Assessing and Improving Value in Cancer Care Workshop Summary (2009) / Chapter Skim
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3 Clinician–Patient Communication and Its Influence on Value
3 Clinician–Patient Communication and Its Influence on Value
Pages 9-22
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Back emphasized that communication skills could, in fact, be learned. Transitions from active anticancer treatment to end-of-life care that assures comfort and prepares the patient and family for death are moments in the trajectory of care that can serve as a useful paradigm for considering
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Back phrased "Don't offer, don't dwell." There is limited data on whether physician discomfort translates into fewer end-of-life discussions, but one study found that medical students maintained greater positive affect if they concealed bad news in simulated encounters with standardized patients compared to those who disclosed Positive affect was measured using the Positive and Negative Affect Scale (Watson et al., 1988)
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7.2 (0.3) Nonsignificant aDisorders included major depressive disorder, panic disorder, generalized anxiety disorder, and post-traumatic stress disorder.
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How long would it take to address patient emotion in a clinical encounter? Not very long, according to a randomized study of women with breast cancer who watched one of two videos of physicians speaking to them, one video with basic empathic language and the other with none.
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. The skills acquired included improvements in fellows' ability to assess patient perceptions, request permission, use the word cancer when delivering bad news, make empathic statements after delivering news, elicit patients' reactions, and summarize a follow-up plan (Back et al., 2007)
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Light bars indicate 95% confidence intervals. SOURCES: Back presentation, February 9, 2009; Back et al., 2007.
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recommends a regular assessment of domains of concern to patients, including the emotional capacity of the patient and family, as well as their educational, financial, legal, and work needs. The report lays out the evidence base supporting communication to meet the wider needs of the patient, including the psychosocial needs that very clearly include cost issues.
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Ms. Blum recalled a magazine article entitled "Patrick Swayze Is Winning His Battle Against Cancer" in which the actor said of his pancreatic cancer, "I'm a miracle, dude" and "I'm going to beat this." Ms.
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Possible sources of information are many, and there is often too little time for patients to review and understand them all, whether during a clinical encounter or at other times. Outright fraud masquerading as effective treatment can also drive false hope, taking advantage of the sense that cures for advanced cancer must exist and can be found if one just looks hard enough.
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This view is supported by the surprising increased survival results of the large-scale, observational BRiTE study recently published by Grothey and colleagues (Grothey et al., 2008)
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Dr. Betty Ferrell of City of Hope commented on policy remedies to improve value in cancer care, saying that Americans with advanced lung, pancreatic, ovarian, and other cancers are effectively denied access to hospice care because of the current reimbursement system, and many more hospitals could improve the quality of the care they deliver if reimbursement was realigned to cover pain management and psychosocial and palliative care services necessary for high-quality care.
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2007. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care.
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1995. A controlled trial to improve care for seriously ill hospitalized patients.
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