Effective communication skills are the key to good cancer care

Abstract

Communication within oncology is a core clinical skill but one in which few oncologists or specialist cancer nurses have received much formal training. Inadequate communication may cause much distress for patients and their families, who often want considerably more information than is usually provided. Many patients leave consultations unsure about the diagnosis and prognosis, confused about the meaning of—and need for—further diagnostic tests, unclear about the management plan and uncertain about the true therapeutic intent of treatment. Additionally, communication difficulties may impede the recruitment of patients to clinical trials, delaying the introduction of efficacious new treatments into clinics. Lack of effective communication between specialists and departments can also cause confusion and a loss of confidence amongst the team. Oncologists themselves acknowledge that insufficient training in communication and management skills is a major factor contributing to their own stress, lack of job satisfaction and emotional burnout. Consequently, over the past few years there have been several initiatives aimed at improving basic communication skills training for healthcare professionals in the cancer field. In this paper, some of the issues that influence communication within an oncology setting, and ultimately affect patient care, are discussed.

Introduction

Doctors and nurses usually talk and listen to patients more often than they perform any other single medical or nursing procedure. For example, during a clinical career spanning approximately 40 years, an oncologist is likely to conduct between 150 000 and 200 000 consultations with patients and their families. Thus, communication should be viewed as a core clinical skill that merits a considerable investment of time and resources in training. Unfortunately few oncologists or nurses have received adequate formal education in communication skills using methods likely to promote change, confidence and competence [1]. This is a serious omission as good communication has many positive effects on the patients' adjustment to cancer and its treatment, whereas poor communication has negative consequences for both healthcare professionals [2] and patients [3].

Effective communication during a consultation is probably the major determinant of the accuracy and completeness of the data collected. It influences the range and number of symptoms elicited, permits a more precise assessment of the efficacy of therapy, affects adherence to treatment recommendations, impacts on emotional and physical well-being and contributes to both patient and healthcarer satisfaction. There is compelling evidence from the literature demonstrating that good, patient-centred communication is associated with many important and meaningful health outcomes, including adherence to drug regimens and diets, pain control, resolution of physical and functional symptoms, improvements to physiological measures such as control of blood sugar and hypertension, and good psychological functioning of patients [4]. Trust in the doctor is a primary motivating factor in the acceptance of clinical trial participation [5]. The substantial clinical benefits that accrue from good communication should be sufficient argument for the inclusion of better training, and although most undergraduate curricula and postgraduate specialist programmes now make some reference to psychosocial issues and communication, often these are still considered somewhat peripheral topics.

Not surprisingly, many cancer patients are dissatisfied with much of the communication that takes place within hospitals. The omission of adequate information about the diagnosis, prognosis and potential therapeutic options can increase anxiety and uncertainty and can lead to dissatisfaction with healthcare in general [6]. Many of the complaints reported each year to the British National Health Service Ombudsman concern communication failures rather than technically negligent medical practice [7]. Litigation is more likely if doctor–patient communication has been poor [8]. These unsatisfactory circumstances are not only distressing for patients, but they are also professionally and personally unrewarding for the doctors and nurses involved [2].

The fundamental prerequisites for successful interactions between healthcarers and their patients are that the amount of information given is adequate, and that it is understood, believed, remembered and hopefully, acted upon. Sadly, many published studies reveal that these basic requirements are achieved infrequently. The reasons underlying poor communication are complicated. They involve both personality and attitudinal characteristics of patients and their healthcarers, together with difficulties created by the cancer care delivery systems.