Communication is a critical element in the physician-patient relationship, especially between a patient with cancer and their oncologist.
Communication is a critical element in the physician-patient relationship, especially between a patient with cancer and their oncologist. It builds trust, provides peace of mind, and contributes positively to treatment adherence, all of which are crucial during the cancer journey.
In addition to its life-threatening nature, cancer carries a social stigma. “When people want to portray something as horrible, they will often use the word cancer,” says Walter Baile, MD, professor of behavioral science and director of I*CARE, or Interpersonal Communication and Relationship Enhancement at the University of Texas M.D. Anderson Cancer Center. “When people think about cancer, they think about dying and they think about suffering. And so the anxiety and the fear that are associated with the disease creates an emotional terrain through which the oncologist and the oncology clinician need to navigate.”
Navigating this terrain isn’t always easy.
Skip Granai, MD, chief of the program in women’s oncology at Women & Infants Hospital in Rhode Island, believes that physicians and caregivers need to do a better job of communicating with their patients. And in borrowing from a professor colleague, he suggests that they start by being better performance artists.
“If you’re telling someone that they have cancer, and they’re surrounded by their family, as soon as you say the word cancer, their ears will go deaf, or they won’t hear things the way you mean it,” Granai explains. “They’re all looking at you. You’re dead center in their spotlight, like a performance artist, and all of them are hearing or interpreting something different.”
Granai believes it’s not so much the words that the oncologist says, but the intention that’s key. That begins the process of communication even beyond the words, because there are times when doctors simply do not know what to say. In those times, a colleague once told Granai, he will fluff up the patient’s pillow. “It’s the smallest thing, but sometimes the smallest gestures can say so much. And I guarantee that if a doctor fluffs up a pillow for a patient laying in bed, the patient remembers that, and so do their families.”
Learn what not to say
Suzanne Lindley is a colon cancer survivor and patient who lobbies on Capitol Hill for cancer patients’ rights and research funding. She received her cancer diagnosis 10 years ago, when she was 31-years old. She says that following her surgery, the surgeon told her that there wasn’t much hope, and to go home, spend time with her family, and get her affairs in order. “If the doctor would have said, ‘There’s only one treatment and it has been around for 45 years. But you’re young, you’re otherwise healthy, so let’s give it a shot,’ I would have had a totally different perspective on my treatment.”
Lindley says that physicians often use the phrase “the patient has failed the chemotherapy.” She points out, however, that it’s not the patient who failed the chemotherapy, it’s the treatment that failed the patient. A doctor once told her that she was terminal. “We’re all terminal,” she says, “but we want to live as fully as we can and not think about being terminal. The language and the words that are put behind the conversation are very important.” That language, Lindley adds, needs to be realistic, but it can also inspire hope. “And if we don’t have hope, what do we have?”
Tools for the job
Both Granai and Baile believe that good communication skills can be taught. To that end, Baile and the M.D. Anderson Cancer Center have created I*CARE, an online education tool to help healthcare professionals communicate more effectively with cancer patients and their families. Video lectures are geared not only to help doctors tell the truth, but to respond in a way that the patient feels the doctor is there with them, doing everything he or she can.
“That’s sort of an attachment that cancer patients have with their treatment team, and it’s a very deep attachment,” Baile says. “Clinicians need to know how to take advantage of that relationship to promote the patient’s quality of life; how to validate the patient’s emotions; and how to provide the kind of education that is honest and yet hopeful.”
The bottom line, says Baile, is that communication is not some nebulous thing that physicians either have or they don’t have. It’s a skill, and those who have been exposed to communication skills training value it highly. “[Physicians] who are exposed to techniques like how to deliver bad news or respond to a patient’s emotions really feel more confident about their communication skills. If you’re caring, and you’re interested in the patient as a person, those variables rate extraordinarily high on a patient’s list of what’s meaningful to them.”
Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at email@example.com.