Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communication Along the Disease Trajectory
Significant predictors of patient satisfaction with the conversation included the following:
- Perceiving the physician as personally interested.
- Being able to understand the information given.
- Being informed in the proper environment (doctor's office).
- Having more time invested in discussing the information.
Although most patients wish to have complete and accurate information regarding their condition, many patients feel that the news is forced upon them unless their right to have the news given according to their preferences is acknowledged by the physician (e.g., "Are you someone who wants to know all the details about your condition?").
A study [Level of evidence: II] of 351 patients who had a variety of cancers at different stages and who were seen at M.D. Anderson Cancer Center elicited patient communication preferences when they were given bad news of the initial cancer diagnosis or recurrence. The highest rated elements included the following:
- The doctor being up-to-date on the latest research on the patient's cancer.
- The doctor informing the patient about the best treatment options and taking time to answer all patient questions.
- The doctor being honest about the severity of the condition.
- The doctor using simple and clear language, giving the news directly, and giving full attention to the patient.
Differences were noted in patient preferences based on sex, age, and level of education, underscoring the importance of tailoring the discussion to the individual patient. Cancer type did not predict patient preferences. It is important for a physician to elicit patient perspective on his or her condition because many incorrect beliefs can be clarified for the patient's benefit.
One protocol or method of disclosing bad news is represented by the acronym SPIKES, an approach that comprises the following six steps:
- S -S etting up the interview (choosing the right location, establishing rapport).
- P -Assessing the patient's P erception of the medical situation.
- I -Obtaining the patient's I nvitation (asking the patient's permission to explain).
- K -Giving K nowledge and information to the patient.
- E -Addressing the patient's E motions with empathic responses (addressing emotions that might occur during bad news disclosure and strategizing a treatment plan).
- S -S trategy and S ummary (summarizing the plan for the patient and family).