Jean Klastersky

How to Optimize Physicians’ Communication Skills in Cancer Care: Results of a Randomized Study Assessing the Usefulness of Posttraining Consolidation Workshops

PURPOSEnAlthough there is wide recognition of the usefulness of improving physicians communication skills, no studies have yet assessed the efficacy of post-training consolidation workshops. This study aims to assess the efficacy of six 3-hour consolidation workshops conducted after a 2.5-day basic training program.nnnMETHODSnPhysicians, after attending the basic training program, were randomly assigned to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual patient interviews that were audiotaped at baseline and after consolidation workshops for the consolidation-workshop group, and approximately 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients perceptions of communication skills improvement were assessed using a 14-item questionnaire.nnnRESULTSnSixty-three physicians completed the training program. Communication skills improved significantly more in the consolidation-workshop group compared with the waiting-list group. In simulated interviews, group-by-time repeated measures analysis of variance showed a significant increase in open and open directive questions (P =.014) and utterances alerting patients to reality (P =.049), as well as a significant decrease in premature reassurance (P =.042). In actual patient interviews, results revealed a significant increase in acknowledgements (P =.022) and empathic statements (P =.009), in educated guesses (P =.041), and in negotiations (P =.008). Patients interacting with physicians who benefited from consolidation workshops reported higher scores concerning their physicians understanding of their disease (P =.004).nnnCONCLUSIONnConsolidation workshops further improve a communication skills training programs efficacy and facilitate the transfer of acquired skills to clinical practice.

Physicians' communication with a cancer patient and a relative : A randomized study assessing the efficacy of consolidation workshops

Although patients with cancer are often accompanied by a relative during medical interviews, to the authors knowledge little is known regarding the efficacy of communication skills training programs on physicians communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5‐day basic training program.

Factors that influence physicians' detection of distress in patients with cancer - Can a communication skills training program improve physicians' detection?

No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians ability to detect distress in patients with cancer.

Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum

BackgroundIneffective physicians’ communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians’ key communication skills, contributing to improvements in patients’ satisfaction with care and physicians’ professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients.Curriculum descriptionThe 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians’ knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice.ConclusionsThe BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.

Does psychological characteristic influence physicians' communication styles? Impact of physicians' locus of control on interviews with a cancer patient and a relative

ContextPhysicians’ psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication.ObjectiveOur aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an “external” locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an “internal” LOC (who believe that life outcomes are controlled by their own characteristics or actions).Design, setting, participants and interventionEighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative.Main outcome measuresPhysicians’ communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians’ LOC was assessed using the Rotter I–E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student’s t test.ResultsIn actual interviews, physicians with an “external” LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an “internal” LOC. In simulated interviews, physicians with an “external” LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an “internal” LOC.ConclusionThese results provide evidence that physicians’ LOC can influence their communication styles. Physicians’ awareness of this influence constitutes a step towards a tailoring of their communication skills to every patient’s and relative’s concerns and needs and thus towards a patient-centred communication.

Insight on variables leading to burnout in cancer physicians

Although communication skills training programs have been recommended to reduce physicians burnout, few studies have investigated their efficacy. This study assessed the impact of two training programs on cancer physicians burnout. Especially, it identified some variables leading to burnout in order to develop effective interventions. Burnout was assessed with the Maslach Burnout Inventory. No statistically significant impact of training programs on burnout was observed. The amount of clinical workload and the overuse of some facilitative communication skills were associated with cancer physicians burnout. The content of such programs must be redefined to reduce burnout.

Erratum: Impact of medical specialists' locus of control on communication skills in oncological interviews (British Journal of Cancer (2003) 88 (502-509))

Correction to: British Journal of Cancer (2003) 88, 502–509. doi: 10.1038/sj.bjc.6600797 Unfortunately because of a typesetting error, Tables 1 and 3 were reproduced incorrectly. The correct versions are printed below: The publisher would like to apologise for any inconvenience this may have caused.

Physicians’ communication with a cancer patient and a relative: A randomised study assessing the efficacy of consolidation workshops

BACKGROUNDnAlthough patients with cancer are often accompanied by a relative during medical interviews, to the authors knowledge little is known regarding the efficacy of communication skills training programs on physicians communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program.nnnMETHODSnAfter attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients and relatives perceptions of and satisfaction with physicians communication performance were assessed using a 15-item questionnaire.nnnRESULTSnSixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022).nnnCONCLUSIONSnSix 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews.