Original PaperEffective communication skills are the key to good cancer care
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.
Section snippets
Patients' communication difficulties
Lay populations often have less knowledge about basic biology and medical terminology than doctors and nurses realise, so patients may have genuine difficulty understanding what is wrong [9]. Anxiety about having a life-threatening disease can make interpretation and comprehension of complex information even more difficult. However, attempts to minimise anxiety are necessary and worthwhile otherwise patients may overestimate the seriousness of their condition [10]. For example, there is
Communication problems of doctors and nurses
Some doctors acknowledge that their own communication skills are limited and consequently abrogate much of the responsibility for information-giving to specialist nurses. There is, however, no evidence that nurses' skills are any better than those of doctors. Nurses often display similar distancing tactics and inappropriate interviewing behaviours [32]. Furthermore, contrary to popular belief, patients want to receive their diagnosis and information from the most senior hospital doctor, not a
System constraints producing communication difficulties
Many consultations take place in environments that are not conducive to the practice of good skills. Some hospital departments provide less privacy for intimate or distressing consultations than one would find routinely in the office of an accountant, bank manager or veterinary surgeon. Also, there are constant interruptions. During a research project in which patients were provided with tape recordings of their consultations, one doctor expressed surprise at how often his consultations were
Communication in multidisciplinary teams
Another problem within oncology that impacts upon care concerns the quality of the communication within the multidisciplinary team. Poor communication between different specialists and departments can add to the confusion about the diagnosis, test results and management. Improvements in communication provided by a multidisciplinary team approach to cancer care may be shown, but such organisational structures are alien to many healthcare professionals [44], many of whom have been educated within
Communicating about clinical trials
Good cancer care demands efficacious treatments tested in clinical trials. Unfortunately, the rate of patient accrual to trials is very low, delaying progress in research and the consequent introduction of new cancer treatments. Poor recruitment arises from many sources, including some of the system constraints of cancer care delivery, concern about ethical and medico-legal issues, and the personality factors and attitudes of both patients [45] and doctors 46, 47.
The reluctance of doctors to
Can better communication skills be taught?
Medical and nurse education has undoubtedly produced many healthcare professionals working within oncology who possess excellent communication skills, but the system has failed the majority, to the detriment of both their own [36] and their patients' well-being [4].
Communication skills are critical to the practice of medicine and nursing but there is little consensus regarding criteria for adequate performance [62]. Insufficient attention has been paid to the development of standardised
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