Communication in cancer care

Ask anyone about their experience with their own or a loved one’s cancer, and the response will likely include a story or remark about an oncologist, surgeon, nurse, or other health care provider. These are often positive stories: the oncologist who remembered a child’s birthday, the nurse who stayed after his shift to wait with an elderly patient until her daughter arrived to pick her up, or the surgeon who attended a husband’s funeral. Other times however, there are negative stories: the doctor who disclosed a cancer recurrence and then left the room immediately, or the nurse who was noticeably annoyed with how slowly the patient got out of the hospital bed for the first time after surgery. Whatever the experience, it is difficult to separate the cancer treatment from the care of those who provide it.

The importance of good communication during cancer care can make a real difference in the patient’s and family’s experience and can even have an impact on their health and well-being. This is backed not only by anecdotal evidence, but also scientific research, which has focused mostly on the doctor-patient relationship. The result of good doctor-patient communication is clear – patients make more informed decisions, have better quality of life, and have lower incidences of anxiety.

Additionally, well-informed patients are less likely to use futile care and less likely to bring malpractice cases.

Yet, why is it that communication during cancer care often falls short of desirable?

Many of the pressures that make good communication difficult in cancer care are universal. Doctors and all health care providers must deal with time constraints, complicated cases or chronic illness, extensive paperwork, language barriers, cultural differences, racial bias, old models of paternalism, and so forth. In addition to impacting communication, these burdens too often lead to burnout and low job satisfaction for health care providers.

Notwithstanding these real pressures, there’s also the simple fact that sometimes doctors haven’t honed the communication skills necessary to help them cope with the challenging situations that accompany cancer care. Doctors will invariably face adult children that plead with the doctor not to tell their mother she has cancer, for fear that she may “give up”; family members who insist on futile treatments, despite the patient’s wishes to prioritize quality of life over a very limited survival benefit; or the need to console the patient who is upset after agreeing to a clinical trial to find he was randomized to the usual care treatment group.

Making communication a part of medical education at all levels is critical to prepare providers to manage such challenging situations. In most developed countries, medical schools teach and evaluate communication skills throughout the curriculum. However, this is not necessarily the case in developing countries. (For instance, at the hospital where I work in the Arabian Gulf, only about one-third of doctors received communication training as part of their medical school curriculum.) Medical school education is a good start, but it is not enough. The last two decades have brought a growing recognition of the particular communication challenges facing oncology providers, prompting research and interventions to better understand and improve communication in cancer care – both with physicians in training (residents and fellows) as well as with practicing providers.

International leaders in health care communication training use experiential methods –with standardized patients (actors), practice, and feedback. Participants tend to give these experiences high praise, appreciating the learning and reflection that occurs. Organizations such as EACH: International Association for Communication in Healthcare and the American Academy on Communication in Healthcare lead and support efforts in improving healthcare communication around the world. Such courses are a relatively small investment with a potentially big payoff in terms of patient and family experience and health. In Switzerland, the recognition of the importance of communication skills training led to the 2006 mandate for all medical oncologists to complete a communication skills training course, including supervision and follow up.

Ultimately, though, good healthcare communication comes from more than a course; it is a result of the choices an oncology provider makes over and over again every day. They must make the choice to explain clearly and carefully when giving treatment choices to the thousandth patient, all while tailoring information and decision making to patients’ needs. They must make the choice to put their day on hold rather than walking away, and say “tell me more” in response to a patient-created emphatic opportunity. In short, providers must make the choice to connect at a human level during a very inhumane experience.

Featured image credit: Hand in Hand by TusitaStudio. Public Domain via Pixabay.