Commitment and Acceptance Therapy is working focused on the acceptance of the condition and a relevant coping strategy.

When I was a medical student, the people in the Liaison Psychiatry offices received patients by asking them:                                                                                                                What do you think is the reason why you've been referred here?

The SEOM manual of continued care, 2004 edition, spreads the mental attitudes towards malignant disease as.

+ fatalism

+ positive avoidance

+ helplessness-despair

+ fighting spirit

+ anxious worry

and propose drawing an individual profile by adequate questionnaires, as MAC scale (Mental Attitude to cancer).

The steps a patients goes through after receiving a malignancy diagnosis are known, the 'Manual of Oncologic Therapeuics 1991-1992', by Robert E Wittes, describes 'the usual emotional response as an initial 'shock' and disbelief, followed by symptoms of anxiety and depression including irritability, anorexia, insomnia, decreased concentration, and diminished ability to function in normal spheres of activity, distress symptoms that usualy resolve in 7 to 10 days, and are the normal response to the crisis of diagnosis, relapse, or treatment failure'.

Same as in bereavement, the persistence of symptoms after two weeks and functional impairment may point the difference between a noncomplicated normal response to a first grade stressor, and an added disease or comlication.

Recommendations exist as how to tell 'bad news', one of the most basic may be never lie, lying will put patient in a permanent anxiety situation, that may be compared to the personal insecurity actors have, being professionally able to simulate any feeling, the doubt always remains inside their minds about the feelings they think detecting in the person in front of them is sincere or faking.

Progressive communication of information tregarding diagnosis and prognosis to the grade the patient requests seems also essential, and if the 'therapeutic contract' or 'agreement' between physician and patient is harmed early, referral to another practitioner may be considered, consultations and assement of situation by care providers specializing in conflicts and mental symptoms may help.

I always like remarking that in the studies that give information about effects on sexual functioning of different Prostate cancer therapies, not many reported having used any assement instrument or specific history taking about baseline sexual performance. A good history, just an organ and apparatus questioning may take at least 20 minutes, helps a lot in care, and can avoid some demands and clinical mistakes

Denial as a main mechanism is considered as an immature defense mechanism, supposedly being overwhelmingly present in the so called 'psychopatic-bordeline personalities', however, old proverbs said: 'Out of sight, out of mind', 'There no worse blind than those who refuse to see', or as a woman said: 'My husband, who doesn't deceive me, if he's unfaithful to me, that I don't know, and if I become aware, that I don't mind'. 

'Ruts DC', had an album cover indicating. 'Grin and bear it', this is an approach in the way C G Jung preferred: empowering of self.

Dear Colleagues

Thank you for responses.Borderlines PD s or normal individuals .I hope related studies are available.In fact patient deny their status ,it barely help in treatment actually worsen treatment faster  metastasis  and chances of secondary infections after chemotherapy

Grin and bear it or grin and share it ,which campaign is better

Regards

Dear Joe Graymer

I like to share you an experience from my country India .A mason/construction worker suddenly felt giddy and fall and reached emergency/casualty.By his good luck hospital caring and compassionate oncho surgeon was present there. Who found his respiratory distress and a huge cancerous growth in side trachea, did tracheotomy and saved him.Very next day he called him oncho OPD explained severity of his condition.

Actually this meson never turned back never listen poor doctor,After 10-11 days doctor observed him he is carrying brick bats on his head in the construction site with his tracheostomy opening.Doctor jumped out from his car to catch him he also observed poor doctor ! The man with tracheotomy wound  hides in the crowd !

This is my country and denial of acceptance of this fatal disease!

reality is so hurshe