ASCO 2006 Presented by Bella August, NJ-based advocate Session Summary: Patient/Physician Communication on Treatment and Prognosis My comments: It was encouraging to see that this session took place and that at least some physicians are becoming more aware of this issue and seem to be tuned in to the patient’s point of view. Sadly, there were many empty seats there and you always wonder if those who need it the most are not in the room. But, to be fair, it was an enormous room. Chair: John C. Ruckdeschel from Karmanos Cancer Institute in Detroit, MI 1. His introductory presentation was entitled: Patient/Physician communication of Treatment and Prognosis--What do we actually know? This is not a well-studied area. It is known that there are a “substantial” number of miscommunications. Most knowledge is anecdotal. The common model is that the MD gives information to the Patient who receives it and responds. The conventional wisdom says that the MD lacks skills; training will change the situation. But there is a “perceptual filter.” MD gives information, it goes through the filter, patient receives something. Nurses are often the “interpreter” between MD and patient. There is little understanding of the filtering process, little recognition of the complexity of the interaction. For example, what is the role of family members in the communication process? We need to have a model that is non-linear, that recognizes the family role, that complexity is key, that there are many interactions; we need to focus on the process. What does “bad news” mean? How does the MD prepare emotionally and in other ways? Side effects and other information may also be seen as “bad news.” 2. Paul Helft, Indiana University Cancer center His stress was on a collaborative approach. Sometimes the “new” diagnosis is Stage 4—how do we deal with it? We need to be sensitive to verbal and non-verbal cues. We need to balance information and hope. The doctor’s prognosis has the “weight of prophesy,” but prognostication is not exact. There is always a range of estimates of the number of months of life expectancy. There is an issue of curable vs. “incurable” cancers. There is a different balance of hope for each. There is an ambulatory period and the terminal phase. Bad news comes again and again, not only once. It is said that you need Honesty, Accuracy and Optimism. Pick only 2. Honesty: what exactly to say? There are always exceptions to the usual course of the illness. There are differences among patients as to what they want to hear. Some docs convey a “false optimism”, and enter into a “collusion” to avoid direct discussion. Better to avoid numerical estimates. What patients want? That depends. If in the worst prognostic group, they often wanted less. In Stage 4, patients often want QUALITATIVE information. It should be tailored to the needs of the specific person. Accuracy: Docs not so accurate. Often overestimate survival time. Optimism: Need to preserve hope. What kind of hope? Open endedness needed. An intimate collaboration is what enables the doc to communicate effectively and convey hope at different points. 3.Anthony Back at Fred Hutchinson Cancer Center, Seattle WA Reported on a study of a model to teach docs better communication. (Interesting to me that his attitude, as conveyed in casual comments and body language, was very similar to ours regarding the typical oncologist.) Is this teachable? Can MDs learn? How to optimize the learning? Only 5% of oncologists have formal training in communication. They are learning through a series of traumatic experiences. Barriers to learning: medical education model, failure to address communication, belief that it does not matter Habitual patterns: they do not explore the patients’ values, engage in blocking(diversion of the topic), poor assessment of the patients’ distress, too narrow and technical, they have a higher burnout rate, it is a vicious cycle. Research indicates that interactive workshops are more effective than lestures. Cochrane review indicates that experience alone does NOT improve their skills. Good training CAN be effective. They developed the “oncotalk” project—4 days of small group workshops and interactions with simulated patients. Each day increased the difficulty of what needed to be communicated. Success was defined by three elements: Awkward moments were handled well, docs used a “toolbox” of methods, patient felt was a therapeutic interaction. Follow-up showed improvement in all areas after the project. 4. Terrance Albrecht of Karmanos, Detroit (This was the least interesting presentation to me. It was focused more on issues in communication to recruit to clinical trials.) The method was largely using video cameras to observe the interactions of docs and patients, and looked at how they communicated the idea of participating in clinical trials and what the patient heard or understood. They found that the role of family members (even when not present in the room) was key and most docs were blind to this. Also, many misperceptions on the part of patients, e.g., thinking the doc recommended a clinical trial, when they had only described one, and vice versa. Many factors influence accrual decisions-- how docs discuss trials with patients is one of the key factors. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. 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