1. DiGiulio, Sarah

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Better communication means better outcomes when it comes to medicine. That's something doctors and health care researchers have known for a long time. But implementing strategies to improve health care provider-patient communications is easier said than done.

Walter F. Baile, MD.... - Click to enlarge in new windowWalter F. Baile, MD. Walter F. Baile, MD

Now ASCO has taken an important step forward by issuing the organization's first set of guideline recommendations to outline best practices for cancer clinicians when communicating with patients and their loved ones (J Clin Oncol 2017: doi:10.1200/JCO.2017.75.2311).


"Communication skills are essential to providing patient-centered, comprehensive oncology care and should be a key competency for all oncologists," said Walter F. Baile, MD, Professor of Behavioral Science and Psychiatry in the Department of Behavioral Science, Division of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center, Houston, who served as Co-Chair of the ASCO expert panel that authored the guidelines.


ASCO has always taken an interest in promoting good clinician-patient communication, though these are the first clinical practice guidelines that have been issued, Baile told Oncology Times. "More recently, however, we have come to recognize how profoundly important [such communications] are to the patient and family-and are associated with important outcomes, such as end-of-life decisions.


"In addition, we now have evidence that [these skills] can be taught and learned," said Baile, who is also Director of the Interpersonal Communication And Relationship Enhancement (I*CARE) program in the Department of Faculty Development at MD Anderson.


The guideline expert panel conducted a systematic review of previous guidelines, research, and reviews published in the past decade to draft and finalize the recommendations. Key recommendations from the new guideline include the following:


* communication skills training programs should be available to oncologists at every level of practice;


* clinicians should clearly establish care goals with their patients and make sure their patients understand their prognosis, as well as their treatment options;


* clinicians should encourage patients to discuss their concerns and guide conversations;


* clinicians should initiate conversations about patients' end-of-life preferences early in the course of incurable illness, as well as throughout their care;


* clinicians should discuss patient concerns about cost of care; and


* clinicians should make patients aware of all their treatment options, which may include clinical trials or palliative care for some patients.



Here's what else Baile said is important for oncologists and all cancer care providers to know about the new recommendations.


1 The new guideline notes: "Good interpersonal skills are not a substitute for strong health care communications skills." Can you elaborate on what that means and why it's important in these recommendations?

"Communication skills should not be confused with being 'charming' or having good 'bedside manners'-although these may help in establishing rapport with patients and families. Beyond this, many conversations with patients and families can be very challenging, including giving bad news and discussing complex treatments and end-of-life conversations. These require specific skills that can be learned and taught. Moreover, patients value their relationship with their oncologist, which is anchored in good communication skills. In fact, these skills are recognized as an essential component of patient satisfaction with care."


2 How do you intend for clinicians to use these guidelines?

"First of all, we hope they can serve as a guide to help our training programs define what communication skills are essential for our fellows to master as part of their training.


"Secondly, we feel they serve as a tool for how to, not only establish a collaborative relationship with the patient and family, but make recommendations as to when and how to approach difficult communications, such as talking about prognosis and cancer recurrence.


"[And,] they are important guidelines, but providers must remember that every patient and family is different. The guidelines are meant to provide flexibility and a 'patient-centered' or better yet a 'relationship-centered' approach so they can be adapted to the needs and concerns of each patient resulting in truly personalized care."


3 What else needs to happen to actually make these changes (and improvements) in patient-doctor communication happen?

"Communication skills training needs to begin in fellowship and use methods such as simulation and role-play so learners can master specific skills. Barriers are always time and competition with other learning in the curriculum. [But], beginning early during formative years can allow oncologists to master skills that will serve them during the more than 30,000 encounters with patients and families they are likely to have over the course of their career. For more senior clinicians, learning to use communication protocols for giving bad news is useful."