Anger is a powerful emotion experienced when individuals perceive unfair, cruel, or unacceptable treatment from others. It is characterized by feelings of annoyance, displeasure, and hostility.

In palliative care, anger is a frequently encountered emotion in both patients and their families as they grapple with advanced illness. While understandable as a reaction to significant health challenges and loss, anger can create difficulties in the care process, particularly impacting healthcare providers who are the targets of this emotion.

In the context of cancer and palliative care, anger is a common emotional response. It’s crucial for healthcare professionals to understand the roots of this anger and to go beyond simply allowing its expression. Effective management requires facilitating a shift in perspective, providing robust social support, and encouraging adaptive coping mechanisms in patients and families.

The sense of injustice associated with illness and mortality is a fundamental trigger for anger in individuals facing cancer and other life-limiting conditions.

Common Origins of Anger

Fear is arguably the most prevalent underlying cause of anger, especially for those facing end-of-life and their loved ones. Common fears driving anger include:

1. Uncertainty: Fear of the unknown future and what lies ahead in illness progression and beyond.

2. Suffering: Fear of physical pain and other forms of suffering associated with their condition.

3. Family Well-being: Worry and fear concerning the future security and well-being of family members after their passing.

4. Abandonment: Fear of being left alone, isolated, or neglected during their illness journey.

5. Unfinished Matters: Anxiety related to unresolved personal affairs, goals, or relationships.

6. Loss of Control: Fear of losing control over bodily functions, cognitive abilities, and personal autonomy.

7. Being a Burden: Worry about becoming an emotional, physical, or financial burden on family and caregivers.

8. Dying Alone: Fear of facing death in isolation, without loved ones present.

9. Justified Indignation (Rational Anger): Anger stemming from legitimate grievances or unacceptable situations, such as prolonged wait times for medical attention or perceived mistreatment.

10. Underlying Medical Conditions: Anger caused by organic factors, such as frontal lobe lesions, dementia, or delirium, which can directly impact emotional regulation and behavior.

11. Personality Traits: Anger as a habitual response or characteristic of a person’s personality or due to an underlying personality disorder, where anger is a default coping mechanism.

The “BATHE” Communication Technique

Employ the “BATHE” approach to cultivate an empathetic and supportive environment. Effective communication is paramount to prevent escalating frustration and bitterness in challenging patient interactions.

1. Background: Actively listen to the patient’s narrative to grasp the full context of their situation and understand their personal circumstances.

2. Affect: Identify and name the emotion you observe, for example, “You seem very angry.” Validating their feelings is critical to show you are listening and understanding. Avoid dismissing, countering, or ignoring their anger, as this will likely worsen the situation. Acknowledging their right to feel angry can be the first step towards resolution and building a stronger patient-provider relationship.

3. Troubles: Explore their deepest fears and anxieties about their current situation and the future. Simply asking, “What frightens you most?” can help them articulate unspoken worries and focus on underlying concerns they may not have explicitly considered.

4. Handling: Assess their coping mechanisms and resources for managing their situation. Ask, “How are you handling everything?” Determine if they are taking practical steps to address their concerns, such as financial or estate planning, or seeking emotional support. Consider suggesting professional counseling to address anger and depression.

5. Empathy: Express empathy and genuine concern to make the person feel understood, supported, and less alone. Avoid clichéd or dismissive phrases like “I know how you feel.” Instead, use paraphrasing to demonstrate active listening and understanding, such as, “It sounds like you feel it’s incredibly unfair that this illness has struck you after so many years.”

Effective Strategies for Managing Anger

1. Empathy through Understanding: Recognize the immense challenges faced by patients and families. Acknowledge that being a patient or having a critically ill loved one is an exceptionally difficult experience that no one would willingly choose.

2. Demonstrate Empathy Actively: As a caregiver, actively show empathy by focusing on their emotions, verbal and non-verbal cues, and actions. Convey genuine interest and demonstrate that their feelings and concerns are valued and important.

3. Allow Emotional Release: Permit patients to express their anger and “vent steam” before attempting to offer explanations or solutions. Remember that their anger is often rooted in distress about their illness. Remain calm and patient while they express their emotions.

4. Respect Personal Space: Be mindful of personal boundaries. Avoid standing too close or too far, allowing them to feel they have adequate personal space and a sense of safety during the interaction.

5. Avoid Unnecessary Physical Contact: Refrain from touching the patient without explicit consent, particularly when they are expressing anger. Maintain a comfortable distance that allows for open communication without feeling intrusive.

6. Practice Sensitivity: Be sensitive to their emotional state by accepting and respecting their feelings, regardless of the situation. If a patient becomes angry, avoid labeling them as “difficult.” Instead, try to understand their anger from their perspective and consider how you would feel in their position.

7. Respond with Gentleness: When responding, speak calmly and kindly. To improve the situation, avoid negativity in your responses and focus on offering helpful solutions or acknowledging their concerns. Think carefully before responding to ensure your words are helpful and not inflammatory.

8. Avoid Argumentation: Prioritize truthfulness and avoid defensiveness or the need to be “right.” Effective communication and a positive, solution-oriented approach are key to resolving conflict.

9. Apologize When Appropriate: Offering an apology for inconvenience or perceived shortcomings is a sign of strength and professionalism, not weakness. A sincere apology can de-escalate tension and build trust.

10. Address Issues Promptly: Address complaints and concerns as quickly as possible. The patient or family member’s anger is often a signal of an unmet need or problem. Investigate the details of their complaint and work to find a timely resolution.

11. Keep Commitments: Be mindful of your words and avoid making promises you cannot keep. Reliability and follow-through are essential in building trust and managing expectations.

12. Establish and Maintain Boundaries: Prioritize your own safety while ensuring the patient feels heard. Defuse potentially escalating situations by setting clear boundaries. For example, while patients have the right to participate in medical decisions, unreasonable or demanding behavior is not acceptable.

13. Maintain Open Communication: Be transparent and honest in your communication. Be accessible and responsive to patient needs, avoiding any perception of ignoring or dismissing their concerns.

14. Acknowledge and Validate Emotions: Explicitly acknowledge and validate the patient’s emotional state. Let them know that their feelings are understandable and legitimate in the context of their situation. This helps them feel heard and understood.

15. Practice Active Listening: Engage in active listening by focusing on understanding the patient’s perspective. Pay close attention to their words, both verbal and non-verbal, before offering assistance or solutions. Retain key information to demonstrate attentiveness and understanding.

16. Utilize Open-Ended Inquiry: Employ gentle, open-ended questions to encourage the person to elaborate on their thoughts and feelings. Seek clarification if needed to ensure you fully understand their concerns and perspective.