Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communication Along the Disease Trajectory
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).
The SPIKES method is useful because it is short, is easily understandable, and focuses on specific skills that can be practiced. Moreover, this protocol can be applied to most situations of breaking bad news, including diagnosis, recurrence, transition to palliative care, and even error disclosure. This method also includes reflective suggestions for physicians on how to deal with their own distress in being the messenger of bad news. In an innovative qualitative study focused on communicating bad news related to cancer recurrence, patients with diagnoses of gastrointestinal cancers during the previous 2 years listened to audio recordings of oncologists using the SPIKES approach (with standardized actors) and then identified what they liked and disliked about the communications. Three major themes were identified:
- Recognition, which involved the physician acknowledging or reflecting the patient's emotional response, without becoming overly emotional or offering platitudes.
- Guidance, which referred to the physician remaining in charge of the dialogue, pointing out the patient's strengths and offering positive recommendations.
- Responsiveness, which involved the physician moving back and forth between providing "recognition" and providing "guidance," using an interacting, rather than lecturing, style.