Improving Physician-Patient Communication
By Jo Cavallo
March 10, 2023
In 2017, ASCO published a new guideline in the Journal of Clinical Oncology outlining the best practices for communicating effectively with patients and their family members.1 The goal of the communication guideline is to provide oncologists with a framework of specific practices to enable them to deliver complex information to patients in a supportive manner and to build on oncology care that is both patient-centered and relationship-centered to help oncologists gain an understanding of who their patients are and what is important to them, so patients can be more active participants in their care.
Here are a few key guideline recommendations:
- Start conversations with patients by asking what their understanding is of their disease and collaboratively set an agenda to discuss the issues that are most important to patients and family members, as well as to the clinician.
- Engage in behaviors that foster trust, confidence in the clinician, and collaboration by reviewing the patient’s medical chart in advance of the meeting; be friendly, but not overly casual; make eye contact; engage in reflective listening; get to know the patient and how cancer has changed the patient’s life; ask about how the patient and family are coping and feeling; and be honest, genuine, and respectful.
- Provide diagnostic and prognostic information tailored to patients’ needs and ensure that patients understand their prognosis and treatment options; clarify the goals of treatment, including cure vs prolongation of survival vs quality of life, and that the care goals align with the patients’ values and priorities. Oncologists should also ask about whether the cost of care is a concern; if it is, specific concerns should be addressed directly with patients, or patients should be referred to a financial counselor or social worker for resources.
- Initiate conversations about end-of-life preferences early in the course of incurable illness and then revisit the discussion when there are important changes in patients’ condition or in the course of their disease.
- Provide patients with all treatment options, including clinical trials or palliative care alone if appropriate. For patients with incurable cancers, discuss the option of starting palliative care simultaneously with active cancer therapy.
In addition to these steps, ASCO’s guideline recommends that communication skills training be made available to oncologists at every level of practice and that training emphasize skills practice and experiential learning using role-play scenarios conducted by trained facilitators and direct observation of patient encounters. The guideline also recommends that skills-practice exercises include structured feedback, so clinicians can learn which of their behaviors are effective and where their performance may need improvement.
1. Gilligan T, Coyle N, Frankel RM, et al: Patient-clinician communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 35:3618-3632, 2017.
Studies have shown that although patients with advanced cancer want their oncologists to give them an honest assessment of their prognosis, most patients still perceive their illness as curable.1 And that lack of understanding of their prognosis can lead to reduced use of hospice care and increased ...