Senior doctors working in cancer medicine could benefit from intensive communication-skills training to assist the often complex and distressing issues surrounding cancer care, conclude authors of a UK study in this week’s issue of THE LANCET.
Doctors’ communication with patients is commonly hampered by a lack of communication-skills training. Lesley Fallowfield and colleagues from the University of Sussex, UK, aimed to assess the efficacy of an intensive 3-day training course on communication skills in a randomised controlled trial. 160 oncologists from 34 UK cancer centres were randomly allocated to four groups: written feedback followed by course; course alone; written feedback alone; and control. At each of two assessment periods, consultations with six to ten consecutive, consenting patients per doctor were videotaped. Around 2400 patients participated. Outcome measures included objective and subjective ratings made by researchers, doctors, and patients. The primary outcomes were objective improvements after training in key communication skills. Course content included structured feedback, videotape review of consultations, role-play with simulated patients, interactive group demonstrations, and discussion led by a trained facilitator.
Course attendance substantially improved communication skills. Doctors given training were more likely to: use focused questions (34% increase compared with non-attenders); use both focused and open questions (27%); use expressions of empathy (69%); give appropriate responses to patients’ cues (38%). Doctors given training had a 24% lower rate of use of leading questions. There was little evidence for the effectiveness of written feedback.
Lesley Fallowfield comments: “We hope that our results can contribute to the many calls for improvements in this core clinical skill and for proper funding of communication-skills training. To offer such training only as part of the undergraduate medical school curriculum is not sufficient. The most credible role models for juniors are their senior colleagues, so postgraduate training is vital. The senior doctors in cancer medicine and surgery who felt that they have benefited from our courses are in the most powerful position to lobby for the establishment of the sort of supportive clinical environments that permit the practice of good communication skills. Better training in communication skills contributes to personally and professionally more rewarding consultations, which can have a significant impact on clinical care and on doctors’ and patients’ well-being.”
Contact: Professor Lesley J Fallowfield, Psychosocial Oncology Group, Cancer Research UK, School of Biological Sciences, University of Sussex, Falmer, East Sussex, BN1 9QG, UK; T) +44 (0)1273 873017; F) +44 (0)1273 873022; E) L.Fallowfield@biols.susx.ac.uk
Journal
The Lancet