Communicating with cancer patients
As in all specialities, good communication with patients is vital, but the emotional nature of cancer creates a potential barrier for both students and doctors in training. Furthermore, poor communication can result in medical, legal and ethical problems, precipitating strain on the patients and healthcare professionals.
Although healthcare professionals will have individual techniques for communicating with patients depending on their personality, most will follow some basic techniques. The key point is to understand what works best for you and to incorporate appropriate tools and tactics (Tables 9.1 and 9.2), while remembering that nothing is more transparent to a patient than speaking to someone who is ‘acting’. It is important to develop insight into what may be preventing the patient from communicating effectively with you and vice versa. An awareness of any barriers to mutual communication is a key skill for the healthcare professional.
The doctor–patient relationship
Cancer patients are seen over long periods of time and often when emotions are at their most fraught. It is essential to create a trusting environment where the patient feels safe, and to establish expectations and professional boundaries at the primary consultation.
Patients should be involved in the planning of their own treatment and the role of an oncologist is to outline the diagnosis, implications, potential outcome and the rationale and expectations of treatment. Patients should be able to make informed decisions about their treatment or, indeed, the withdrawal of their treatment and planning of end of life care. Patients can feel overwhelmed with the treatment options available to them and clarity of communication is vital.
Breaking bad news
In order to break bad news, it is important to consider what this encompasses. ‘Bad news’ can be anything that negatively alters the patient’s view of their future, resulting in a cognitive, behavioural, or emotional deficit in that person. It is important not to become so detached that one cannot realise that a patient is experiencing what may be bad news for them when you had not imagined it to be so. Every healthcare professional should be able to pre-empt a situation where bad news is to be shared and there are steps to follow that will help.
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