Background
Navigating challenging discussions with adolescents and young adults (AYAs) is a universal experience for clinicians working in this speciality area. It is a skill set of AYA clinicians that is often considered intuitive and difficult to qualify. We most commonly associate challenging clinical discussions with relapse and end of life, however, these difficult conversations often need to occur when first meeting a patient. Entering a challenging conversation in the absence of established rapport can elicit uncertainty for clinicians.
Method
Three de-identified cases were examined to illustrate the factors that contribute to a successful outcome. Success was defined as an intact therapeutic relationship following the challenging discussion. The challenging conversations included fertility preservation, sexual health and breastfeeding.
Impact on Practice
For each case the challenging conversation occurred at the beginning of the cancer experience when it is difficult to determine how much is in the clinician/patient trust bank. Recognising when the moment is right to introduce a challenging topic requires rapid assessment of physical and verbal cues. These assessments and decisions are made in a matter of moments and it can often require the clinician to take a risk and hope for the best outcome. We aim to define the common elements that make it possible to guide a patient through a challenging conversation while continuing to build and sustain the therapeutic relationship.
Discussion
For clinicians, navigating challenging clinical discussions when first meeting a patient can evoke a sense of uncertainty at the prospect of jeopardising the therapeutic relationship. The three cases highlight the clinical skills required to determine how and when to navigate these discussions to ensure the continued development of the therapeutic relationship and future effective care delivery and positive patient outcomes.