cancer; anxiety; medical consultation; communication skills; training
[en] Background: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. Patients and methods: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. Results: No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed. Conclusions: This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.
Author, co-author :
Boniver, Jacques ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Anatomie et cytologie pathologiques
Etienne, Anne-Marie ; Université de Liège - ULiège > Département de personne et société > Psychologie de la santé
Slachmuylder, Jean Louis
Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians
Stark DP, House A. Anxiety in cancer patients. Br J Cancer 2000; 83: 1261-1267.
Razavi D, Delvaux N, Marchal S et al. Does training increase the use of more emotionally laden words by nurses when falling with cancer patients? A randomised study. Br J Cancer 2002; 87: 1-7.
Stark D, Kiely M, Smith A et al. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 2002; 20: 3137-3148.
House A, Stark D. Anxiety in medical patients. Br Med J 2002; 325: 207-209.
Fogarty LA, Curbow BA, Wingard JR et al. Can 40 seconds of compassion reduce patent anxiety? J Clin Oncol 1999; 17: 371-379.
Fallowfield LJ, Hall A, Maguire GP et al. Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. Br Med J 1990; 301: 575-580.
Hawighorst S, Schoenefuss G, Fusshoeller C et al. The physician-patient relationship before cancer treatment: A prospective longitudinal study. Gynecol Oncol 2004; 94: 93-97.
Fallowfield L, Jenkins V. Effective communication skills are the key to good cancer care. Eur J Cancer 1999; 35: 1592-1597.
Ellis PM, Tattersall MH. How should doctors communicate the diagnosis of cancer to patients? Ann Med 1999; 31: 336-341.
Cull A, Miller H, Porterfield T et al. The use of videotaped information in cancer genetic counselling: A randomized evaluation study. Br J Cancer 1998; 77: 830-837.
Freeman-Wang T, Walker P, Linehan J et al. Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: A randomised trial of written and video information. BJOG 2001; 108: 482-484.
Garrud P, Wood M, Stainsby L. Impact of risk information in a patient education leaflet. Patient Educ Couns 2001; 43: 301-304.
Lobb EA, Butow PN, Barratt A et al. Communication and information-giving in high-risk breast cancer consultations: Influence on patient outcomes. Br J Cancer 2004; 90: 321-327.
Montgomery GH, David D, Goldfarb AB et al. Sources of anticipatory distress among breast surgery patients. J Behav Med 2003; 26: 153-164.
De Lorenzo F, Ballatori E, Di Costanzo F et al. Improving information to Italian cancer patients: Results of a randomized study. Ann Oncol 2004; 15: 721-725.
North N, Combleet MA, Knowles G et al. Information giving in oncology: A preliminary study of tape-recorder use. Br J Clin Psychol 1992; 31 (Pt 3): 357-359.
Schofield PE, Butow PN, Thompson JF et al. Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol 2003; 14: 48-56.
Evans BJ, Kiellerup FD, Stanley RO et al. A communication skills programme for increasing patients' satisfaction with general practice consultations. Br J Med Psychol 1987; 60 (Pt 4): 373-378.
Leydon GM, Boulton M, Moynihan C et al. Cancer patients' information needs and information seeking behaviour: In depth interview study. Br Med J 2000; 320: 909-913.
Gattellari M, Voigt KJ, Butow PN et al. When the treatment goal is not cure: Are cancer patients equipped to make informed decisions? J Clin Oncol 2002; 20: 503-513.
van der Molen B. Relating information needs to the cancer experience: 1. Information as a key coping strategy. Eur J Cancer Care 1999; 8: 238-244.
Meechan GT, Collins JP, Moss-Morris RE et al. Who is not reassured following benign diagnosis of breast symptoms? Psycho-Oncology 2005; 14: 239-246.
Stark D, Kiely M, Smith A et al. Reassurance and the anxious cancer patient. Br J Cancer 2004; 91: 893-899.
Lucock MP, Morley S, White C et al. Responses of consecutive patients to reassurance after gastroscopy: Results of self administered questionnaire survey. Br Med J 1997; 315: 572-575.
Donovan JL, Blake DR. Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: 'just a touch of arthritis, doctor?' Br Med J 2000; 320: 541-544.
Fallowfield L. Quality of life: A new perspective for cancer patients. Nat Rev Cancer 2002; 2: 873-879.
Delvaux N, Merckaert I, Marchal S et al. Physicians' communication with a cancer patient and a relative: A randomized study assessing the efficacy of consolidation workshops. Cancer 2005; 103: 2397-2411.
Jenkins V, Fallowfield L. Can communication skills training after physicians' beliefs and behavior in clinics? J Clin Oncol 2002: 765-769.
Razavi D, Merckaert I, Marchal S et al. How to optimize physicians' communication skills in cancer care: Results of a randomized study assessing the usefulness of posttraining consolidation workshops. J Clin Oncol 2003; 21: 3141-3149.
Maguire GP. Psychological interventions to reduce affective disorders in cancer patients - research priorities. Psycho-Oncology 1995; 4: 113-119.
Merckaert I et al. Factors influencing physicians' detection of cancer patient distress: Can a communication skills training programme improve physicians' detection? Cancer 2005; In press.
Booth C, Maguire P. Development of a rating system to assess interaction between cancer patients and health professionals. London: Report to Cancer Research Campaign 1991; 37.
Delvaux N, Razavi D, Marchal S et al. The effectiveness of a 105 hours psychological training programme for health care professionals: The results of a randomised study. Psycho-Oncology 1998; 7: 184.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370.
Razavi D, Delvaux N, Farvacques C et al. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry 1990; 156: 79-83.
Spielberger CD, Lushene RE. State Trait Anxiety Inventory Test Manual. P.A.C.P. Press 1983.
Bruchon-Schweitzer M, Manuel PI. Inventaire d'anxiété Etat-Trait Forme Y (STAY-Y). Paris: E.C.P.A. 1993.
Leighl N, Gattellari M, Butow PN et al. Discussing adjuvant cancer therapy. J Clin Oncol 2001; 19: 1768-1778.
Shilling V, Jenkins V, Fallowfield L. Factors affecting patient and clinician satisfaction with the clinical consultation: Can communication skills training for clinicians improve satisfaction? Psycho-Oncology 2003; 12: 599-611.
Lang EV, Hatsiopoulou O, Koch T et al. Can words hurt? Patient-provider interactions during invasive procedures. Pain 2005; 114: 303-309.