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.
- Development of an innovative assessment instrument to facilitate curricular mapping of palliative care education.
- Efforts to enhance residents' knowledge, skills, and attitudes needed for effective palliative care.
- 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.
- The use of serial standardized patient-based assessments of medical students' acquisition of core clinical skills.[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.
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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- Back AL, Arnold RM, Tulsky JA, et al.: Teaching communication skills to medical oncology fellows. J Clin Oncol 21 (12): 2433-6, 2003.
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- 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.
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- 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.
- Fins JJ, Nilson EG: An approach to educating residents about palliative care and clinical ethics. Acad Med 75 (6): 662-5, 2000.
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- 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.
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- 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.
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- 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.
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