Effective communication skills enable physicians and nurses to improve patients' understanding of their illnesses and their adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment.
Multiple studies document that physician/nurse–patient communication is suboptimal: they fail to identify the concerns of individual cancer patients and their families. Many physicians and nurses have not had effective teaching in communication skills and lack conviction that an educational intervention could improve their skills. Also, continuing medical education consisting of lecture-style presentations consistently fail to change physician behavior.
However, new educational models are being used — in both practice and training — that result in the improvement of physician/nurse communication skills.
Studies and expert practice describe important information about communication with patients and their families for physicians and nurses to reflect upon, outlining a cognitive map of communication that caring professionals can follow during a patient's experience with cancer.
FUNDAMENTAL COMMUNICATION SKILLS
Behaviors to avoid
occurs when a patient raises a concern, but the physician/nurse either fails to respond or redirects the conversation, which usually results in failing to elicit the range of patient concerns.
occurs when a physician/nurse delivers a large amount of information without giving the patient a chance to respond or ask questions.
occurs when patients hesitate to bring up difficult topics and their physicians/nurses do not ask them specifically: a “don't ask, don't tell” situation.
occurs when a physician responds to a patient concern with reassurance before exploring and understanding the concern.
Behaviors to cultivate
This principle is based on the idea that education requires knowing what the learner already knows, then building on that knowledge.
the patient to describe their current understanding of the issue.
the patient in direct language what you need to communicate: bad news, treatment options, or other information.
• Tell me more
. If the conversation is going off track, it is helpful to invite the patient to explain where they are in the conversation, and to remember that every conversation has at least three levels:
1) The “What is happening?” conversation, in which the patient is trying to understand information.
2) The “How do I feel about this?” conversation, in which the patient is trying to realize and understand their emotions.
3) The “What does this mean to me?” conversation, in which the patient is trying to identify what the new information means in terms of their sense of self.
• Respond to emotion
. Rather than providing immediate reassurance, refutation, or agreement, the “accepting response” accepts what the patient says without judgment, acknowledges that patients ought to hold their own views and feelings, and validates the importance of the patient's contributions. It is important to note that “acceptance” is not the same as “agreement.” A physician or nurse could “accept” that a patient wishes to be cured of cancer, but not “agree” that it is possible.
The mnemonic NURSE (N
xploring) summarizes what to do in accepting and responding to patient emotions.
See reference for more information.
Adapted from Back AL et al. Approaching difficult communication tasks in oncology. CA: a cancer journal for clinicians. Internet. Available at https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.55.3.164 Accessed on February 24, 2020.