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Communication: What Do Patients Want and Need?

2008; American Society of Clinical Oncology; Volume: 4; Issue: 5 Linguagem: Inglês

10.1200/jop.0856501

1935-469X

Empathy and Medical Education

Communication: What Do Patients Want and Need?Oncologists face special challenges when it comes to communicating with patients.The treatment options and adverse effects are complex.Patients are at a time of crisis in their lives.Often, communication involves giving patients bad news.In the midst of these complex aspects of care, dealing with patients' emotions is critical.The good news is that specific communication techniques can help oncologists to improve patient interactions, and training makes a difference, according to communication experts. Establish Rapport and Lay the Groundwork for PartnershipOncologist Lidia Schapira, MD, notes that at the outset oncologists often face patient cynicism and mistrust."There are numerous reasons that a patient might have initial mistrust.They might have had a bad experience with other doctors.They might have been given incorrect information about you or about the cancer center.Many patients don't trust established medicine in general.I've had many patients who talk to me as though there's a kind of conspiracy, such as pushing drugs for profit or personal motives.They sometimes distrust the pharmaceutical industry."Schapira practices at the Gillette Center for Breast Oncology at the Massachusetts General Hospital (Boston, MA) and publishes on oncology communication issues.To gain patients' trust, Schapira offers these practical suggestions: "The most important thing is a genuine, caring presence.Show interest in the person.Let the patient know that you have reviewed the records, that you understand the diagnosis and pathology.Set the agenda to work collaboratively with the patient, aligning your expectations with those of the patient.Only then discuss the treatment options."Debbie, a patient from Virginia with stage 4 melanoma, corroborates this approach.She sings the praises of her current oncologist: "He's always prepared when he comes in.He's not afraid to make physical contact-he puts his hand on my shoulder or back when he listens to my lungs.He makes eye contact.He never rushes me."Listening actively is critical for establishing patient rapport.Let the patient tell his or her story.Do not interrupt or break in with your conclusion or even your questions.If you need to write something in the record, explain that you need a moment to jot down some notes.These behaviors help convey attentiveness. Devote Time to ExplanationsBefore explaining treatment options and your recommendations, tell the patient that you realize he or she is probably anxious, that anxiety is quite normal, and that it may result in the patient's not remembering everything.Acknowledging their anxiety helps puts patients at ease.