Abstract
Background
Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer.
Aim
The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals.
Method
We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format.
Results
A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals’ self-report.
Conclusions
The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.
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References
Cassell EJ (1978) The healer’s art: a new approach to the doctor-patient relationship. Penguin, Harmondsworth
Simpson M, Buckman R, Stewart M (1991) Doctor-patient communication: the Toronto consensus statement. BMJ 303:1385–1387
Stewart MA (1996) Effective physician-patient communication and health outcomes: a review. Can Med Assoc J 152:1423–1433
Bartlett EE, Grayson M, Barker R, Levine DM, Golden A, Libber S (1984) The effects of physician communication skills on patient satisfaction, recall and adherence. J Chronic Dis 37:765–772
Levinson W, Roter DL, Mullooly JP, Dull V, Frankel R (1997) Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 277:553–559
Ford S, Fallowfield L, Lewis S (1996) Doctor-patient interactions in oncology. Soc Sci Med 42:1511–1519
Heaven C, Maguire P (1996) Training hospice nurses to elicit patient concerns. J Adv Nurs 23:280–286
Ley P (1982) Satisfaction, compliance, and communication. Br J Clin Psychol 21:241–245
Mishler EG (1984) The discourse of medicine: dialectics of medical interviews. Ablex, Norwood
Spiro H (1992) What is empathy and can it be taught? Ann Intern Med 116:843–846
Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM (1996) Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 347:724–728
Walker LG (1996) Communication skills: when, not if, to teach. Eur J Cancer 32:1457–1459
Maguire P (1990) Can communication skills be taught? Br J Hosp Med 215–216
Department of Health (2002) The NHS Cancer Plan, London
Gysels, M, Higginson IJ, Richardson A (2003) Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness. Support Care Cancer 12(10):692–700
Mann, T (1996) Clinical guidelines: using clinical guidelines to improve patient care within the NHS. NHS Executive
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 359:650–656
Klein S (1999) The effects of the participation of patients with cancer in teaching communication skills to medical undergraduates: a randomised study with follow-up after 2 years. Eur J Cancer 35:1448–1456
Razavi D, Delvaux N, Marchal S, Bredart A, Farvaques C, Paesmans M (1993) The effects of a 24-h psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study. Eur J Cancer 29:1858–1863
Razavi D, Delvaux N, Marchal S, Durieux J-F, Farvacques L, Dubus L et al (2002) Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. Br J Cancer 87:1–17
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 Onc 16:1961–1968
Faulkner A, Argent J, Jones A, O’Keeffe C (1995) Improving the skills of doctors in giving distressing information. Med Educ 29:303–307
Maguire P, Faulkner A (1988) Improve the counselling skills of doctors and nurses in cancer care. BMJ 297:847–849
Maguire P, Booth K, Elliott C, Jones B (1996) Helping health professionals involved in cancer care acquire key interviewing skills—the impact of workshops. Eur J Cancer 32:1486–1489
Wilkinson S, Bailey K, Aldridge J, Roberts A (1999) A longitudinal evaluation of a communication skills programme. Palliat Med 13:341–348
Wilkinson S, Gambles M, Roberts A (2002) The essence of cancer care: the impact of training on nurses’ ability to communicate effectively. Journal of Advanced Nursing 40:731-738
Anderson JL (1982) Evaluation of a practical approach to teaching about communication with terminal cancer patients. Med Educ 16:202–207
Baile W, Kudelha AP, Beale EA, Glober GA, Myers EG, Greisinger AJ et al (1999) Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer 86:887–897
Wilkinson S, Roberts A, Aldridge J (1998) Nurse-patient communication in palliative care: an evaluation of a communication skills programme. Palliat Med 12:13–22
Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I (2003) Enduring impact of communication skills training for oncologists: 12-month follow-up results of a randomised trial. Br J Cancer 89:1445–1449
Jenkins V, Fallowfield L (2002) Can communication skills training alter physicians’ beliefs and behavior in clinics? J Clin Oncol 20:765–769
Ford S, Hall A, Ratcliffe D, Fallowfield L (2000) The medical interaction process system (MIPS): an instrument for analysing interviews of oncologists and patients with cancer. Soc Sci Med 50:553–556
Booth K, Maguire P (1991) Cancer research campaign interview rating manual. Alphabet Studio, Manchester
Barrows HS (1971) Simulated patients (programmed patients). The development of a new technique in medical education. Thomas, Springfield
Acknowledgements
This work was undertaken by King’s College London, which received funding from National Institute of Clinical Excellence (NICE). The views expressed in this publication are those of the authors and not necessarily those of the institute. We thank Lesley Fallowfield for helpful comments on this paper.
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Appendix
Appendix
Reference list of excluded studies (Table 3):
-
1.
Bartlett EE, Grayson M, Barker R, Levine DM, Golden A, Libber S (1984) The effects of physician communication skills on patient satisfaction, recall and adherence. J Chronic Dis 37:765–772
-
2.
Berglund G,.Sjoden P-O (1987) Communication problems with medical staff: a correlate of distress in cancer patients. Scand J Behav Therapy 16:111–120
-
3.
Bucher JA, Loscalzo M, Zabora J, Houts PS, Hooker C, BrintzenhofeSzoc K (2001) Problem-solving cancer care education for patients and caregivers. Cancer Pract 9:66–70
-
4.
Butow PN, Dunn SM, Tattersall MHN (1995) Communication with cancer patients: does it matter? J Palliat Care 11:34–38
-
5.
Cantwell BM, Ramirez AJ (1997) Doctor-patient communication: a study of junior house officers. Med Educ 31:17–21
-
6.
Chan A, Woodruff RK (1997) Communicating with patients with advanced cancer. J Palliat Care 13:29–33
-
7.
Cegala DJ, Lenzmeier Broz S (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ 36:1004–1016
-
8.
Dunn SM, Patterson PU, Butow PN, Smartt HH, McCarthy WH, Tattersall MHN (1993) Cancer by another name: a randomised trial of the effects of euphemism and uncertainty in communicating with cancer patients. J Clin Onc 11:989–996
-
9.
Evans BJ, Kiellerup FD, Stanley RO, Burrows GD, Sweet B. A communication skills programme for increasing patients’ satisfaction with general practice consultations. Br J Med Psychol 60:373–378
-
10.
Fallowfield L, Jenkins V, Beveridge HA (2002) Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med 16:297–303
-
11.
Fallowfield L, Saul J, Gilligan B (2001) Teaching senior nurses how to teach communication skills in oncology. Cancer Nurs 185–191
-
12.
Ford S, Fallowfield L, Lewis S (1996) Doctor-patient interactions in oncology. Soc Sci Med 42:1511–1519
-
13.
Girgis A, Sanson Fisher RW, McCarthy WH (1997) Communicating with patients: Surgeons’ perceptions of their skills and need for training. Aust N Z J Surg 775–780
-
14.
Glimelius B, Birgegard G, Hoffman K, Kvale G, Sjoden P-O (1995) Information to and communication with cancer patients: improvements and psychosocial correlates in a comprehensive care program for patients and their relatives. Patient Educ Couns 25:171–182
-
15.
Hulsman RL, Ros WJ, Winnubst JA, Bensing JM (1999) Teaching clinically experienced physicians communication skills. A review of evaluation studies. Med Educ 33:655–668
-
16.
Kruyver IPM, Kerkstra A, Francke AL, Bensing JM, van de Wiel HBM (2000) Evaluation of communication training programs in nursing care: a review of the literature. Patient Educ Couns 39:129–145
-
17.
Langewitz WA, Eich P, Kiss A, Wossmer B (1998) Improving communication skills—a randomised controlled behaviorally oriented intervention study for residents in internal medicine. Psychosom Med 276
-
18.
Lerman C, Daly M, Walsh WP, Resch N, Seay J, Barsevick A et al (1993) Communication between patients with breast cancer and health care providers. Determinants and implications. Cancer 72:2612–2620
-
19.
Levinson W, Roter D (1993) The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med 8:318–324
-
20.
Levinson W, Roter DL, Mullooly JP, Dull V, Frankel R (1997) Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 277:553–559
-
21.
Ley P. Satisfaction, Compliance, and Communication (1982) Br J Clin Psychol 21:241–245
-
22.
Libert Y, Conradt S, Reynaert C, Janne P, Tordeurs D, Delvaux N et al (2001) [Improving doctor’s communication skills in oncology: review and future perspectives]. Bull Cancer 88:1167–1176
-
23.
Lilly CM, De Meo DL, Sonna LA, Haley KJ, Massaro AF, Wallace RF et al (2000) An intensive communication intervention for the critically ill. Am J Med 109:469–475
-
24.
Macleod Clark J (1983) Nurse-patient communication: an analysis of conversations from surgical wards in nursing resarch. In: Wilson-Barnett J (ed) Ten studies in patient care, Wiley, Chichester, pp 25–56
-
25.
Morton J, Blok GA, Reid C, van Dalen J, Morley M (2000) The European Donor Hospital Education Programme (EDHEP): enhancing communication skills with bereaved relatives. Anaesth Intensive Care 28:184–190
-
26.
Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L (2001) Breaking bad news about cancer: patients’ preferences for communication. J Clin Onc 19:2049–2056
-
27.
Parle M, Maguire P, Heaven C (1997) The development of a training model to improve health professionals’ skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 44:231–240
-
28.
Razavi D, Delvaux N, Marchal S, De Cock M, Farvacques C, Slachmuylder J-L (2000) Testing health care professionals’ communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators. Psychooncology 9:239–302
-
29.
Reynolds PR, Sanson-Fisher RW, Poole AD, Harker J, Byrne MJ (1981) Cancer and communication: information-giving in an oncology clinic. Br Med J 282:1449–1451
-
30.
Stewart MA (1996) Effective physician-patient communication and health outcomes: a review. Can Med Assoc J 152:1423–33
-
31.
Walker LG (1996) Communication skills: when, not if, to teach. Eur J Cancer 32:1457–1459
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Gysels, M., Richardson, A. & Higginson, I.J. Communication training for health professionals who care for patients with cancer: a systematic review of training methods. Support Care Cancer 13, 356–366 (2005). https://doi.org/10.1007/s00520-004-0732-0
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DOI: https://doi.org/10.1007/s00520-004-0732-0