Using humour in cancer

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

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

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

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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 youre 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.
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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, Ive 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
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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!!!
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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
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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)

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• 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
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Astedt-Kurki Liukkonen 1994

• Patients often regard a sense of humour as an
  essential characteristic of a good nurse.

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• 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
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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 cant 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 P28
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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
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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 patients situation unless
  the patient allows this

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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 wont be going shopping anymore.
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• Humour is a survival tool for health
  professionals who wish to remain compassionate
  and caring.
• Wooten 1997

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Strategies to promote humour

• Give your patient permission to laugh
• Know your patient really well
• Look for the ludicrous
• Dont 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.
  

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Life was a funny thing that occurred on the way
to the grave. Quentin Crisp
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Thank you for listening
Mr R Becker Senior Lecturer in Palliative
Care Email bobb_at_severnhospice.org.uk