Effective communication is an essential part of all patient-centered oncology care, and a new guideline from the American Society of Clinical Oncology (ASCO) now offers a framework of specific practices that can improve communication with patients.
The guidance was published September 11 in the Journal of Clinical Oncology.
“The guideline is both patient-centered and relationship-centered. It underscores that an important skill for each provider is to understand the patient as an individual and their families’ unique needs,” said Walter F. Baile, MD, co-chair of the ASCO Expert Panel that developed the guideline.
“The recommendations can help doctors form a trusting relationship with patients that is characterized by empathy, honesty, and a human connection with the patient and family,” Dr Baile said in a statement.
Cancer is a devastating diagnosis, the authors point out in their paper, and clinicians must learn to support patients and to help them cope. This includes the ability to efficiently build rapport, give them adequate information, and address any concerns within the time constraints of clinical practice.
Most patients do not have an educational background that allows them to fully comprehend the complexity of a cancer diagnosis and treatment. In addition, many clinicians have only limited training to “prepare them to deliver information about complex health issues in a manner that results in comprehension and retention by patients and other nonexperts,” the ASCO authors write.
In the past, say the authors, good communication skills were often viewed as being something innate or that could be acquired by emulating role models. Clinicians were often simply expected to figure it out by themselves, but research suggests that well-designed training programs can improve both the communication skills of providers and patient experience
Thus, this new paper is designed to guide oncology clinicians on effective communication, which will in turn optimize the patient-clinician relationship and patient care.
Key Recommendations
The goal of the guidelines was to answer this question: What communication skills and tasks can clinicians use to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being?
A panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, and communication skills experts along with experts in health disparities and advocacy was convened, and a systematic review of literature published from January 1, 2006, through October 1, 2016, was conducted.
The guideline offers recommendations for core communication skills and discussion of goals for care and prognosis, treatment options and clinical trials, end-of-life care, and cost of care.
It also offers strategies for using communication to facilitate family involvement in care, communicating effectively when barriers exist, meeting the needs of underserved populations, and for clinician training for improving communication skills.
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Programs offering communication skills training should be available to oncologists at every level of practice; they should emphasize role-playing to develop skills, as well observation of interactions with patients in order to provide individual feedback.
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Care goals need to be established with all patients, and it is imperative that the patient understand both their prognosis and treatment options; care goals and the treatment decisions should align with individual patient values and priorities.
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Patients should be encouraged to discuss any concerns and to participate in deciding what issues are discussed during each visit. This type of collaboration fosters trust and confidence for the patient, and it also engages patients and allows them to take an active role in their care.
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Clinicians should initiate conversations about end-of-life preferences early in the course of incurable illness, and the topic should be raised periodically and discussed, based on symptoms, disease progression, and patient preferences.
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Cost of care should be discussed, and for patients who have concerns about this issue, clinicians should work to understand and address the specific concerns directly or make a referral to a financial counselor or social worker.
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Patients should be made aware of all treatment options, which may include clinical trials or palliative care alone, depending on the diagnosis and other individual factors. For appropriate patients, such as those with incurable disease, clinicians should also discuss the option of starting palliative care at the same time as active therapy.
Several of the coauthors report relationships with industry, as noted in the paper.
J Clin Oncol. Published online September 11, 2017. Full text
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