Abstract
To develop recommendations for effective communication between cancer health care providers and patients based on a systematic review of methods of clinician-patient communication that may affect patient outcomes associated with distress at critical points in the course of cancer care. A systematic review of the literature was conducted, and evidence-based recommendations were formulated to guide clinician-patient communication in cancer care. A formal external review was conducted to validate the relevance of these recommendations. Recommendations for communication in cancer care are presented, based on guidelines from the Australian National Breast Cancer Centre and the Australian National Cancer Control Initiative,an updated systematic review of the research evidence, and a consensus by the Clinician-Patient Communications Working Panel of the Program in Evidence-Based Care of Cancer Care Ontario. The recommendations were sent to 110 Ontario practitioners for external review: 33 responded (30% response rate). Most of these respondents (87%) agreed with the draft recommendations and approved of their use as a practice guideline (90%). A condensed version of the recommendations, including 10 key points, was also created. There is evidence to support general clinician-patient communication approaches, although the preferences of cancer patients regarding such communication exhibit individual and cultural variability. Recommendations are provided, based on evidence, the consensus of an expert panel, and feedback from a survey of external practitioners. Evidence evaluating the role of decision aids and strategies to facilitate better communication is inconsistent, although such tools may be of value for some patients.
Highlights
A relationship of health care providers with patients, based on trust, respect, and reciprocity, and with mutually negotiated goals and expectations, can be an important support and buffer for cancer patients experiencing distress
Evidence evaluating the role of decision aids and strategies to facilitate better communication is inconsistent, such tools may be of value for some patients
Clinician–patient communication is a fundamental aspect of cancer care that significantly affects the therapeutic relationship, the well-being of patients and families, treatment decision-making and compliance, and the capacity of patients and families to plan for alternative trajectories in the disease and treatment course
Summary
A relationship of health care providers with patients, based on trust, respect, and reciprocity, and with mutually negotiated goals and expectations, can be an important support and buffer for cancer patients experiencing distress. Communication serves to build and maintain this relationship, to transmit information, to provide support, and to negotiate treatment decisions. The process of communication between providers and cancer patients can significantly affect clinical outcomes 1. Recent evidence demonstrates that communication in cancer care may often be suboptimal, with regard to the emotional experience of the patient 2. The aim of the present paper is to present recommendations for effective clinician–patient cancer-related communication during consultation visits, which may prevent or alleviate patient distress. We hope that the recommendations will help to promote empathic and effective communication in medical and cancer care settings
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