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


Other approaches that have been used to enhance the communication skills of physicians include the following:

  • A skills-based approach to design structured training activities for teaching communication skills.[16]
  • Development of an innovative assessment instrument to facilitate curricular mapping of palliative care education.[17]
  • Efforts to enhance residents' knowledge, skills, and attitudes needed for effective palliative care.[18]
  • Listening to the patient and responding with care as a model for teaching communication skills and to frame the patient-physician relationship around trust and respect.[19]
  • The use of serial standardized patient-based assessments of medical students' acquisition of core clinical skills.[20][Level of evidence: II]

Nurses in Communication with Physicians

In general, nurses spend more time with patients than do their physician counterparts. Nurses play a vital role in supporting the patient through the crisis of cancer. Nurses are frequently left to pick up the pieces after physicians have delivered bad news or explained information about an illness. Questions such as "How bad is it?" or "How long do I have to live?" are often posed to nurses by patients who either are reluctant to bother the doctor or feel uncomfortable about asking for information. Nurses play a vital part on the treatment team, advocating for patients and acting as intermediaries for patient requests or concerns. Thus, teamwork between physicians and nurses is essential. However, role and status differences between nurse and physician can sometimes make communication challenging.

While nurses receive a fair amount of training in communication and interpersonal skills during their undergraduate years, it is widely recognized that for oncology nurses, advanced training in communication skills and subjects such as death and dying are highly desirable. Research suggests that these training programs are useful and well-received.[21]

Training Patients in Communication Skills

Although less common than interventions for providers, a number of interventions have been designed to help cancer patients navigate their health care issues and improve communication with their providers. The goals of these interventions have varied across studies and have included outcomes such as increasing patients' question-asking in the consultation,[22,23,24] increasing recall of the information discussed in the consultation,[25,26] increasing patient satisfaction,[27,28] and improving patients' psychological adjustment.[26,29,30] These interventions have met with varying degrees of success, but most are quite labor intensive.


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  2. Lee SJ, Back AL, Block SD, et al.: Enhancing physician-patient communication. Hematology Am Soc Hematol Educ Program : 464-83, 2002.
  3. Fallowfield L, Jenkins V: Effective communication skills are the key to good cancer care. Eur J Cancer 35 (11): 1592-7, 1999.
  4. Penson RT, Dignan FL, Canellos GP, et al.: Burnout: caring for the caregivers. Oncologist 5 (5): 425-34, 2000.
  5. Cegala DJ, Broz SL: Provider and patient communication skills training. In: Thompson TL, Dorsey AM, Miller KI, et al., eds.: Handbook of Health Communication. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2003, pp 95-119.
  6. Baile WF, Kudelka AP, Beale EA, et al.: Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer 86 (5): 887-97, 1999.
  7. Beckman HB, Frankel RM: Training practitioners to communicate effectively in cancer care: it is the relationship that counts. Patient Educ Couns 50 (1): 85-9, 2003.
  8. Back AL, Arnold RM, Tulsky JA, et al.: Teaching communication skills to medical oncology fellows. J Clin Oncol 21 (12): 2433-6, 2003.
  9. Back AL, Arnold RM, Baile WF, et al.: Approaching difficult communication tasks in oncology. CA Cancer J Clin 55 (3): 164-77, 2005 May-Jun.
  10. Fallowfield L, Jenkins V, Farewell V, et al.: Enduring impact of communication skills training: results of a 12-month follow-up. Br J Cancer 89 (8): 1445-9, 2003.
  11. Fallowfield L, Jenkins V: Current concepts of communication skills training in oncology. Recent Results Cancer Res 168: 105-12, 2006.
  12. Razavi D, Delvaux N, Marchal S, et al.: Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. Br J Cancer 87 (1): 1-7, 2002.
  13. Delvaux N, Razavi D, Marchal S, et al.: Effects of a 105 hours psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study. Br J Cancer 90 (1): 106-14, 2004.
  14. Back AL, Arnold RM: Discussing prognosis: "how much do you want to know?" talking to patients who are prepared for explicit information. J Clin Oncol 24 (25): 4209-13, 2006.
  15. Back AL, Arnold RM: Discussing prognosis: "how much do you want to know?" talking to patients who do not want information or who are ambivalent. J Clin Oncol 24 (25): 4214-7, 2006.
  16. Wagner PJ, Lentz L, Heslop SD: Teaching communication skills: a skills-based approach. Acad Med 77 (11): 1164, 2002.
  17. Meekin SA, Klein JE, Fleischman AR, et al.: Development of a palliative education assessment tool for medical student education. Acad Med 75 (10): 986-92, 2000.
  18. Fins JJ, Nilson EG: An approach to educating residents about palliative care and clinical ethics. Acad Med 75 (6): 662-5, 2000.
  19. DiBartola LM: Listening to patients and responding with care: a model for teaching communication skills. Jt Comm J Qual Improv 27 (6): 315-23, 2001.
  20. Prislin MD, Giglio M, Lewis EM, et al.: Assessing the acquisition of core clinical skills through the use of serial standardized patient assessments. Acad Med 75 (5): 480-3, 2000.
  21. Kennedy Sheldon L: Communication in oncology care: the effectiveness of skills training workshops for healthcare providers. Clin J Oncol Nurs 9 (3): 305-12, 2005.
  22. Butow PN, Dunn SM, Tattersall MH, et al.: Patient participation in the cancer consultation: evaluation of a question prompt sheet. Ann Oncol 5 (3): 199-204, 1994.
  23. Clayton J, Butow P, Tattersall M, et al.: Asking questions can help: development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer 89 (11): 2069-77, 2003.
  24. Ford S, Fallowfield L, Hall A, et al.: The influence of audiotapes on patient participation in the cancer consultation. Eur J Cancer 31A (13-14): 2264-9, 1995.
  25. Hogbin B, Fallowfield L: Getting it taped: the 'bad news' consultation with cancer patients. Br J Hosp Med 41 (4): 330-3, 1989.
  26. McHugh P, Lewis S, Ford S, et al.: The efficacy of audiotapes in promoting psychological well-being in cancer patients: a randomised, controlled trial. Br J Cancer 71 (2): 388-92, 1995.
  27. Damian D, Tattersall MH: Letters to patients: improving communication in cancer care. Lancet 338 (8772): 923-5, 1991.
  28. Tattersall MH, Butow PN, Griffin AM, et al.: The take-home message: patients prefer consultation audiotapes to summary letters. J Clin Oncol 12 (6): 1305-11, 1994.
  29. Deutsch G: Improving communication with oncology patients: taping the consultation. Clin Oncol (R Coll Radiol) 4 (1): 46-7, 1992.
  30. McHugh P, Lewis S: Psychological treatments in cancer patients. BMJ 304 (6836): 1247-8, 1992.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
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