Researchers Look for Ways to Improve Communication Between Cancer Patients and Doctors

Frank, open discussions between cancer patients and their doctors is a key part of getting good care. Ideally, these discussions help patients make informed decisions by giving them a good understanding of what to expect from treatment and their chances for recovery (prognosis).

But often, especially for patients who may be near the end of life, high quality conversations about quality of life, prognosis, and treatment choices happen either too late or not at all. And when they do happen, misunderstandings often occur that can lead patients to have unrealistic expectations and make treatment choices that they or their loved ones might later regret.

Researchers from the University of Rochester set out to learn whether training patients/caregivers and oncologists would help improve their communication. The study involved 265 people with advanced cancer and 38 oncologists. Half the people in each group were randomly assigned to receive training.

The training was brief, so it was more likely participants would complete it. Training for patients included meetings with social workers or nurses to practice asking questions, expressing their fears, being assertive, and stating their preferences. They were also given a booklet to read. Doctors’ coaching included mock office sessions with actors portraying patients, video training, and customized feedback.

Mixed results

In conversations among trained doctors and patients, the patients were much more likely to be motivated to ask questions. Their oncologists were also more emotionally engaged. In addition, more meaningful discussions occurred about difficult topics including prognosis and end-of-life issues.

However, gaps in understanding between patients and oncologists remained. For example, some patients believed it was likely they would be cured, and more than half thought they would still be alive in 2 years, but average survival in this study was 16 months. “We need to embed communication interventions into the fabric of everyday clinical care,” said co-author Ronald Epstein, MD. “This does not take a lot of time, but in our audio-recordings there was precious little dialogue that reaffirmed the human experience and the needs of patients. The next step is to make good communication the rule, not the exception, so that cancer patients’ voices can be heard.”

Tips for meaningful discussions

The goals of training were to get patients more involved in discussions with doctors about their care and to encourage doctors to be more responsive to patients’ emotions and discussions about prognosis. As a result, the researchers found that patients were more likely to ask about their treatment choices and their chances of getting better.

Patients who received training were encouraged to:

  • Be assertive
  • Ask questions about their disease, treatment choices, prognosis, and quality of life
  • Ask about the pros and cons of important choices
  • Ask for clarification when they didn’t understand something
  • Express concerns and opinions
  • Express emotions including fear and sadness

Doctors who received training were encouraged to:

  • Ask patients what questions were most important to them
  • Ask patients what they wanted to know about their prognosis and treatment choices
  • Check that patients understood what they were saying
  • Give pauses in the conversation for patients to answer or process the information just discussed
  • Explain the percentage of patients who are likely to benefit from a treatment, and the percentage of patients who are not likely to benefit
  • Identify and acknowledge patients’ emotions and express empathy

The study was published online September 9, 2016 in JAMA Oncology.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer. Published online September 9, 2016 in JAMA Oncology. First author Ronald M. Epstein, MD, University of Rochester Medical Center, Rochester, NY.

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