Jean-Louis Slachmuylder

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.

Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study

Background:Although patients with cancer are often accompanied by a relative during breaking bad news (BBN) consultations, little is known regarding the efficacy of training programmes designed to teach residents the communication skills needed to break bad news in a triadic consultation.Methods:Residents were randomly assigned to a 40-h dyadic and triadic communication skills training programme (n=48) or a waiting list (n=47). A simulated BBN triadic consultation was audiotaped at baseline, and after training for the training group, and 8 months after baseline for the waiting list group. Transcripts were analysed using content analysis software (LaComm). A coder determined the moment of bad news delivery and the relative’s first turn of speech regarding the bad news. A generalised estimating equation was used to evaluate residents’ communication skills, BBN timing, and the relative’s inclusion in the consultation.Results:Ninety-five residents were included. After training, the duration of the pre-delivery phase was found to be longer for the trained residents (relative risk (RR)=3.04; P<0.001). The simulated relative’s first turn of speech about the bad news came more often during the pre-delivery phase (RR=6.68; P=0.008), and was more often initiated by the trained residents (RR=19.17; P<0.001). Trained residents also used more assessment (RR=1.83; P<0.001) and supportive utterances (RR=1.58; P<0.001).Conclusion:This study demonstrates that a training programme that focuses on the practice of dyadic and triadic communication skills can improve the communication skills of the participating residents in a BBN triadic consultation. Such a training should be included in resident curriculum.

Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying in older cancer patients.

Anxiety at the first radiotherapy session for non-metastatic breast cancer: Key communication and communication-related predictors.

BACKGROUND AND PURPOSE Patients may experience clinically relevant anxiety at their first radiotherapy (RT) sessions. To date, studies have not investigated during/around the RT simulation the key communication and communication-related predictors of this clinically relevant anxiety. MATERIAL AND METHODS Breast cancer patients (n=227) completed visual analog scale (VAS) assessments of anxiety before and after their first RT sessions. Clinically relevant anxiety was defined as having pre- and post-first RT session VAS scores ⩾4 cm. Communication during RT simulation was assessed with content analysis software (LaComm), and communication-related variables around the RT simulation were assessed with questionnaires. RESULTS Clinically relevant anxiety at the first RT session was predicted by lower self-efficacy to communicate with the RT team (OR=0.65; p=0.020), the perception of lower support received from the RT team (OR=0.70; p=0.020), lower knowledge of RT-associated side effects (OR=0.95; p=0.057), and higher use of emotion-focused coping (OR=1.09; p=0.013). CONCLUSIONS This study provides RT team members with information about potential communication strategies, which may be used to reduce patient anxiety at the first RT session.

Une « toxicité » sous-estimée : les impacts psychosociaux des traitements sur les proches aidants principaux

