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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Training in Communication Skills

Training Providers

Some believe that effective communication between doctor and patient is a core clinical skill that should be taught as rigorously as other medical sciences are taught.[1] Underlying this belief is a growing body of research and development of guidelines acknowledging that physicians need not be born with excellent communication skills but can learn as they practice various other aspects of medicine.[2]

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About This PDQ Summary

Purpose of This Summary This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about treatment of plasma cell neoplasms (including multiple myeloma). It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Reviewers and Updates This summary is reviewed regularly and updated as necessary...

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Clinicians specializing in cancer acknowledge that insufficient training in communication and management skills is a major factor contributing to their stress, lack of job satisfaction, and emotional burnout.[3,4] Unfortunately, few oncologists or nurses have received adequate formal education in communication skills using methods likely to promote change, confidence, and competence.[3,4] On the other hand, good physician-patient communication is associated with adherence to drug regimens and diets, pain control, resolution of physical and functional symptoms, control of blood sugar and hypertension, and good psychological functioning of patients.[3,4]

Most (80%) patient-physician communication studies involve primary care physicians (i.e., family medicine physicians, general internists, or pediatricians). However, approximately 20% of studies in one review [5] used cancer providers, revealing a trend of inadequate training in patient communication for oncologists and other health professionals who deal with cancer patients, particularly with respect to breaking bad news and handling strong, emotionally charged interview contexts.[5,6]

One group of authors believes there are four tasks in teaching effective practitioner–cancer patient communication:[7]

  1. Defining and distributing a comprehensive, evidenced-based curriculum.
  2. Recruiting faculty and/or local practitioners who embrace this curriculum and employ it in practice.
  3. Anchoring the curriculum in evidence-supported behaviors to promote effective interventions and focus clinical controversies on the spectrum of naturally occurring communication styles that arise when working with patients.
  4. Employing longitudinal reinforcement.

Given a well-developed and broadly accepted curriculum, the next step in establishing a successful communication program is to create surroundings that maximize the opportunity to learn, practice, and internalize the curriculum. Longitudinal learning programs that utilize a cohesive faculty result in more meaningful incorporation of curricular elements into the practice styles of learners.[7]

Various approaches to training physicians to deal with cancer patients have been instituted to meet these guidelines. One approach is a program titled Oncotalk,[8] a communication skills program built around evidence-based educational techniques. In an intensive 4-day retreat focused on communication at the end of life, medical oncology fellows are exposed to didactic material that incorporates specific interviewing skills. They then interview standardized patients while they are observed by trained facilitators, who act as coaches to help the oncology fellows recognize and deal with obstacles and challenges in the encounter. The curriculum encompasses basic communication skills such as how to respond to emotional concerns and affect and communication skills along the disease trajectory: giving bad news, conducting a family conference, managing the transition from curative to palliative therapy, and responding to requests for futile treatments.[8,9] Societies such as the American Society of Clinical Oncology (ASCO) have developed and adopted specialized curricula for communicating with older cancer patients.[7] Several authors have published positive results from randomized trials or other outcomes assessments of communication skills training in oncology.[10,11];[12,13][Level of evidence: I][14,15]

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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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