Effective clinician communication is a core element of all patient-centered oncology care.

The complexities of cancer, and its ever-present association with mortality, require specialised communication skills.

A new guideline from the American Society of Clinical Oncology (ASCO) outlines best practices for cancer clinicians when communicating with patients and their loved ones.

The new guideline recommendations emphasise the importance of strong provider-patient relationships to more effectively support patients.

"Clinicians face a monumentally difficult task: to guide patients on what may be the scariest and most unpleasant journey of their lives. We need to preserve their hope while at the same time giving them accurate information," said Timothy Gilligan, MD, FASCO, co-chair of the ASCO Expert Panel that developed the guideline. "Helping oncology clinicians improve their communication skills ultimately helps patients, and that is what is most important."

ASCO convened a panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, and communication skills experts along with experts in health disparities and advocacy to develop the consensus-based recommendations.

The panel conducted a systematic review of medical literature published from January 1, 2006 through October 1, 2016.

Key guideline recommendations:

• Communication skills training programs should be available to oncologists at every level of practice. Such programs should emphasize role playing to develop skills, as well observation of patient interactions in order to provide feedback to clinicians.
• Clinicians should clearly establish care goals with patients, and ensure that patients understand their prognosis and treatment options. Care goals and the treatment decisions based on these goals should align with patient values and priorities.
• Clinicians should partner with patients by encouraging them to discuss concerns, and participate in deciding what is discussed during each visit. Such collaboration fosters trust and confidence for the patient, while also engaging patients to take an active role in their care.
• Clinicians should initiate conversations about patients' end-of-life preferences early in the course of incurable illness, and raise the topic for discussion periodically based on symptoms, disease progression, and  patient preferences.
• Clinicians should discuss patient concerns about cost of care. For patients who are concerned about cost of care, clinicians should work to understand and address the specific concerns directly or refer the patient and their family to a financial counselor or social worker.
• Clinicians should make patients aware of all treatment options, which may include clinical trials or palliative care alone for certain patients. For appropriate patients, such as those with incurable cancers, clinicians should also discuss the option of starting palliative care at the same time as cancer therapy.

"The guideline is both patient-centered and relationship-centered. It underscores that an important skill for each provider is to understand the patient as an individual and their families' unique needs," said Walter F. Baile, MD, co-chair of the ASCO Expert Panel that developed the guideline.

"The recommendations can help doctors form a trusting relationship with patients that is characterised by empathy, honesty, and a human connection with the patient and family."

Source: ASCO