Improving Doctor/Patient Communications
At a conference sponsored by the Canadian Breast Cancer Research Initiative, Jane Graydon, a University of Toronto nursing professor, noted that cancer patients have strong needs for information and supportive, communicative relationships with healthcare providers. She said such relationships can significantly affect their emotional health and possibly even treatment outcomes.
At the same conference, University of Western Ontario researcher Moira Stewart, a specialist in the study of patient-centered care, gave high marks to doctors who participated in an intensive educational program to improve communication with breast cancer patients. In areas ranging from validating patients' feelings to understanding patients' needs to feel in control, the doctors who participated in the program scored significantly higher in communication surveys from patients.
Not surprisingly, an ongoing lack of effective doctor/patient communication while a disease is being treated can result in a communication conflict if a patient becomes terminally ill.
Writing in the Journal of the American Medical Association, Dr. Susan Dorr Goold of the University of Michigan Medical School and colleagues noted frequent clashes between physicians and families when end-of-life issues needed to be discussed. Goold said families might not fully understand the terminal medical situation, either because they are misinformed or because their emotions interfere with comprehension. Doctors themselves may have difficulty discussing end-of-life issues, she said, because they may feel insecure about their own performance or they may not have taken the time to understand the family's values and beliefs.
Attendees at the recent annual meeting of the American Urological Association in Atlanta were told that a significant percentage of urologists are not aware that their prostate cancer patients are experiencing pain, hot flashes, weight changes and other side effects from their various cancer treatments. A survey by Roper Starch Worldwide concluded it was possible that doctors were not proactive enough in inquiring about side effects, or patients themselves were not forthcoming about their symptoms-or both.
The survey noted that more than half of the prostate cancer patients experienced one or more of these side effects, but only 25 percent of the treating urologists were aware that their patients were experiencing such difficulties. And 40 percent of the urologists said they had never discussed any potential emotional side effects of cancer treatment with their patients, even though anxiety and depression can frequently occur during the course of cancer treatment.
Very little research has focused on the actual communication between doctors and patients regarding sexuality. In fact, while many patients have difficulty speaking with their loved ones about sexual issues, the topic can be especially intimidating when speaking with their physician.
A few years ago, an important presentation was made at the annual meeting of the American Society for Therapeutic Radiology and Oncology. Dr. Luci Chen of the University of Chicago told the attendees that a vast majority of clinicians fail to discuss any sexual side effects of cancer treatments with their patients. In a study of patients undergoing radiation therapy for various forms of cancer, Chen and her colleagues noted that:
Reasons cited for these difficulties included pain, physical changes due to treatment, anxiety, depression, and impaired communication with their sexual partners. However, despite such overwhelming sexual impacts from their treatments for cancer, nearly a third of the patients reported receiving no information from their doctors about sexual side effects. Yet, twenty percent said they would have wanted more information, Chen said.
Patients themselves are often at fault for not adequately communicating to their doctors their concerns and needs or, importantly, any treatments that they are undertaking on their own. This is especially true when it comes to alternative therapies. An ongoing study by researchers at the University of California, San Francisco, found that over 70 percent of breast cancer patients used alternative therapies such as acupuncture, herbs, prayer or nutritional supplements. However, only a third of these patients disclosed their use of such alternative treatments to their medical doctors.
This lack of disclosure can lead to serious complications. For example, some herbal supplements can skew the results of certain laboratory tests; others may cause side effects that are incorrectly attributed to an otherwise successful medical treatment.
Cancer specialists agree that patients can take at least the following minimum steps to ensure better communication with their physician:
SOURCES:
The National Cancer Institute (http://www.nci.nih.org)
The American Cancer Society (http://www.cancer.org)
The 95th annual meeting of the American Urological Association, Atlanta, Georgia
Journal of the American Medical Association, Dec. 22/29, 1999; 282:24
European Journal of Cancer, Dec. 22, 1999; Vol. 35
Journal of the American Medical Association, Feb. 16, 2000; 283:7
Canadian Research Breast Cancer Initiative (http://www.breast.cancer.ca)
Abstracts from the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, 1997, Orlando, Florida
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