RésuméDans le cadre d’une étude belge multicentrique, cet article rapporte l’évaluation qualitative et quantitative des besoins psychosociaux des proches aidants principaux des patients atteints d’un cancer, ainsi que les difficultés vécues par ces proches à faire face aux besoins psychosociaux des malades. De janvier à novembre 2004, l’ensemble des proches aidants principaux des patients atteints d’un cancer et hospitalisés au sein de sept unités de soins en oncologie, ainsi que le proche aidant principal d’un patient sur deux consultant au sein de ces mêmes unités ont étéinvités à prendre part à l’étude. Les proches aidants principaux ont rempli une adaptation du questionnaire Cancer Rehabilitation Evaluation System (CARES) permettant l’investigation de 24 types de difficultés ayant pu être rencontrées au cours du dernier mois, ainsi qu’une seconde adaptation du CARES permettant d’évaluer leur perception de 38 types de difficultés potentielles chez leur proche malade au cours du dernier mois. Les sujets ont également étéinvités à indiquer s’ils avaient eu des difficultés à faire face à chaque difficulté perçue chez leur proche malade. Les informations médicales relatives aux patients ont étérécoltées auprès de leurs oncologues. Parmi les 284 proches aidants principaux inclus, une grande majoritéa rencontré au cours du dernier mois une à plusieurs difficultés physiques, psychosociales, sexuelles de même que des difficultés de communication avec leur partenaire. La majorité des proches aidants principaux perçoit de nombreuses difficultés chez leur proche malade et 20 à 60 % d’entre eux rapportent éprouver au moins un peu de difficulté à faire face à ces difficultés. À côtéde leurs nombreuses difficultés personnelles, les proches aidants principaux des patients atteints d’un cancer perçoivent donc de nombreuses difficultés psychosociales chez leur proche malade. Les proches aidants principaux éprouvent également de nombreuses difficultés à gérer ces difficultés perçues. Le nombre et l’importante variété des difficultés rapportéesdans cette étude reflètent une « toxicité » sous-estimée : celle liée aux impacts et conséquences psychosociaux des traitements sur les proches aidants principaux.AbstractAs part of a multicenter, descriptive, cross-sectional study in Belgium, this report offers a qualitative and quantitative assessment of the psychosocial needs of cancer caregivers and the problems they experience in providing care to family members suffering from cancer. FromJanuary to November 2004, all the primary caregivers caring for the inpatients in seven oncology departments, as well as half of the primary caregivers caring for outpatients in the same departments, were invited to participate in the study. They completed a French version of the Cancer Rehabilitation Evaluation System (CARES) form, which assesses 26 problems potentially experienced by caregivers during the previous month. A second version of CARES evaluated their perception of 38 problems experienced during the previous month by their family members under treatment for cancer. The caregivers also reported the difficulties they faced when addressing the problems they perceived in their ill relatives. The majority of the 284 participants experienced physical, psychosocial, and sexual difficulties, including problems communicating with their partners during the time period studied. In addition, most of them perceived many psychosocial and physical problems in the patients they were caring for, and 20 to 60 % of the caregivers reported at least a little difficulty managing those problems. The number and diversity of the problems reported in this study reveal an underestimated “toxicity,” defined by the psychosocial impact of cancer treatment on caregivers.

Les besoins psychosociaux et le soutien apporté aux patients atteints d'un cancer : une étude nationale belge

