Terry Murray shares helpful hints on how patients can ask family and friends for help.

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My sister Roxe has always been generous to a fault. I’ve been a recipient of that generosity, as have her friends in need, friends on their birthdays and other holidays, and complete strangers such as the countless people behind her in the Tim Horton’s drive-thru whose coffees she paid for.

When she was diagnosed with metastatic endometrial cancer, I was happy to travel from my home in Toronto to hers in Ottawa to be with her for chemotherapy sessions and the days afterward. But for the times I couldn’t be with her, Roxe was reluctant to ask any of her friends or neighbours for help.

“What about asking someone for a drive to the hospital for a chemo session?” I suggested, knowing it would be a longish trip across town.

“It’s too far, too early in the morning and during rush hour,” Roxe said.

“What about asking someone to come and sit with you, after rush hour?” I said.

“I can’t ask someone to sit with me for five hours!” she said.

“You could ask them to sit with you for an hour,” I offered, to which Roxe just shrugged.

“What about groceries?” I continued.

“The store delivers,” she countered.

She was even exhorted by her doctors to enlist and accept the help of friends and neighbours. But we were all fighting a losing battle with my sister’s stubbornness.

And therein lies the problem: It’s not enough to urge people in similar situations to ask for help – it’s necessary to help them to ask for help. A person’s reluctance to ask for help can stem from many things – concern about imposing and a fear of rejection among them – all of which need to be addressed with strategies and reassurance.

Concern about imposing was recently addressed by Washington Post columnist Carolyn Hax. “People often have a backward understanding of asking favors,” said Hax in the advice column she’s been writing since 1997.

“We worry it’s an imposition to ask, but sometimes, especially from someone normally independent, asking is actually a gift. Have you ever had a friend trust you with something big and felt flattered to be asked? And/or grateful for the chance to show this person you care? That could be what you offer here. Trusting someone with your vulnerability can help can bring the friend you choose (carefully, of course) a notch closer to you — especially if you’re able to return this level of favor for him or her.”

I used a variation on this approach with Roxe, adding more than a dash of guilt: “How would you feel if someone could have used your help and you would have liked to help, but the person decided for you that you were too busy?”

I soon learned that her friends and neighbours were almost desperate to help. On my first trip to Ottawa, I rented a car, but not one available at the train station. I called Janet, one of Roxe’s neighbours, to ask if it she or her husband could pick me up and drive me to the rental location. “Finally!” said Janet. “I can do something!”

It’s a little harder to allay the fear of rejection. When friends are told of the person’s illness, their response is almost invariably, “Call me if you need anything!” Sometimes they say that just to be polite and sometimes because they really mean it. There are ways of differentiating between the two.

My own personal rule is if someone is unavailable, stop asking after three requests. The would-be helper might legitimately be unable to offer assistance on all three occasions, but that’s a sign that the person may be over-committed elsewhere.

For people in need, a “no” puts them no further behind than they were before asking. They just need to ask another person or find another solution.

It’s also worth noting that people who say, “Call me if you need anything,” may need to have the type of help spelled out for them. It’s important to be specific, even for a request as simple as asking someone to pick up bread and milk. For example, what kind of bread: White? Whole wheat? Absolutely not 12-grain? And milk: Whole? Skim? 2%?

The individuals asking for help may feel they are being picky, but the more specific they can be in their requests, the easier it is for their helpers. The fewer decisions helpers have to make the greater the chance requesters will actually receive exactly what they need and want.

I’ve used these strategies with Roxe, and have started to break through her objections. I’ve also put these and other suggestions in a free, downloadable booklet on my website in the hope they’ll be helpful to other reluctant people in need.

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Terry Murray is a medical journalist and author living in Toronto. @terromur

A version of this commentary is also posted on Murray’s Review of Medical Journalism.