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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communication Along the Disease Trajectory

Basic Communication Skills

Communication with the patient and family entails a number of essential skills, which can be remembered as five E's:[1]

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  • E ngaging the patient.
  • E liciting the patient's understanding/current concerns.
  • E ducating the patient.
  • Addressing E motions.
  • E nlisting the collaboration of the patient and caregiver.

These skills serve the purpose of developing rapport; establishing patient understanding of their condition and important concerns; providing information about the illness and treatment; responding to emotions using empathic, validating, and clarifying responses; and enlisting the patient and family in the treatment plan. An online lecture titled "Communication and Interpersonal Skills in Cancer Care" further explains these basic skills and may be found on the Web site of the International Psycho-Oncology Society.

The application of basic communication skills to a number of oncologic challenges—including breaking bad news, shared decision making, and dealing with depression and challenging patients—has been outlined.[2]

Clinicians should remember that many patients are anxious about medical visits. Putting patients at ease will allow better assimilation of information; and the skills of inquiring about the patient's point of view, listening without interrupting, and being empathic will be perceived as supportive and caring. As one study [3] found, the first few moments of the interaction are especially important in forming lasting impressions; a friendly handshake and making eye contact are important first steps in creating trust and rapport. Sitting down puts the health care provider at patient eye level and invites discussion rather than one-way conversation; asking the names and relationships of others in the room acknowledges their potential role as allies in the care of the patient. Inquiring briefly about the patient's hometown, family, or other personal aspects of life helps shift the focus from patienthood to personhood. Not interrupting while patients are talking and acknowledging the importance of their concerns conveys respect for their point of view.

Breaking Bad News

Giving bad news is a frequent and significant communication challenge for oncologists. Moreover, a typical oncologist in practice may give bad news thousands of times over the course of a career. Increased cancer survival now means not only that information regarding the state of the disease and its response to a multitude of treatments over time must be communicated effectively to the patient, but also that adverse information related to irreversible and potentially irreversible side effects, complications of the illness, and the treatment and diminished prospects for the future must be disclosed. This process is made difficult by several factors. Oncologists are rarely trained in techniques for giving bad news.[4,5] Physicians often experience negative emotions such as anxiety and fear of being blamed when they must tell patients that treatment has not worked.[6,7] There is thus the danger that physicians may react to patient emotions by offering false hope or premature reassurance, or they may omit important information from the disclosure.[8] Moreover, patients may process information through a repertoire of coping strategies or styles called denial or blunting,[9] which may include avoiding asking questions, being overly optimistic about the outcome, and distorting information to put it in a better light.

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