In a recent article published in the Journal of Oncology Practice,
semi-structured interviews with 75 oncology patients and 45 caregivers across
national settings revealed four major gaps in cancer care delivery.1 Two major
identified deficiencies were related to communication: poor doctor-patient communication
overall, and inadequate conversations addressing prognosis, specifically. These
responses confirm that communication challenges within cancer care persist,
and a lack of physician training and education remains a significant deterrent
to quality cancer care. It remains to be seen whether mandatory communication
skills training will be implemented in oncology practices; however, I recall
an incident in my past experience that forced us to take a closer look at this
Years ago I worked with a radiation oncologist whose communication skills were marginal, at best. I would often advocate for his patients, asking him to explain again and take the time to reiterate the “why” of the proposed treatment plan. He would do it, but with a grunt, and taking as little time as possible to do it.
One spring, I was told that this oncologist would be taking an extended leave. His elderly mother, a widow, was just diagnosed with cancer and he was returning to the Midwest where she lived to be with her as she started treatment. Upon his return to work, I asked how his mother was and how the visit went. He immediately went into a tirade:
“Her care was abominable! I couldn’t believe how they treated her. Her
docs never explained anything to her and when they did talk to her, they never
bothered to check if she had her hearing aid in. She was frightened and confused.
By the time I got there, she was in tears, saying she just wanted to die. I
had to call multiple times just to get the doc to call me back, and when he
did, I don’t think he spent more than five minutes on the phone with me. They
treated my mother like an old lady who didn’t need to be told anything. My mother
was a teacher for 40 years. She deserved better.”
What was the outcome this radiation oncologist brought back to his practice? You guessed it—a complete turnaround. Being on the opposite side of the bed did more than any communication workshop could have done.
Cancer conversations are central to the provision of quality care. They are just as essential as expertise in diagnosing, treating, and managing the sequelae of cancer. We need to speak up more about communication deficiency in clinical practice. Until we do, the status quo will remain the norm, and our patients will continue to be affected negatively as a result.
Patel M, Periyakoil V, Blayney D, et al. Redesigning cancer care delivery: views from patients and caregivers. J Oncol Practice. 2017;13(4): e291-9.