DEPARTMENT: Cochrane Nursing Summary
Good communication between health professionals and their patients is essential for high-quality healthcare in all settings. Patients with cancer and their relatives often experience psychological stress, which may be reduced by effective communication and support from health professionals. The ability to communicate supportively should be part of any health professional’s practice; however, this skill does not reliably improve with experience alone. Therefore, it is important to offer communication skills training (CST) for health professionals working with cancer patients.
Are forms of CST effective in improving communications skills of health professionals working in cancer care and in improving patient health status and satisfaction?
The intervention of interest was any type of CST, for example, study days, teaching pack, distance learning, and workshops. The reviewers included all types and approaches to teaching, any length of training, and any focus of communication. Interventions should be compared with other CST or no CST. Participants were qualified healthcare professionals (HCPs) working in cancer care, such as medical, nursing, and allied health professionals, working in a hospital, hospice, and/or ambulatory care settings. The primary outcomes of interest were changes in communication skills of health professionals measured by interactions with real and/or simulated patients with cancer, using objective scales. Secondary outcomes included burnout of HCPs, patient health status, and patient perception of HCPs’ communication skills.
A total of 15 randomized controlled trials conducted mainly in outpatient settings were included in the review. A total of 1138 HCPs participated in the studies: 536 doctors, 522 nurses, and 80 mixed HCPs. The majority of trials (n =11) compared CST with no communications skills training; 1 trial compared 1 type of CST with another, and the other 3 compared a follow-up intervention after initial CST. Six trials focused on nurses, whereas the others involved oncologists, residents, other doctors, and a mixed team. The majority of the studies included in the review (12 of 15) were considered to be at low risk of being subject to biases. Meta-analysis was undertaken where possible.
CST Compared With No CST
- Six studies were included in a quantitative synthesis (meta-analysis).
- The intervention groups were statistically significantly more likely than the control groups to use open-ended interview questions (P = .04).
- The intervention groups were statistically significantly more likely than the control groups to show empathy (P = .004).
- There were no statistically significant differences between the 2 groups regarding clarifying and/or summarizing, eliciting concerns, giving appropriate information, giving facts only, and negotiating.
- The following skills were evaluated in some single studies, but could not be included in the quantitative synthesis (meta-analysis):
- ○ Emotional depth: 2 studies found a significantly greater emotional depth in the intervention group (P = .03 and P = .05).
- ○ Empathy: 1 study found less empathy in the intervention group (P = .024).
- ○ Checking that the patient understands: 1 study reported significantly less checking of patients understanding in the intervention group. Two studies reported no difference between the groups.
- ○ Emotional support: 1 study reported an improvement in emotional support in the intervention group, but gave no information about significance.
- ○ Appropriate information: 1 study reported less appropriate information giving in the intervention group (P = .05). Two studies reported an improvement in information-giving skills.
- ○ Team-oriented focus: 1 study reported greater team orientation in the intervention group (P = .023).
- ○ Blocking behaviors: 3 studies found no significant effect of intervention (P = .66). One study found significantly less blocking behavior in the intervention group (P = .001).
- ○ Global score: Two studies reported significantly better global score for communication skills in the intervention group (P = .001 and P = .007).
- Doctors only: 3 studies enrolling doctors were included in a meta-analysis for this subgroup. Doctors in the intervention group were statistically more likely than the control group to use open-ended questions (P = .02) and to show empathy (P = .04).
- Nurses only: 2 studies enrolling nurses were included in a meta-analysis for this subgroup, but no statistically significant differences were found.
- Other HCP outcomes: 2 studies were included in a meta-analysis for burnout. No significant difference was found for the outcomes “emotional exhaustion” (P = .25) and “personal accomplishment” (P = .30).
- Patient outcomes: The following patient outcomes were evaluated in some single studies, but could not be included in the quantitative synthesis (meta-analysis): patient satisfaction, patients’ perception of communication skills, and patients’ perception of anxiety.
Various types of CST seem to be effective in improving some communications skills. Nevertheless, it remains unclear whether the effects are sustained over time and which types of training are most likely to work. No evidence was found for a beneficial effect of CST for preventing burnout in health professionals or for improving patient-related outcomes.
Implications for Practice
Communication skills training for HCPs in cancer care using learner-centered, experimental education methods by experienced facilitators can positively influence some relevant communications skills, such as gathering information and conveying empathy. The training should also address appropriate information-giving skills in HCPs. It remains unclear if there are benefits for patients and what type, duration, and intensity of training are most effective.
Antje Tannen, PhD, MPH
Department of Health and Nursing Science
Charité University Berlin, Germany
Member of the Cochrane Nursing Care Field