Thomas A. D'Agostino

Communication Skills Training for Oncology Professionals

PURPOSE To provide a state-of-the-art review of communication skills training (CST) that will guide the establishment of a universal curriculum for fellows of all cancer specialties undertaking training as oncology professionals today. METHODS Extensive literature review including meta-analyses of trials, conceptual models, techniques, and potential curricula provides evidence for the development of an appropriate curriculum and CST approach. Examples from the Memorial Sloan-Kettering Cancer Center CST program are incorporated. RESULTS A core curriculum embraces CST modules in breaking bad news and discussing unanticipated adverse events, discussing prognosis, reaching a shared treatment decision, responding to difficult emotions, coping with survivorship, running a family meeting, and transitioning to palliative care and end of life. Achievable outcomes are growth in clinicians self-efficacy, uptake of new communication strategies and skills, and transfer of these strategies and skills into the clinic. Outcomes impacting patient satisfaction, improved adaptation, and enhanced quality of life are still lacking. CONCLUSION Future communication challenges include genetic risk communication, concepts like watchful waiting, cumulative radiation risk, late effects of treatment, discussing Internet information and unproven therapies, phase I trial enrollment, and working as a multidisciplinary team. Patient benefits, such as increased treatment adherence and enhanced adaptation, need to be demonstrated from CST.

Doctor–Patient Communication About Cancer-Related Internet Information

This article explores the effect of doctor–patient communication about cancer-related Internet information on self-reported outcomes. Two hundred and thirty cancer patients and caregivers completed an online survey regarding their experiences searching for and discussing with their doctors cancer-related Internet information. Participants who assertively introduced the Internet information in a consultation were more likely to have their doctor agree with the information. When doctors showed interest and involvement and took the information seriously, participants were less likely to report a desire to change the doctors response. Taking the information seriously was also associated with greater satisfaction. This preliminary evidence that the doctors response is associated with patient outcomes indicates the potential for improving patient-centered communication. In an effort to maximize patient-centered communication, doctors should be encouraged to take their patients and the information they present seriously, as well as show their patients that they are interested and involved.

Impact of provider-patient communication on cancer screening adherence: A systematic review.

Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a persons decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.

Improving Clinical Communication and Promoting Health through Concordance-Based Patient Education

In recent years, communication education has been used as a means of improving the clinician–patient relationship and promoting health. The focus of these interventions has primarily centered on clinician training. An area that has received less focus, although equally important, is training patients to be good communicators. The purpose of the paper is to first introduce clinician–patient ‘concordance’ as a conceptual framework for patient communication education. Second, we provide a review and critique of the literature on existing patient communication interventions. Finally, we conclude with a discussion of two specific patient populations that face challenges and obstacles in clinician–patient communication and preliminary work we are doing in these areas: complementary and alternative medicine users and the medically underserved.

Evaluation of a pilot communication skills training intervention for minority cancer patients.

The aim of this study was to pilot test in a minority cancer patient population a communication workshop to improve doctor–patient communication skills. Thirty-two patients participated. Eighteen evaluated a face-to-face workshop, while 14 completed surveys only. Participants in the workshop group completed the Patient Report of Communication Behavior (PRCB) before and after the workshop and a course evaluation. Participants did not differ on baseline PRCB scores. Posttest scores were significantly higher than pretest scores (p < 0.01). All participants agreed or strongly agreed that they would use the communication skills; 93% agreed or strongly agreed that the skills would improve their health care.

Disengagement beliefs in South Asian immigrant smokeless tobacco users: A qualitative study

Gutka and tambaku paan (smokeless tobacco products used by South Asian immigrants) are carcinogenic to humans (and perceived as such), yet, one-fourth of South Asian immigrants report current use. This study examined disengagement beliefs that perpetuate gutka/tambaku paan use among South Asians despite awareness of health risks. Six focus groups were conducted with immigrant South Asian adult gutka/tambaku paan users, in Gujarati, Bengali and Urdu languages in New York, USA. Participants included 39 South Asian adults residing in the New York City Metropolitan area, current (a minimum of weekly gutka or tambaku paan use in the last 12 months) or former (regular use prior to past 12 months) gutka or tambaku paan users and self-reported spoken fluency in Gujarati, Urdu or Bengali languages. Participants identified many health risks associated with gutka/tambaku paan use including locked jaw, high blood pressure and cancer. Five themes of disengagement beliefs emerged: (a) skepticism about the gutka/tambaku paan–cancer link, (b) perceived invulnerability to harm, (c) compensatory beliefs, (d) faith-based rationalization and (e) acknowledgment of addiction. To promote smokeless tobacco cessation among South Asians, interventions to counter disengagement beliefs and heighten the discomfort between the dissonant cognitions represent a promising area warranting further attention.

Cancer-related internet information communication between oncologists and patients with breast cancer: a qualitative study

Many patients with cancer search out information about their cancer on the internet, thus affecting their relationship with their oncologists. An in‐depth analysis of patient–physician communication about information obtained from the internet is currently lacking.

Exposure to and Intention to Discuss Cancer-Related Internet Information Among Patients With Breast Cancer

PURPOSE Previous studies have reported a significant number of patients with breast cancer seek cancer-related information from the Internet. Most studies have asked whether a patient has ever read Internet information since her diagnosis. The purpose of this study was to assess the frequency with which patients with breast cancer come to physician appointments having recently read and intending to discuss cancer-related information from the Internet. PATIENTS AND METHODS We asked 558 patients with breast cancer who were waiting to see their physicians about their experiences reading cancer-related information from the Internet and their intent to discuss the information in their current visit. RESULTS Fifteen percent reported reading cancer-related Internet information in the past month. Patients who had read such information in the past month were younger, had been diagnosed more recently, and were more likely to be attending a new visit. Of those who had read in the past month, 45% reported intending to discuss what they had read with their physician. Nineteen percent of patients reported having ever read breast cancer-related Internet information since their diagnosis. CONCLUSION The proportion of patients with breast cancer planning to discuss Internet information during their current physician visit was relatively small. Few characteristics were associated with recent Internet use or intent to discuss.

Patient-Reported Physical Function Measures in Cancer Clinical Trials

Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.

Prognostic Awareness and Communication Preferences among Caregivers of Patients with Malignant Glioma.

Malignant glioma (MG) is a devastating neuro‐oncologic disease with almost invariably poor prognosis, yet many families facing malignant glioma have poor prognostic awareness (PA), or the awareness of the patients incurable disease and shortened life expectancy. Accurate PA is associated with favorable medical outcomes at end‐of‐life for patients and psychosocial outcomes for informal caregivers (ICs) through bereavement. To date, however, no study has specifically examined PA among MG ICs and the information they receive that shapes their awareness.