Courageous Conversations—Mastering Patient–Caregiver Communication

When a pancreatic cancer diagnosis enters the equation, roles and routines can shift dramatically—no matter how solid your relationship.

A spouse becomes a caregiver. A child becomes an advocate. Appointments, scans, and tests crowd out “real life.” “Everyone is scared of what comes next and many people struggle to talk honestly about what they’re feeling or what they really need,” says Stephanie Davidson, Psy.D., clinical psychologist and Clinical Manager of the Couples Coping Together Against Cancer program at City of Hope, Los Angeles, California. “But it turns out that the way forward is to lean into that vulnerability and choose to have courageous, values-based conversations early and often.”

Focus Questions On What Matters Most

One of the most powerful shifts a patient–caregiver pair can make is moving away from unanswerable questions—things like “Will this treatment work?” or “How much time do we have left?”—and toward questions that uncover what matters most right now.

“No one has a crystal ball, not even your medical team,” Davidson states. “But you can talk about what would make your life better right now, knowing that your answer to that question will change over time.”

She encourages patients and caregivers to engage in meaningful conversations that center on questions like:

• What is most important to you today?
• What do you most want to be able to do or experience in the coming weeks or months?
• What is your biggest fear? Pain? Loss of independence? Missing a family milestone?

Sometimes patients yearn to be at their daughter’s wedding or see their first grandchild enter the world. Sometimes they’re most concerned about comfort. They don’t want to be in pain or linger in a state of disease-related decline. And sometimes, patients and caregivers may disagree about the next best steps.

“It’s important to remember that treatment can have different goals,” notes Davidson. Instead of thinking in terms of treatment or no treatment, you might ask:

• What are we hoping treatment will do for us now—more time, more comfort, or both?
• Given what matters most, does this treatment bring us closer to that goal or further away?

“These questions don’t have right or wrong answers, but they help anchor decisions in what matters most, rather than in fear or uncertainty,” she adds.

Plan Discussions Strategically

Challenging conversations go more smoothly when they happen proactively rather than when you’re facing an acute crisis or critical decision. “We encourage patients and partners to begin talking about values at the start of treatment and discuss difficult topics regularly,” Davidson explains. “So instead of one huge, terrifying talk, you have a series of smaller, honest conversations.”

Over time, these discussions become less charged, and both patients and caregivers develop a sense of emotional safety and a shared understanding of how to support each other.

Help me find a pancreatic cancer expert near me.

Learn more

“The form of communication is important to consider, too,” she says. “Not everyone feels comfortable sharing their feelings face-to-face. Some people find it easier to express themselves in writing. Others prefer to read information first and then come back to talk.”

There’s no one “right” way to communicate. Instead, caregivers and patients need to consider what form of communication feels most supportive for each person—and that might change over time. “The best method is the one that helps each person feel seen, heard, and understood.”

Ask for Professional Support

Many caregivers and patients want to talk, but they’re afraid of saying the wrong thing or making the other person feel bad. That’s where professional support can help. Social workers, psychologists, and marriage and family therapists, especially those who work in oncology, are trained to guide these conversations. They understand both relationship dynamics and the emotional and practical challenges of cancer.

“Sometimes having a professional in the room gives everyone permission to say what they were already thinking and feeling, but didn’t know how to voice,” Davidson notes. “It takes courage to say, ‘I’m scared,’ ‘I’m tired,’ ‘I need space to process,’ but those courageous conversations can deepen connection, build trust, and help you make decisions that reflect your values.”

In many cases, support services are available on site where you’re receiving treatment—yet they often go underutilized. Ask your doctor for a referral to a social worker, psychologist, or patient advocate. You can also ask: What services are available to help us navigate these conversations?

Still need additional support? Consider contacting organizations like the American Cancer Society, CancerCare, or the Pancreatic Cancer Action Network (PanCAN), which offer counseling, support groups, and caregiver resources. “It takes courage to ask for help and acknowledge that you’re overwhelmed,” says Davidson. “But when you commit to staying in the conversation—with each other and with your care team—you create a shared understanding that can guide decisions, reduce uncertainty, and help you move forward together, even when the path ahead is unclear.”