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Communication in cancer

Isenberg-Grzeda, Elie; Ellis, Janet

Current Opinion in Supportive and Palliative Care: March 2019 - Volume 13 - Issue 1 - p 31–32
doi: 10.1097/SPC.0000000000000416

Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Correspondence to Janet Ellis, MB, BChir, MD, FRCPC, Department of Psychiatry, University of Toronto, Psychosocial Oncology, Odette Cancer Centre, Psychosocial Care in Trauma, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, TG-230, Toronto, ON M4N 3M5, Canada. Tel: +1 416 480 4073; e-mail:

Communication is an essential part of being human – we are human first and healthcare professionals second. This concept can sometimes be lost in the training and practice of medicine, and we may find ourselves needing to relearn how to communicate at various points or around various topics. In addition, emotional intelligence varies, for different reasons. Fortunately, communication skills can certainly be learned, and being an effective communicator is a core competency of both US [1] and Canadian [2] postgraduate medical education. Central to good communication is the ability of the healthcare provider (HCP) to codevelop therapeutic relationships with patients and families and work effectively as part of a healthcare team. The latter requires valuing and making use of interprofessional skills, as well as effective interprofessional communication. Yet, the scientific literature is replete with examples of the serious impact of ineffective communication between HCPs and patients and family members. Patient recall of information, understanding of prognosis, establishment of goals of care, and shared decision-making are only some of the examples common to medical practice that are critically dependent on effective communication. The world of cancer care is not exempt and may in fact demand even more effective communication skills because of the emotional valence and technical complexity of the content matter within interprofessional oncology practice. Effective communication in cancer care increases treatment compliance and improves outcomes, including satisfaction with care. Person-centered care requires increased skill in communication, as patient values need to be understood and decision-making needs to be informed and collaborative. The paternalistic model of the HCP recommending the ‘best treatment’ without such consideration or knowledge is outmoded; yet, time in oncology clinics is more limited and treatment options more complex; thus, high communication skill, emotional intelligence, and efficiency are all needed.

It is no surprise, therefore, that researchers have been studying communication skills’ training (CST) attempting to improve cancer care providers’ communication. Bos – van den Hoek et al. (pp. 33–45) began this year's section on psycho-oncology with a review of reviews on CST in cancer care over the past 10 years. They found that while some studies point to the effectiveness of CST in improving oncology HCPs’ communication skills, the field is lacking high-quality evidence for which aspects (e.g., intensity, format, or content) make for the most effective CST. Despite calls for more research, Bos – van den Hoek (pp. 33–45) found that many authors nonetheless endorsed incorporating CST into oncology HCP training. This is reassuring in an age when we understand quite well the value of effective communication skills in the healthcare setting.

Next, we included a series of articles on four commonly encountered subtopics related to communication issues in cancer: anger and denial in the oncology setting, communication about fertility, conversations about assisted death, and communicating with the elderly.

Pene and Kissane (pp. 46–52) reviewed issues around communicating with angry patients and patients in maladaptive denial. Anger and maladaptive denial in the clinical oncologic encounter can have a number of deleterious effects on patients, families, clinicians, and collaborative decision-making. The authors found that interventions geared toward either clinicians or patients can benefit clinician-perceived self-efficacy and work quality of life and patients’ emotional responses and engagement in decision-making, respectively. They summarize approaches and management strategies identified through their literature search.

Shen et al. (pp. 53–58) review issues related to communication about fertility in cancer care – a conversation that can be easily overlooked when survival is seen as the highest priority, yet one that is considered highly important by many patients. The authors look at which factors make it more or less likely for oncologists to discuss fertility and provide recommendations for which information to discuss. Improvements in this area have been made over time; further knowledge and increased access are still needed and equity in care needs to be the goal, irrespective of age, sex, social economic, and relationship status, with open-minded consideration of each patient's values.

Assisted death is now legal in a number of jurisdictions, and because cancer patients generally make up the majority of requests for assisted death, oncologists must be prepared for these conversations. Selby and Bean (pp. 59–63) reviewed the recent literature on communication issues around assisted death and identified a number of barriers to effective communication around this topic. Based on their literature search, they recommend fostering a strong therapeutic relationship with patients to facilitate these longitudinal conversations and, where legally permissible, raising the issue as one potential end-of-life option. Since talking about death and dying has traditionally been the domain of palliative care, they also recommend that oncologists and other HCP become familiar and comfortable with several open questions and nonjudgmental responses for when patients ask about assisted death or talk about how difficult it is to go on living.

Given the disproportionately high rates of cancer among older adults as well as other factors unique to older adults with cancer, we included the review by Adelman et al. (pp. 64–68) on communicating with older adults about cancer. The authors covered four areas of communication issues within their review: ageism, cancer screening, treatment, and end of life. Importantly, they found age-related disparities in a number of important communication-related domains including screening, treatment, and end-of-life communication. They suggest that more research is needed to better understand the communication needs of older adults around cancer care, and we hope this review inspires clinicians and researchers alike to pay greater attention to this overlooked area.

We conclude this year's issue with a review of interprofessional communication, by D’Alimonte et al. (pp. 69–74). The authors emphasize the importance of how the care of patients and families is enhanced by good interprofessional communication. They found that interprofessional education and assessment of training programs are a cornerstone of the collaborative care model, and they highlight the best practices in promoting and enhancing interprofessional communication within team-based cancer care.

We hope that this year's issue provides our readership with a clear understanding of the importance of addressing this topic and a useful and comprehensive overview of the successes and challenges encountered around communicating in cancer, both between HCP and with patients and family members. Further research is much needed in this area with clear thinking, consensus parameters, interventions, and outcomes, to pool evidence on how to improve communication skills, patient experience and outcomes, as well as HCP quality of work experience.

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Conflicts of interest

There are no conflicts of interest.

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1. Accreditation Council for Graduate Medical Education. [Accessed 20 December 2018]
2. Royal College of Physicians and Surgeons of Canada CanMEDS Roles. [Accessed 20 December 2018]
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