will require the assistance of additional support services or professionals.

Additional resources

To be an effective supporter, it’s helpful to understand more of what your family member or friend’s experiencing. Check out these resources to provide more context about their experiences: