A difficult topic is one that you are finding hard to talk about or one that you assume another person does not want to talk about. Maybe it's a topic that most people have difficulty talking about, like sexual intimacy or end of life. Maybe the person with cancer has said they don't want to discuss it; yet matters important to you are not being addressed.

Whatever the topic, here are some suggestions for bringing it up:

1. Think about your tone and approach. It will help if you make "I" statements. For example:
   
   
   1. You feel this: "I feel so frustrated that you are in pain."
   2. Think about what you want: "I would like you to feel more comfortable."
   3. Put this into a reasonable request: "Would you consider getting a second opinion at a pain clinic?"
   
   
2. Think about your expectations for the conversation. You can only bring up your concerns and offer suggestions for how things could change. The other person can either accept or reject your suggestions. If they stick to their position, you might have to modify your expectations, as difficult as that may be.
3. Think about backing off, once you've expressed your concerns. Sometimes, people need a little space to take down some of their defenses and more clearly consider a different point of view.
4. Think about the best way to bring up the subject, knowing the communication preferences of the other person. Sometimes it helps to tell the person in advance that you'd like to talk about a sensitive topic and ask when would be a good time. Or, maybe they prefer a direct approach. Would it help if you emailed them or wrote a letter instead? Sometimes the written word seems less threatening.
5. If you are afraid you'll cry in front of the other person, consider this: Tears mean that you care. If you do cry, the person will be reminded that they matter deeply to you and that the situation is distressing right now.
6. Would it help to talk in the company of a third person? It might help to simply say: "You and I are having trouble talking about [the pain in your hip, the role of alternative medicine in your care...]. Would you be willing to come with me to talk about it with [our rabbi, that social worker at the clinic...]?"
7. Consider attending a cancer support group. Many groups welcome caregivers, with or without the patient. You can just observe the group and see if the members bring up your topic. Or you can ask the group how they've dealt with that issue. Group members can offer valuable "been-there-done-that" advice that is hard to find anywhere else.
8. Consider finding a counselor who is familiar with cancer or other serious medical illnesses. This person may be able to "coach" you through a difficult topic, and help you rehearse how to bring it up, if necessary.
9. Remember: You can always choose to communicate with respect and kindness, even if the other person does not treat you the same way.