“It’s All My Fault”: Responding to Patient Self-Blame in Serious Illness Care

<b><i>Background:</i></b> Expressions of self-blame are common in serious illness care, and determining how best to respond can be challenging, even for clinicians familiar with navigating strong emotion. <b><i>Case Description:</i></b> A 61-year-old woman with metastatic rectal cancer presented to the palliative care clinic to review surveillance imaging results, which demonstrated cancer progression. After processing this news, she expressed how her illness was adversely impacting her family, stating, "This is all my fault." The clinical team considered how to respond. <b><i>Discussion:</i></b> This case illustrates a common pitfall in responding to self-blame: the attempt to dismiss the patient's distress by quickly reassuring them that they did nothing wrong. Resisting the temptation to "fix" self-blame is challenging, yet essential, as empathically acknowledging this emotion and exploring its origins can aid in understanding the patient's concerns and priorities. We offer five strategies to support palliative care clinicians in responding effectively when patients and families invoke self-blame.