Communication in cancer care
By Dr Carma L. Bylund
Image credit: Hand in Hand by TusitaStudio. Public Domain via Pixabay.
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, patients who understand their prognosis are less likely to use futile care at end of life and good doctor-patient communication has been shown to be linked to less likelihood of malpractice cases.
Yet, why is it that communication during cancer care (read this freely available chapter) 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.
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
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. In short, providers must make the choice to connect at a human level during a very inhumane experience.
Carma Bylund, PhD, is Associate Director of Medical Education at Hamad Medical Corporation and Associate Professor of Communication Studies in Clinical Psychiatry at Weill Cornell Medicine-Qatar (Doha, Qatar). She is also Consultant and former Director of the Communication Skills Training and Research Laboratory at Memorial Sloan Kettering Cancer Center in New York, USA, and a fellow in the American Academy on Communication in Healthcare.
Dr Bylund is an editor of Oxford Textbook of Communication in Oncology and Palliative Care, 2nd edition, available in print and online, along with David Kissane, Barry Bultz, Phyllis Butow, Simon Noble, and Susie Wilkinson. She is also a co-editor of Family Communication about Genetics: Research and Practice with Clara Gaff.
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