Clinician-patient communication: a systematic review
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Goal of Work
The goal of this work was to identify methods of clinician–patient cancer-related communication that may impact patient outcomes associated with distress at critical points in the course of cancer care.
Materials and methods
A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines for quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Instrument, and the contributive value for recommendations was assessed. Systematic reviews and randomized trials were also evaluated for methodological rigor.
Four existing guidelines, eight systematic reviews and nine randomized trials were identified. Two of the guidelines were of high quality, and all systematic reviews reported clear search criteria and support for their conclusions; the randomized trials were of modest or low quality. For all situations and disease stages, guidelines consistently identified open, honest, and timely communication as important; specifically, there was evidence for a reduction in anxiety when discussions of life expectancy and prognosis were included in consultations. Techniques to increase patient participation in decision-making were associated with greater satisfaction but did not necessarily decrease distress. Few studies took cultural and religious diversity into account.
There is little definitive evidence supporting the superiority of one specific method for communicating information compared to another. Evidence regarding the benefit of decision aids or other strategies to facilitate better communication is inconsistent. Since patients vary in their communication preferences and desire for active participation in decision making, there is a need to individualize communication style.
KeywordsPractice guideline Systematic review Cancer Communication Relationships
The authors would like to thank Stephanie Dziengo for confirming the accuracy of the extracted data and rating the guidelines.
- 1.The AGREE Collaboration (2001) Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument (monograph on the Internet). http://www.agreecollaboration.org. Cited 6 Dec 2006
- 5.Clayton JM, Butow PN, Tattersall MH, Devine RJ, Simpson JM, Aggarwal G et al (2007) Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol 25(6):715–723 doi:10.1200/JCO.2006.06.7827 PubMedCrossRefGoogle Scholar
- 8.Dowsett SM, Saul JL, Butow PN, Dunn SM, Boyer MJ, Findlow R et al (2000) Communication styles in the cancer consultation: preferences for a patient-centred tactics. Psychooncology 9(2):147–156 doi:10.1002/(SICI)1099-1611(200003/04)9:2<147::AID-PON443>3.0.CO;2-X PubMedCrossRefGoogle Scholar
- 13.Holland JC, Andersen B, Breitbart WS, Dabrowski M, Dudley MM, Fleishman S et al (2007) Distress management: clinical practice guidelines in oncology. J Natl Compr Cancer Netw 5:66–98Google Scholar
- 16.National Breast Cancer Centre (2000) Psychosocial clinical practice guidelines: information, support and counselling for women with breast cancer [monograph on the Internet]. http://www.nhmrc.gov.au/publications/. Cited 06 Dec 2006
- 17.National Breast Cancer Centre, National Cancer Control Initiative (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown (Australia): National Health and Medical Research Council. http://www.nhmrc.gov.au. Cited 24 July 2006
- 18.National Institute for Health and Clinical Excellence (2004) Guidance on cancer services: improving supportive and palliative care for adults with cancer. http://www.nice.org.uk. Cited 24 July 2006
- 19.National Institute for Health and Clinical Excellence (2004) Improving supportive and palliative care for adults with cancer: research evidence. http://www.nice.org.uk. Cited 24 July 2006
- 20.National Institute for Health and Clinical Excellence (2004) Improving supportive and palliative care for adults with cancer: the manual. http://www.nice.org.uk. Cited 24 July 2006
- 22.Scott JT, Harmsen M, Prictor MJ, Entwistle VA, Sowden AJ, Watt I (2003) Recordings or summaries of consultations for people with cancer. Cochrane Database Syst Rev Art No CD001539. doi:10.1002/14651858.CD001539
- 24.Stewart MA (1996) Effective physician-patient communication and health outcomes: a review. CMAJ 152:1423–1433Google Scholar
- 25.Strasser F, Palmer JL, Willey J, Shen L, Shin K, Sivesind D et al (2005) Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. J Pain Symptom Manage 29(5):489–497 doi:10.1016/j.jpainsymman.2004.08.011 PubMedCrossRefGoogle Scholar
- 29.Whelan TM, O’Brien MA, Villasis-Keever M, Robinson P, Skye A, Gafni A et al (2002) Impact of cancer-related decision aids. Evidence Report/Technology Assessment No: 46 (Prepared by McMaster University under contract no 290-97-0017) AHRQ Publication No. 02-E004. Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar