communication skills; physician; cancer; training; relatives
[en] BACKGROUND. Although patients with cancer are often accompanied by a relative during medical interviews, to the authors' knowledge little is known regarding the efficacy of communication skills training programs on physicians' communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program. METHODS. After attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' perceptions of and satisfaction with physicians' communication performance were assessed using a 15-item questionnaire. RESULTS. Sixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022). CONCLUSIONS. Six 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives' concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews. (c) 2005 American Cancer Society.
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
Fontaine, Ovide ; Université de Liège - ULiège > Services généraux (Fac. de psycho. et des sc. de l'éducat.) > Relations académiques et scientifiques (Psycho et sc.éduc.)
Beisecker AE, Moore WP. Oncologists' perceptions of the effects of cancer patients' companions on physician-patient interactions. J Psychosoc Oncol. 1994;12(1/2):23-39.
Labrecque MS, Blanchard CG, Ruckdeschel JC, Blanchard EB. The impact of family presence on the physician-cancer patient interaction. Soc Sci Med. 1991;33:1253-1261.
Adelman RD, Greene M G, Charon R. The physician-elderly patient-companion triad in the medical encounter: the development of a conceptual framework and research agenda. Gerontologist. 1987;27:729-734.
Ballard-Reisch DS, Letner JA. Centering families in cancer communication research: acknowledging the impact of support, culture and process on client/provider communication in cancer management [review]. Patient Educ Couns. 2003;50:61-66
Greene MG, Majerovitz SD, Adelman RD, Rizzo C. The effects of the presence of a third person on the physician-older patient medical interview. J Am Geriatr Soc. 1994;42:413-419.
Maguire P. Can communication skills be taught? Br J Hosp Med. 1990;43:215-216.
Maguire P, Faulkner A, Booth K, Elliott C, Hillier V. Helping cancer patients disclose their concerns. Eur J Cancer. 1996; 32A:78-81.
Fallowfield L, Jenkins V. Effective communication skills are the key to good cancer care. Eur J Cancer. 1999;35:1592-1597.
Novack DH. Therapeutic aspects of the clinical interview. J Gen Intern Med. 1987;2:346-355.
Fallowfield L, Lipkin M, Hall A. Teaching senior oncologists communication skills: results from Phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol. 1998;16:1961-1968.
Hulsman RL, Ros WJ, Winnubst JA, Bensing JM. Teaching clinically experienced physicians communication skills. A review of evaluation studies. Med Educ. 1999;33:655-68.
Baile WF, Kudelka AP, Beale EA, et al. Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer. 1999;86:887-897.
Jenkins V, Fallowfield L. Can communication skills training alter physicians' beliefs and behaviors in clinics? J Clin Oncol. 2002;20:765-769.
Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet. 2002;359:650-656.
Razavi D, Merckaert I, Marchal S, et al. How to optimise physicians' communication skills in cancer care: results of a randomised study assessing the usefulness of post training consolidation workshops. J Clin Oncol. 2003;16:3141-3149.
Fellowes D, Wilkinson S, Moore P. Communication skills training for health care professionals working with cancer patients, their families and/or carers [review]. Cochrane Database Syst Rev. 2003;2:CD003751.
Parle M, Maguire P, Heaven C. The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med. 1997;44:231-240.
Razavi D, Delvaux N. Psycho-oncologie: le cancer, le malade et sa famille [Psycho-oncology: cancer disease, patients and their relatives]. Paris: Masson-Collection Médecine et Psychothérapie, 1998.
Razavi D, Delvaux N. Psycho-oncologie: la prise en charge médico-psychologique du patient cancéreux [Psycho-oncology: the medico-psychological care of cancer patients]. Paris: Masson-Collection Médecine et Psychothérapie, 1998.
Razavi D, Delvaux N, Marchal S, De Cock M, Farvacques C, Slachmuylder J-L. Testing health care professionals' communication skills: The usefulness of highly standardized role-playing sessions with simulators. Psychooncology. 2000; 9:293-302.
Booth C, Maguire P. Development of a rating system to assess interaction between cancer patients and health professionals. Report to cancer research campaign. London: Cancer Research Campaign Psychological Medicine Group, 1991.
Delvaux N. Contribution à l'évaluation des effets de la formation psychologique des soignants en oncologie [A contribution to the assessment of the impact of psychological training programs for health care professionals working in oncology; dissertation]. Brussels: Université Libre de Bruxelles, 1999.
Karnofsky DA, Burcheval JH. The clinical evaluation of chemotherapeutic agents in cancer patient. In: McLeod CM, editor. Evaluation of chemotherapeutic agents. New York: Colombia University Press, 1949:191-205.
Grieco A, Lung C. Investigation of the Karnofsky performance status as a measure of quality of life. Health Psychol. 1984;3:129-142.
SPSS Inc. SPSS version 10.0 for Macintosh. Chicago: SPSS Inc., 1999.
SAS Institute Inc. SAS version 8 for Windows. Cary, NC: SAS Institute Inc., 2003.