Talking So That Cancer Patients Can Hear

Doctor-patient communication presents challenges even in the best situations. When the patient is a cancer patient, trying to cope with the stress and complexity of their disease and their treatment options, communication can be especially tough.

The American Society of Clinical Oncology (ASCO) recently published a set of guidelines and best practices designed to help clinicians improve how they communicate with patients and families receiving cancer therapy. Published as a special article in the Journal of Clinical Oncology, the guidelines address nine questions around communication in the oncology setting. These questions range from broad (eg, “What core communication skills and tasks apply at every visit, across the cancer continuum?”) to more specific (eg, “Should clinicians discuss cost of care with patients?”).

“The first and more obvious challenge is that a cancer diagnosis is often frightening,” Sioux Falls medical oncologist John Bleeker told MED. “There is going to be more fear there than with, say, hypertension or diabetes, which makes communicating about it more difficult.”

In addition, says Dr. Bleeker, patients often come to the oncologist with preconceived notions of what a cancer diagnosis means. Often, their situation and their options are more complex than they realize.

“If you see a physician for another type of problem, he or she may recommend surgery or a treatment and that is all that is needed,” says Bleeker.  “But cancer care is extraordinarily complex. You are often trying to coordinate a lot of different people and that can make the whole course of treatment more difficult.”

 But Dr. Bleeker says the skill needed to clearly communicate these complexities even to fearful or confused patients can be learned and mastered - with practice. “The old idea that you just have to be a good person to be able to communicate well is going away,” he says. “We now know that there are specific skills that can be learned and that we can train oncologists to use.”

To compile the new guidelines, ASCO reviewed the medical literature for best communication practices. While the resulting tips and suggestions may not be groundbreaking for many practicing physicians, even Bleeker, who has practiced oncology at both Mayo Clinic and Sanford, says there are some “pearls” within the recommendations.

“For instance, we always strive to ensure that patients have an understanding of what we just said. One way to do this is to say ‘Does that make sense to you?’ or to ask the patient to describe in his or her own words what I just said.”

Another tip is to “ask first, then tell”, inviting the patient to lay out her questions or concerns first to ensure that they are addressed. “It can be valuable to ask the patient how much they’d like to know,” says Dr. Bleeker. “People process data in many different ways.”

Check out the  link to the ASCO research and guidelines.

 http://ascopubs.org/doi/abs/10.1200/JCO.2017.75.2311