Using humour in cancer & palliative care

1. Using humour in cancer & palliative care Mr R Becker Senior Lecturer in Palliative Care Staffordshire University Faculty of Health and Severn Hospice Shropshire, UK

3. Aims • To highlight the context of humour in cancer and palliative care • To look at the literature which supports its use • To explore the merits and pitfalls of using humour in a clinical, managerial and educational setting

4. “Life does not cease to be funny when people die, any more than it ceases to be serious when people laugh.” George Bernard Shaw

6. The 5 primary functions of humour • As a coping strategy • Reframing • Communication • Expressing hostility • Constructing identities Kahn WA (1989) Towards a sense of organisational humour: implications for organisational diagnosis and change, Journal of Applied behavioural Science. 25: 45-63

7. The holistic value of humour: - • Stimulates respiration • Stimulates the immune system • Allows the release of emotion • Stimulates the circulation • Fosters hope • Promotes relaxation • It is a positive coping mechanism Pasquali 1993

8. The Physiology of Humour Laughter increases the levels of hormones such as endorphin and decreases levels of stress hormones, cortisol and adrenaline.

9. “It worked! I made the joyous discovery that 10 minutes of genuine belly laughter had an anaesthetic effect and would give me at least 2 hours of pain free sleep.” Cousins N. Anatomy of an Illness. Bantam Books, New York; 1979.

10. Klein A (2000) The Courage to Laugh: Humour, Hope, and Healing in the Face of Death and Dying Pub: Jeremy P Tarcher ISBN-10: 0874779294

12. Humour as an aid to good communication • Helps relax people • Helps establishes a rapport • Enables people to talk about difficult situations in safety • Is used as a means of helping people face the taboo of death and dying • Allows recognition that others feel the same way

13. Alex was a young man who was dying. His family was with him. I went in to see if anyone wanted a drink and Alex came out with the usual corny joke and some cheeky comment. I answered back “Any more of that mate and you’re dead meat.” I just wanted the ground to open up and swallow me. Alex laughed like a drain and after a moments silence, so did his family.

14. Harry is a 94 year old Yorkshire man, with a prostate problem. I visit him at home to help with his bath and change his catheter leg bag. He said to me “Ron, I’ve been thinking, do I have this problem with my prostate because I over used it when I was younger?” I looked up, “What? You mean!” “Yes” he said with a wicked grin on his face. I left the house that day with a smile on my face, a warm feeling in my heart and the sound of Harry chuckling in my ear

15. Lilly told me that she wanted to pass urine. I was in a hurry, and misheard her so when I returned with a kettle she smiled and said. ‘No nurse, I want a pee, not a cup of tea!!!’

16. Humour is difficult to define. • What is funny to one person is not to another. • Humour should be sensitive and appropriate to the situation For example:

19. What does the research say about humour? • “Humour helps engender hope, create a sense of perspective and establish a sense of connectedness with self and others.” (Herth 1990) • “A few moments of humour may in many instances help to sustain people through difficult life experiences, including terminal illness.” (Kanninen 1998)

20. A large percentage of the literature and research considers the therapeutic value of humour when used in the nurse patient relationship. Simon 1998, Bellert 1989, Schmitt 1990, Fry 1992, Erdman 1993 Holden 1993, Astedt-Kurki & Liukkonen 1994, Mathew 2003, Becker 2003, Herth 1990, Kanninen 1998, Hunt 1993, Klein 1994, Perry 1996

21. Astedt-Kurki & Liukkonen 1994 “Patients often regard a sense of humour as an essential characteristic of a good nurse.”

22. Protocols: • Observing infection control procedures • Briefings by nursing staff • Patients permission • Debriefing after each round • Meeting with Social Worker monthly Benefits: 6 month evaluation. 34 people rated how well they felt the clown doctors met their aims. Overwhelmingly favourable response from , patients, visitors and volunteers. Staff feedback positive. Richards J T, (2003) Caring Clowning as a healing art in palliative care. European Journal of Palliative Care, 10: 5, 206-211

23. Becker R & Gamlin R (2004) Ch5 Page 52, Managing Symptoms other than Pain, in Fundamental Aspects of Palliative Care Nursing, Quay Books, Salisbury, UK Constipation: “When I got up this morning I took 2 Ex Lax in addition to my Prozac. I can’t get off the toilet, but I feel really good about it.” Reviewer: “This is an enjoyable and informative read, passionately insisting that the art and science of nursing must be bought together. The material is handled sensitively and holistically including the use of some jokes in the text. Each chapter is well referenced, with diagrams and tables…… Nursing Standard September 29th 2004 Vol 19 P:28

25. Humour has value in teaching • Reduces audience stress. • Increases audience motivation, • Improves morale in the classroom • Enjoyment equals attention • Helps understanding • Helps group dynamics to be formed Chan 1993

26. The dangers of humour used wrongly • Be sure of your relationship with the patient before using humour • Do not ridicule, belittle or patronise • Do not use sarcasm, racism, or put downs • Do not joke about a patient’s situation unless the patient allows this

27. One day one of the medical team on my ward was examining a patient and a junior doctor came to the door with information about the death of another patient on the ward. Knowing that the word ‘death’ would be taboo in the room and finding it difficult to think of a substitute, she stood in the doorway and announced. “Guess who won’t be going shopping anymore.”

28. “Humour is a survival tool for health professionals who wish to remain compassionate and caring.” Wooten 1997

29. Strategies to promote humour • Give your patient permission to laugh • Know your patient really well • Look for the ludicrous • Don’t take yourself too seriously because if you do others will not • Smile – whenever you can, even to people you dislike and especially when you are under stress.

30. “Life was a funny thing that occurred on the way to the grave.” Quentin Crisp

31. Thank you for listening Mr R Becker Senior Lecturer in Palliative Care Email: bobb@severnhospice.org.uk