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updated 10/18/2007 8:51:54 AM ET 2007-10-18T12:51:54

When we’re about to ask the boss for a raise, or our kids to clean up their rooms, most of us tend to go out of our way to get the wording just right to ensure a positive outcome. Unfortunately, not everyone is so thoughtful when speaking to people in the midst of a life-threatening illness. Just ask a woman with breast cancer.

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A family member told Laura Kane, currently undergoing chemotherapy, “Oh, that’s no big deal, I’ve known a lot of women who’ve been through it, and you’ll be fine.”

“It takes a lot to tell someone about your illness, and then they’re dismissive,” says Kane, a vice president of corporate communications for the insurance provider Aflac, in Columbus, Ga.

When Diane DeMeerleer, a breast cancer survivor from Kent, Wash., shared the news of her diagnosis, she received an e-mail response from her boss: “Sorry to hear it’s the big C.”

“It was cold and harsh,” DeMeerleer recalls.

Many similar bone-headed and hurtful comments are uttered by well-meaning people who actually believe they are being helpful or attentive.

A survey just released by Aflac that polled 900 unpaid caregivers found that generic offers of help, such as “Let me know if you need anything,” were among the least desirable things to say to patients with a serious illness. Specific offers of assistance were the most welcome, explained Kane, who spearheaded the poll before she was diagnosed with breast cancer.

“What a breast cancer patient doesn’t need is more ambiguity and having to figure out what the limits of your offer are,” says Dr. John Wynn, a psychiatrist at the Swedish Cancer Institute at Swedish Medical Center in Seattle.  “You want to offer a specific package.”

Offering to bring some meals by, for instance, is not helpful, he says. Better to say, “Would it be helpful if next Tuesday, Wednesday and Thursday I brought dinner for four?” Give the other person the specifics and then let them say yes or no, and always allow them to have that control, says Wynn.

Making a specific offer shows that someone has thought about it and is sincere. “Offering to babysit children while a woman is at chemo is easy to say ‘yes’ to,” says Kane.

Even if you’re not extending an offer of physical help, words that carry a bright outlook matter. Laurie Puhn, a mediator and communications expert, points to studies that show optimists enjoy better health than pessimists. “Your job is to motivate your breast cancer friend to be optimistic,” says Puhn, who wrote “Instant Persuasion: How to Change Your Words to Change Your Life.”

Puhn suggests, for example, telling your friend that you admire the way she does a particular thing in the midst of her illness, and that she’s strong.

And to people who inundate breast cancer patients with survival statistics or pepper them with questions about prognosis or how long they’ll need chemotherapy, Puhn advises: “Leave the focus on facts and information to the doctors, and be human.”

Another taboo is bringing up topics that maximize the severity of the situation. Wynn suggests that serious illness somehow engages people’s morbid fascination and fears.

Vicky Agnew, a breast cancer survivor in Charleston, S.C., vividly recalls the alarmist comments she received about how chemotherapy would wipe her out and radiation would cause blistering to her breast.

Whether a person maximizes or minimizes a woman’s breast cancer, it comes out clumsy, says Judith Sills, a clinical psychologist in Philadelphia, who wrote “The Comfort Trap: Or, What If You’re Riding a Dead Horse.” “Compassion is being emotionally where the other person is, and it’s a very hard note to hit, especially in a fearful or negative situation,” she says. 

Sometimes, what works even better than saying something is simply listening. Tell your friend you want to be available, if she needs to talk it out, says Wynn, who adds you don’t have to be the other person’s therapist. “It’s about being an open ear that’s not judgmental or demanding, but caring and available,” he says. “It’s sometimes known as friendship.”

Coeli Carr is a writer in New York City who frequently writes about health topics.

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