Using humour in Using humour in cancer & palliative cancer & palliative

care care

Mr R Becker Senior Lecturer in Palliative Care

Staffordshire University Faculty of Health and Severn Hospice Shropshire, UK

AimsAims 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

“Life does not cease to be funny when people die, any more than it

ceases to be serious when people laugh.”

George Bernard Shaw

The 5 primary functions of humourThe 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

The holistic value of humour: -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

The Physiology of HumourThe Physiology of Humour

Laughter increases the levels of hormones such as endorphin and decreases levels of stress hormones,

cortisol and adrenaline.

“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.

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

Humour as an aid to good communicationHumour 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

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.

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

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!!!’

Humour is difficult to define. 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:

What does the research say about humour?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)

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

Astedt-Kurki & Liukkonen 1994

“Patients often regard a sense of humour as an essential

characteristic of a good nurse.”

Richards J T, (2003) Caring Clowning as a healing art in palliative care. European Journal of Palliative Care, 10: 5, 206-211

Protocols:

• Observing infection control procedures

• Briefings by nursing staff

• Patients permission

• Debriefing after each round

• Meeting with Social Worker monthlyBenefits: 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.

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.”

Becker R & Gamlin R (2004) Ch5 Page 52, Managing Symptoms other than Pain, in Fundamental Aspects of Palliative Care Nursing, Quay Books, Salisbury, UK

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

Humour has value in teachingHumour 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

The dangers of humour used wronglyThe 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

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.”

“Humour is a survival tool for health professionals who wish to

remain compassionate and caring.”

Wooten 1997

Strategies to promote humourStrategies 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.

“Life was a funny thing that occurred on the

way to the grave.”

Quentin Crisp

Thank you for listening

Mr R Becker Senior Lecturer in Palliative Care

Email: bobb@severnhospice.org.uk