Résumé:Dans le cadre d’une étude Belge multicentrique, cet article rapporte l’évaluation qualitative et quantitative des besoins psychosociaux des patients atteints d’un cancer ainsi que les aides qu’ils souhaitent et reçoivent de la part de médecins spécialistes et d’infirmiers (ières). De janvier à novembre 2004, l’ensemble des patients atteints d’un cancer et hospitalisés au sein de sept unités de soins en oncologie, ainsi qu’un patient sur deux consultant au sein de ces mêmes unités ont été invités à prendre part à l’étude. Ces patients ont rempli un questionnaire sociodémographique ainsi qu’une adaptation française du Cancer Rehabilitation Evaluation System (CARES) investigant, à l’aide de 138 items, 38 types de difficultés potentiellement rencontrées au cours du dernier mois. De plus, pour chaque type de difficulté rencontrée, les patients ont signalé s’ils ont souhaité et reçu de l’aide de la part de médecins spécialistes et d’infirmiers (ières). Les informations médicales relatives à ces patients ont été récoltées auprès de leurs oncologues. Parmi les 382 patients inclus, une grande majorité a rencontré au cours du dernier mois une à plusieurs difficultés physiques, psychosociales, sexuelles ainsi que des difficultés liées aux conséquences des traitements. L’intensité des difficultés vécues est la plus élevée au niveau des difficultés physiques dans le cadre professionnel, des difficultés sexuelles et des difficultés liées aux traitements. Les patients ont attendu et reçu de l’aide de la part de médecin(s) spécialistes(s) et d’infirmiers (ières) pour faire face à de très nombreuses difficultés médicales mais également psychosociales. Les seules difficultés pour lesquelles ils rapportent avoir reçu moins d’aide qu’ils n’en ont souhaitée sont les difficultés à obtenir des informations concernant leur maladie. Cette étude souligne la diversité des difficultés rencontrées par les patients atteints d’un cancer et la nécessité d’informer les patients sur les aides que d’autres professionnels que les médecins spécialistes et les infirmiers (ières) peuvent leur apporter pour faire face à ces difficultés.Abstract:The study is part of a Belgian study assessing qualitatively and quantitatively the needs of Belgian cancer patients, and their expectations from specialists and nurses. From January to November 2004, all the inpatients of 7 oncological units were invited to take part in the study, as well as one outpatient out of 2 from the same units. Patients filled in a sociodemographic questionnaire based on the French Cancer Rehabilitation Evaluation System (CARES), which assess 38 types of difficulties experienced over the last month. This questionnaire includes 138 items. For each kind of difficulty experienced, patients were asked to mention if they had wished and obtained help from specialist(s) and nurse(s). In addition, the physicians had to report patients’ disease-related characteristics. The results show that The majority of the 382 patients who took part in the study experienced physical, psychosocial, sexual and treatment-related difficulties in the last month. The most intense difficulties include physical difficulties in the workplace, sexual difficulties and treatment-related difficulties. The patients asked for help to specialists and nurses (and obtained it) to cope with numerous medical difficulties, as well as psychosocial difficulties. The only difficulties for which the patients did not receive the help they had wished were about obtaining information on their disease. This study highlights the diversity of the difficulties experienced by cancer patients, and the need to inform them about the help that could be given by professionals other than specialists and nurses to cope with psychosocial difficulties.

Development of the LaComm 1.0, A French medical communication analysis software: A study assessing its sensitivity to change

OBJECTIVE To test and compare the sensitivity to change of a communication analysis software, the LaComm 1.0, to the CRCWEMs using data from a randomized study assessing the efficacy of a communication skills training program designed for nurses. METHODS The program assessment included the recording of two-person simulated interviews at baseline and after training or 3 months later. Interview transcripts were analyzed using the CRCWEM and the LaComm 1.0 tools. RESULTS One hundred and nine oncology nurses (mainly graduated or certified) were included in the study. The CRCWEM detected 5 changes out of 13 expected changes (38%) (e.g., more open directive questions after training) and the LaComm 1.0, 4 changes out of 7 expected changes (57%) (e.g., more empathic statements after training). For open directive question, the effect sizes of the group-by-time changes were slightly different between tools (CRCWEM: Cohens d=0.97; LaComm 1.0: Cohens d=0.67). CONCLUSIONS This study shows that the LaComm 1.0 is sensitive to change. PRACTICE IMPLICATIONS The LaComm 1.0 is a valid method to assess training effectiveness in French. The use of the Lacomm 1.0 in future French communication skills training programs will allow comparisons of studies.

Predictors and correlates of burnout in residents working with cancer patients.

There are few studies which have investigated variables associated with the development of burnout among residents working with cancer patients. The aim of this study is to identify variables leading to residents’ burnout in order to develop effective interventions. Burnout was assessed with Maslach Burnout Inventory. Person- (i.e., emotional-focused coping) and work-related (i.e., changes in lack of organizational support index) variables explain 28% of the variance in changes in emotional exhaustion. Training programs may be improved by adding specific modules for residents, about problem-focused coping in interviewing patients, and for supervisors, about effective team management.

Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: A randomized clinical trial comparing the benefits of single-component and multi-component group interventions

To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15‐session single‐component group intervention (SGI) based on support with those of a 15‐session multiple‐component structured manualized group intervention (MGI) combining support with cognitive‐behavioral and hypnosis components.

Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study

Although cancer patients frequently experience self‐perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self‐perceived burden to the primary caregiver (SPB‐PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation.