Skip to main content

Advertisement

SpringerLink
Log in

Integrating evidence-based communication principles into routine cancer care

  • Comment
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The global incidence of cancer and available cancer-directed therapy options is increasing rapidly, presenting patients and clinicians with more complex treatment decisions than ever before. Despite the dissemination of evidence-based communication training tools and programs, clinicians cite barriers to employing effective communication in cancer care (e.g., discomfort of sharing serious news, concern about resource constraints to meet stated needs). We present two composite cases with significant communication challenges to guide clinicians through an application of evidence-based approaches to achieve quality communication.

Methods

Composite cases, communication skills blueprint, and visual conceptualization.

Results

High-stakes circumstances in each case are described, including end-of-life planning, advanced pediatric illness, strong emotions, and health inequities. Three overarching communication approaches are discussed: (1) content selection and delivery; (2) rapport development; and (3) empathic connection. The key takeaways following each case provide succinct summaries of challenges encountered and approaches used. A communication blueprint from the Memorial Sloan Kettering Cancer Center Communication Skills Training Program and Research Laboratory has been adapted and is comprised of strategies, skills, process tasks, and sample talking points. A visually concise tool — the Communication Blueprint Traffic Circle — illustrates these concepts and demonstrates the iterative, holistic, and agile considerations inherent to effective communication.

Conclusion

Evidence-based communication is foundational to person-centeredness, associated with improved clinician and patient/caregiver outcomes, and can be integrated throughout routine oncology care. When used by clinicians, evidence-based communication can improve patient and caregiver experiences and assist in ensuring goal-concordant cancer care delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Temel JS, Shaw AT, Greer JA (2016) Challenge of prognostic uncertainty in the modern era of cancer therapeutics. J Clin Oncol Off J Am Soc Clin Oncol 34(30):3605–3608

    Article  Google Scholar 

  2. Back AL, Anderson WG, Bunch L, Marr LA, Wallace JA, Yang HB et al (2008) Communication about cancer near the end of life. Cancer 113(7 Suppl):1897–1910

    Article  PubMed  Google Scholar 

  3. Reyna VF, Nelson WL, Han PK, Pignone MP (2015) Decision making and cancer. Am Psychol 70(2):105–118

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sullivan DR, Eden KB, Dieckmann NF, Golden SE, Vranas KC, Nugent SM et al (2019) Understanding patients’ values and preferences regarding early stage lung cancer treatment decision making. Lung Cancer Amst Neth 131:47–57

    Article  Google Scholar 

  5. CancerProgressReport.org [Internet]. [Internet]. Philadelphia: American Association for Cancer Research; 2022 [cited 2023 Mar 9]. Available from: Available from http://www.CancerProgressReport.org/

  6. Sullivan DR, Forsberg CW, Ganzini L, Au DH, Gould MK, Provenzale D et al (2016) Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol Off J Am Soc Clin Oncol 34(33):3984–3991

    Article  Google Scholar 

  7. Medysky ME, Dieckmann NF, Winters-Stone KM, Sullivan DR, Lyons KS (2021) Trajectories of self-reported physical functioning and symptoms in lung cancer survivors. Cancer Nurs 44(2):E83–E89

    Article  PubMed  Google Scholar 

  8. Sleeman KE, Gomes B, de Brito M, Shamieh O, Harding R (2021) The burden of serious health-related suffering among cancer decedents: global projections study to 2060. Palliat Med 35(1):231–235

    Article  PubMed  Google Scholar 

  9. Green AK, Tabatabai SM, Aghajanian C, Landgren O, Riely GJ, Sabbatini P et al (2022) Clinical trial participation among older adult medicare fee-for-service beneficiaries with cancer. JAMA Oncol 8(12):1786–1792

    Article  PubMed  Google Scholar 

  10. Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR et al (2021) Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 124(2):315–332

    Article  PubMed  Google Scholar 

  11. Joseph G, Lee R, Pasick RJ, Guerra C, Schillinger D, Rubin S (2019) Effective communication in the era of precision medicine: a pilot intervention with low health literacy patients to improve genetic counseling communication. Eur J Med Genet 62(5):357–367

    Article  PubMed  Google Scholar 

  12. Kaphingst KA, Peterson E, Zhao J, Gaysynsky A, Elrick A, Hong SJ et al (2019) Cancer communication research in the era of genomics and precision medicine: a scoping review. Genet Med Off J Am Coll Med Genet 21(8):1691–1698

    Google Scholar 

  13. Kalanithi P (2016) When breath becomes air: What makes life worth living in the face of death? Penguin Random House, London

    Google Scholar 

  14. Gilligan T, Coyle N, Frankel RM, Berry DL, Bohlke K, Epstein RM et al (2017) Patient-clinician communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol Off J Am Soc Clin Oncol 35(31):3618–3632

    Article  Google Scholar 

  15. Bernacki RE, Block SD, American College of Physicians High Value Care Task Force (2014) Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med 174(12):1994–2003

    Article  PubMed  Google Scholar 

  16. Pollak KI, Back AL, Tulsky JA (2017) Disseminating effective clinician communication techniques: engaging clinicians to want to learn how to engage patients. Patient Educ Couns 100(10):1951–1954

    Article  PubMed  Google Scholar 

  17. R S, A G, Ah K (2020) Case for dual training in medical oncology and palliative care. JCO Oncol Pract [Internet] 16(9). [cited 2023 Mar 9] Available from: https://pubmed.ncbi.nlm.nih.gov/32427538/

  18. Stiefel F, Krenz S (2013) Psychological challenges for the oncology clinician who has to break bad news. In: Surbone A, Zwitter M, Rajer M, Stiefel R (eds) New challenges in communication with cancer patients. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3369-9_5

  19. Scholz B, Goncharov L, Emmerich N, Lu VN, Chapman M, Clark SJ et al (2020) Clinicians’ accounts of communication with patients in end-of-life care contexts: a systematic review. Patient Educ Couns 103(10):1913–1921

    Article  PubMed  Google Scholar 

  20. Sanders JJ, Curtis JR, Tulsky JA (2018) Achieving goal-concordant care: a conceptual model and approach to measuring serious illness communication and its impact. J Palliat Med 21(S2):S17-27

    Article  PubMed  Google Scholar 

  21. Tarbi EC, Blanch-Hartigan D, van Vliet LM, Gramling R, Tulsky JA, Sanders JJ (2022) Toward a basic science of communication in serious illness. Patient Educ Couns 105(7):1963–1969

    Article  PubMed  Google Scholar 

  22. Ingersoll LT, Saeed F, Ladwig S, Norton SA, Anderson W, Alexander SC et al (2018) Feeling heard and understood in the hospital environment: benchmarking communication quality among patients with advanced cancer before and after palliative care consultation. J Pain Symptom Manage 56(2):239–244

    Article  PubMed  Google Scholar 

  23. Sisk BA, Friedrich A, Blazin LJ, Baker JN, Mack JW, DuBois J (2020) Communication in pediatric oncology: a qualitative study. Pediatrics 146(3):e20201193

    Article  PubMed  Google Scholar 

  24. Street RL, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 74(3):295–301

    Article  PubMed  Google Scholar 

  25. Bruera E, Hui D (2012) Conceptual models for integrating palliative care at cancer centers. J Palliat Med 15(11):1261–1269

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chapman LR, Molloy L, Wright F, Oswald C, Adnum K, O’Brien TA et al (2020) Implementation of situational awareness in the pediatric oncology setting. Does a ‘huddle’ work and is it sustainable? J Pediatr Nurs 50:75–80

    Article  PubMed  Google Scholar 

  27. Pimentel CB, Snow AL, Carnes SL, Shah NR, Loup JR, Vallejo-Luces TM et al (2021) Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med 36(9):2772–2783

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tulsky JA, Fischer GS, Rose MR, Arnold RM (1998) Opening the black box: how do physicians communicate about advance directives? Ann Intern Med 129(6):441–449

    Article  CAS  PubMed  Google Scholar 

  29. Tulsky JA (2005) Interventions to enhance communication among patients, providers, and families. J Palliat Med 8(Suppl 1):S95-102

    Article  PubMed  Google Scholar 

  30. Curtis JR, Engelberg RA, Wenrich MD, Au DH (2005) Communication about palliative care for patients with chronic obstructive pulmonary disease. J Palliat Care 21(3):157–164

    Article  PubMed  Google Scholar 

  31. Hui D, Hoge G, Bruera E (2021) Models of supportive care in oncology. Curr Opin Oncol 33(4):259–266

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hui D, Hannon BL, Zimmermann C, Bruera E (2018) Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA Cancer J Clin 68(5):356–376

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ferrell BR, Temel JS, Temin S, Smith TJ (2017) Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. J Oncol Pract 13(2):119–121

    Article  PubMed  Google Scholar 

  34. Arora NK, Street RL, Epstein RM, Butow PN (2009) Facilitating patient-centered cancer communication: a road map. Patient Educ Couns 77(3):319–321

    Article  PubMed  Google Scholar 

  35. Hui D, Bruera E (2020) Models of palliative care delivery for patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol 38(9):852–865

    Article  Google Scholar 

  36. Ferrell BR, Chung V, Koczywas M, Smith TJ (2020) Dissemination and implementation of palliative care in oncology. J Clin Oncol Off J Am Soc Clin Oncol 38(9):995–1001

    Article  Google Scholar 

  37. Derry HM, Epstein AS, Lichtenthal WG, Prigerson HG (2019) Emotions in the room: common emotional reactions to discussions of poor prognosis and tools to address them. Expert Rev Anticancer Ther 19(8):689–696

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Griggs JJ (2020) Disparities in palliative care in patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol 38(9):974–979

    Article  Google Scholar 

  39. Goss E, Lopez AM, Brown CL, Wollins DS, Brawley OW, Raghavan D (2009) American Society of Clinical Oncology policy statement: disparities in cancer care. J Clin Oncol Off J Am Soc Clin Oncol 27(17):2881–2885

    Article  Google Scholar 

  40. Esnaola NF, Ford ME (2012) Racial differences and disparities in cancer care and outcomes: where’s the rub? Surg Oncol Clin N Am 21(3):417–37, viii

  41. Bernacki R, Paladino J, Neville BA, Hutchings M, Kavanagh J, Geerse OP et al (2019) Effect of the serious illness care program in outpatient oncology: a cluster randomized clinical trial. JAMA Intern Med 179(6):751–759

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dobrozsi S, Trowbridge A, Mack JW, Rosenberg AR (2019) Effective communication for newly diagnosed pediatric patients with cancer: considerations for the patients, family members, providers, and multidisciplinary team. Am Soc Clin Oncol Educ Book Am Soc Clin Oncol Annu Meet 39:573–581

    Article  Google Scholar 

  43. Browning DM, Meyer EC, Truog RD, Solomon MZ (2007) Difficult conversations in health care: cultivating relational learning to address the hidden curriculum. Acad Med J Assoc Am Med Coll 82(9):905–913

    Article  Google Scholar 

  44. Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD (2009) Difficult conversations: improving communication skills and relational abilities in health care. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 10(3):352–359

    Google Scholar 

  45. Maguire P, Pitceathly C (2002) Key communication skills and how to acquire them. BMJ 325(7366):697–700

    Article  PubMed  PubMed Central  Google Scholar 

  46. Epstein RM, Duberstein PR, Fenton JJ, Fiscella K, Hoerger M, Tancredi DJ et al (2017) Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA Oncol 3(1):92–100

    PubMed  PubMed Central  Google Scholar 

  47. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE et al (2007) Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med 167(5):453–460

    Article  PubMed  Google Scholar 

  48. Lakin JR, Koritsanszky LA, Cunningham R, Maloney FL, Neal BJ, Paladino J et al (2017) A systematic intervention to improve serious illness communication in primary care. Health Aff Proj Hope 36(7):1258–1264

    Article  Google Scholar 

  49. Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a cancer research UK communication skills training model for oncologists: a randomised controlled trial. Lancet Lond Engl 359(9307):650–656

    Article  Google Scholar 

  50. Fallowfield L, Lipkin M, Hall A (1998) Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol Off J Am Soc Clin Oncol 16(5):1961–1968

    Article  CAS  Google Scholar 

  51. Bylund CL, Brown R, Gueguen JA, Diamond C, Bianculli J, Kissane DW (2010) The implementation and assessment of a comprehensive communication skills training curriculum for oncologists. Psychooncology 19(6):583–593

    Article  PubMed  Google Scholar 

  52. Bialer PA, Kissane D, Brown R, Levin T, Bylund C (2011) Responding to patient anger: development and evaluation of an oncology communication skills training module. Palliat Support Care 9(4):359–365

    Article  PubMed  Google Scholar 

  53. Brown R, Bylund CL, Eddington J, Gueguen JA, Kissane DW (2010) Discussing prognosis in an oncology setting: initial evaluation of a communication skills training module. Psychooncology 19(4):408–414

    Article  PubMed  Google Scholar 

  54. Brown RF, Bylund CL (2008) Communication skills training: describing a new conceptual model. Acad Med J Assoc Am Med Coll 83(1):37–44

    Article  Google Scholar 

  55. Baile WF, Beale EA (2001) Giving bad news to cancer patients: matching process and content. J Clin Oncol Off J Am Soc Clin Oncol 19(9):2575–2577

    Article  CAS  Google Scholar 

  56. Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA (2020) Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol 38(9):915–925

    Article  PubMed  PubMed Central  Google Scholar 

  57. Banerjee SC, Manna R, Coyle N, Penn S, Gallegos TE, Zaider T et al (2017) The implementation and evaluation of a communication skills training program for oncology nurses. Transl Behav Med 7(3):615–623

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript. WER, MM, PAP, and AES acknowledge NCI/NIH award number P30 CA008748.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    William E. Rosa, Meghan McDarby & Patricia A. Parker

  2. School of Nursing, Indiana University, Indianapolis, IN, USA

    Kristin Levoy

  3. Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Indianapolis, IN, USA

    Kristin Levoy

  4. Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA

    Kristin Levoy

  5. School of Nursing, Boise State University, Boise, ID, USA

    Katherine Doyon

  6. City of Hope, Duarte, CA, USA

    Betty R. Ferrell

  7. Department of Family Medicine, McGill University, Montreal, QC, Canada

    Justin J. Sanders

  8. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Andrew S. Epstein

  9. Weill Cornell Medical College, Cornell University, New York, NY, USA

    Andrew S. Epstein

  10. Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA

    Donald R. Sullivan

  11. Center to Improve Veteran Involvement in Care (CIVIC), Portland-Veterans Affairs Medical Center, Portland, OR, USA

    Donald R. Sullivan

  12. Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Abby R. Rosenberg

  13. Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Abby R. Rosenberg

  14. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Abby R. Rosenberg

Authors
  1. William E. Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristin Levoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Doyon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meghan McDarby
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Betty R. Ferrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia A. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Justin J. Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrew S. Epstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donald R. Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Abby R. Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WER conceptualized this manuscript. WER and ARR wrote the main manuscript text. KL and KD prepared the figure. All authors provided substantive editing and input to manuscript, figure, and table. All authors reviewed and approved the final manuscript for submission.

Corresponding author

Correspondence to William E. Rosa.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosa, W.E., Levoy, K., Doyon, K. et al. Integrating evidence-based communication principles into routine cancer care. Support Care Cancer 31, 566 (2023). https://doi.org/10.1007/s00520-023-08020-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-08020-x

Keywords

Search

Navigation