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Newsletter of Hong Kong Society of Palliative MedicineStaff, when challenged with a difficultrelative, had their own coping stances whichcould be different from Mr. T. Feelings of beingunhappy, being hurt and scared might be rootedfrom unmet expectation of respect from othersand out of touch with one’s inner self. This wasagain originated from incongruence in theiceberg and such coping might not besustainable. (Figure 3) Some of the staff mightadopt the coping stance of being superreasonableand ended up in arguing with theangry son, which would not be helpful in dealingwith difficult emotional scenes.Behaviour: apologetic, excusesCoping stance: placatingFeeling: hurt, scaredFeeling about feeling: shame, embarassmentPerception: self - victim, others - wrong &unreasonable, world - unsafeExpectation: others to respect me, listen to meranged from 9% to 18% in cancer patients andtheir families in various descriptive studies. 1Verbal abuse in palliative care is also notuncommon. In Australia, a survey in 2005showed 62% of doctors had been verballyabused in the previous 12 months. 2In a descriptive qualitative study on a focusgroup in an acute hospital palliative care team,various aspects of anger were analyzed. Sourceof anger was often shared between patient andthe family. Source of anger from patient mightarise from perceived neglect or abandonmentfrom doctors, delay in diagnosis and accusationof doctors giving too much or toolittle information, or even in thewrong style. Family members’ guilttowards patient might also beexpressed as anger. 3 Negativeimpact of anger on medical staffcould be significant. Staffconfidence and self efficacy mightbe undermined. Staff may feelexhausted with repeated efforts toengage patient or the relatives,rendering staff difficult to showempathy and establish rapportfurther. Staff often feel threatened,and may become defensive or evenangry themselves, with a spiraldown effect as anger escalates.The long term effects on nursingstaff included absenteeism, substandardcare and reduced jobsatisfaction. Dealing with angermight distract time of staff fromother aspects of patient care. Lastbut not least, anger emotion oftenblocks effective communication.Yearnings: to be respected and validatedSelf: out of touch with inner selfFigure 3 :Staff’s iceberg - PlacatingDealing with anger is common in palliativecare. Anger was recognized as one of theessential stages in grieving as described byKubler-Ross. Prevalence of anger emotionsPractical tips in dealing with angerPractical tips for communicationin the challenging scenario ofdealing with anger are suggested. 4(Figure 4) It is important toacknowledge the anger anddemonstrate that you have graspedwhat the client is angry about. It isalso important not to ‘dismiss’ theanger as part of an adjustment process. Alwaystake the source of the anger seriously (e.g.waiting room delays, or other expectations notbeing met), even if the response seems out ofDealing with Anger in Palliative Care SettingHKSPM Newsletter 2009 Sep Issue 2 P38