Results of Poor Communication in Cancer

Unless a doctor can find some way of understanding how a patient integrates and then interprets the often quite complex biomedical information into his everyday world and experiences, the dialogue between them largely proceeds as two parallel and separate monologues. The specifics and detail in explanations about diagnostic tests and management plans and an affective appreciation for the life context within which the patient places these, are necessary prerequisites for successful and effective communication between patients and their doctors.

Poor communication can result in faulty clinical data collection, worsened clinical and psychosocial outcomes, greater likelihood of litigation (Levinson et al. 1997) and confusion over prognosis (Hagerty et al. 2005). In addition, many patients feel that they have received insufficient information and have not been properly involved in decision making about their treatment and care (Davison et al. 1995; Degner et al. 1997). A recent study examined the relationships between decisional role (preferred and assumed) at time of surgical treatment (baseline), congruence between assumed role at baseline and preferred role 3 years later (follow-up), and quality of life in 205 women diagnosed with breast cancer (Hack et al. 2005). The authors reported that a statistically significant number of women had decisional role regret, with most preferring greater involvement in treatment planning than was offered. Women who indicated at baseline that they were actively involved in choosing their surgical treatment had significantly higher overall quality of life at follow-up than women who indicated passive involvement. These actively involved women had significantly higher physical and social functioning and significantly less fatigue than women who assumed a passive role.

In another study involving women with breast cancer, benefits accrued to women being treated by doctors who offered choice of surgery wherever possible (Fallowfield et al. 1994). The results had little to do with choice, however, as even women who could not exercise choice due to constraints such as tumour size had reduced levels of psychological morbidity. The reason for this finding was that doctors who tried to involve patients as much as possible were better communicators and provided much more information about the rationale for treatments being suggested.

Patients today are more aware than ever of what to expect and the sorts of treatments available, which they may have read about through the media or on the Internet. This can either be a help or hindrance to a consultation, depending on whether the patient is well informed or misinformed. Also, there are different types of consultations that require their own complex language, for example discussing treatment options with patients as part of randomised clinical trials (Jenkins et al. 2005).

Most healthcare professionals working within the cancer setting experience some emotional reaction and degree of job dissatisfaction during their career. This can be a reaction to the pressure from management to increase the speed with which patients are diagnosed and treated, often without additional resources and infrastructure. Problematic communication with patients is thought to contribute to emotional burnout and low personal accomplishment (job satisfaction) as well as high psychological morbidity in clinicians (Ramirez et al. 1996), and this finding has not changed perceptibly in 10 years (Taylor et al. 2005). Ramirez and colleagues reported that doctors acknowledged that poor communication and management skills training contributed to their psychological distress and burnout.

Ineffective communication also has negative effects on patient care and causes stress when nurses interact with each other, medical colleagues, patients and relatives (Fallowfield et al. 2001b). As much of the delivery of healthcare services is handled by multidisciplinary teams (Jenkins et al. 2001; Catt et al. 2005), communication between and within teams must be clear and unambiguous to help avoid errors and to ensure that accountability for system failures is recognised and acted upon (Firth-Cozens 2001).

A recent (2002) report by the independent National Confidential Enquiry into Perioperative Deaths ( cited poor communication and teamwork as major contributory factors in the large numbers of deaths that occur within 3 days of a medical intervention. There is some evidence that traditional hierarchical barriers and differing perceptions of informational roles in healthcare teams make discussion about errors problematic (Sexton et al. 2000). The likelihood that errors will be accurately reported and identified so that individuals and systems can benefit and protect future patients may be less in dysfunctional teams.

Many malpractice complaints stem from poor communication vs negligence or error (Vincent et al. 1994). In the US particularly, litigation is a major concern costing billions of dollars annually. There is evidence that sued and non-sued physicians have different styles of communication (Levinson et al. 1997) and that major insurance agencies provide discounts to doctors who attend communications skills training courses.

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