Unique Aspects of Communication with Cancer Patients
Most studies of provider-patient communication have focused on primary care or general internal medicine settings. Although many of the findings may be applicable to oncology, several unique elements present in oncology are not present in many other medical settings. Cancer is a life-threatening illness. Although recent treatments have increased the hope for cure or at least the arrest of the disease, the diagnosis of cancer results in significant fear, uncertainty, and commitment to often arduous, expensive, and complex treatments. Therefore, communication and the provider's relationship with the patient and the patient's family are particularly important in providing support through the crisis of cancer.
Cancer care can also be emotionally taxing on the oncologists who must frequently give bad news and deal with dying and death. Because of reimbursement issues, medical visits have become shorter while patients' desires for information have increased. Patients regard their oncologists as one of the most important sources of psychological support, while oncologists receive almost no training in communication and the interpersonal dimensions of patient care. Communication research in oncology has begun to change this landscape by demonstrating the association of good communication skills with enhanced patient satisfaction, compliance with treatment, increased patient knowledge, enhanced accrual to clinical trials, better transition of patients from curative to palliative treatment, and decreased oncologist stress and burnout.
Caregivers of cancer patients are expected to function broadly, providing direct care, assistance with activities of daily living, case management, emotional support, companionship, and medication supervision. Caregivers of cancer patients generally undertake multifaceted responsibilities for tasks such as the following:
Administrative tasks (case management, management of insurance claims, bill payment).
Instrumental tasks (accompanying the cancer patient to medical appointments;...
The scientific study of communication skills in oncology, however, is still in its infancy. Three key concepts have nonetheless emerged in defining the importance of interpersonal and communication skills in the interaction of providers with cancer patients and their families:
A patient-centered approach best describes the most effective way of providing comprehensive cancer care, and communication skills training can no longer be considered an optional skill.
The communication between the oncology clinician, patient, and patient's family is associated with important outcomes of care.
Communication skills are not innate, do not necessarily improve with clinical experience, but can be taught and learned.
Several reports provide an overview of these issues.[7,8,9,10,11]
Patient-centered or Patient-focused Care
The patient-centered model of care emphasizes the importance of the clinician's relationship with the patient and the patient's family as a therapeutic tool, endorses shared decision making as a key component of treatment, and emphasizes clinician understanding and addressing of patient concerns and information needs as important in promoting patient well-being and quality of life.[12,13] Interpersonal and communication skills are essential in achieving these goals and are also associated with other important clinical outcomes for the patient, the patient's family, and the medical team. These skills are especially important in highly charged emotional situations such as transitioning the patient to palliative care and at the end of life.