The Power of Words: Communication holds the key to better cancer care and survivorship
Celia Bandman from the Center for Communication in Medicine wrote to me several months ago saying “As a writer I am haunted by Mark Twain’s words: ‘The difference between the almost right word & the right word is really a large matter–it’s the difference between the lightning bug and the lightning’.
This quote from Mark Twain resonated with me last week as we hosted physicians, nurses, and research staff from various community oncology practices throughout the United States who team up with our M.D. Anderson Community Clinical Oncology Program (CCOP) Research Base. We discussed clinical trials that we conduct together, and the passion for helping patients and improving care was palpable from beginning to end. It is important to know that these studies are not just focused on cancer treatment, but also on issues for cancer survivors. For example, we are planning an acupuncture study to relieve dry mouth issues for survivors of head and neck cancer treated with radiation. We are also studying ways to understand long-term survivorship issues related to the heart by looking at special tests (biomarkers) at the time that chemotherapy is started (see http://1.usa.gov/fcIJg0). The focus of important research directed towards survivorship might not surprise you much, but it might surprise you to hear that a good part of our focus was on communication skills and their importance to our research enterprise.
As we contemplated barriers to clinical trial participation, it was evident that our choice of words and the way we communicate with our patients and with each other is central to the whole enterprise. Of course, the centerpiece in cancer care is what occurs at the interface between the patient and physician. But other key lanes of communication that must also be effective for research to proceed include: the patient and family, the healthcare team and family, the physician and study principal investigator, the physician and clinic nursing staff, the physician and research staff, and the research staff and clinic nursing staff. It is clearly a complex web of communication.
The Institute of Medicine’s 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century” called for 6 targets for improved care summarized by the acronym STEEP: safe, timely, effective, efficient, equitable, and patient-centered. It turns out that effective communication is integral to every single target, so it is no wonder that we spent an important part of our CCOP Investigators meeting discussing communication skills. Fortunately, in the world of cancer medicine, there has been enormous progress in the science and art of healthcare communication. Here is a list of the last names of 8 leaders in this revolution, just to name a few: Back, Arnold, Tulsky, Baile, Buckman, Emmanuel, von Gunten, and von Roenn. Landmark curricula have been established and implemented through workshops and seminars, and scholarly articles and books have been written. The most recent book, published by Drs. Back, Arnold, and Tulsky, is called Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy & Hope. It is a gem that should be disseminated widely, discussed, taught, and reflected upon by all those who endeavor to improve the quality of cancer care—and this includes cancer survivors!
So what 5 take home points did our group of healthcare professionals take from our communication session this week? What can we share with cancer survivors and caregivers as worthwhile points for reflection?
1) To be mindful and prepared before we initiate our communication, clarifying our intention for the interaction,
2) To notice and acknowledge emotions, including our own,
3) To articulate empathy explicitly,
4) To be curious and open-minded, remembering “ask before tell”, and
5) To be relaxed and confident, yet humble and focused from beginning to end on the patient’s agenda.
Improving communication skills requires more than memorizing a few points or platitudes, but ongoing practice and coaching. The stage is set for such skills training to become more widely applied. The field of cancer medicine has the key leaders, the curricula and scholarly work, and the passion for changing and improving care. And maybe cancer survivors and caregivers who face chronic illness can be also be taught some communication skills. Creative programs with such an aim could help change the narrative of the survivorship experience. The community of cancer survivors can and should be full partners in the emerging communication revolution.
Tags: cancer survivors, cancer treatment, CancerForward, clinical trials, communication skills, empathy, long-term survivorship, M. D. Anderson Community Clinical Oncology Program, Michael J. Fisch MD MPH, patient-centered, The Foundation For Cancer Survivors