Strategies to increase patients’ willingness to discuss and disclose concerns include:29-33
- using a screening tool as a prompt
- taking a positive approach to communication of supportive care issues
- normalising the person’s experience
- encouraging open communication.
Key person-centred communication skills facilitate the process:25
- Empathy – acknowledging and understanding a person’s feelings using verbal and non-verbal strategies
- Active listening – listening in an understanding way using verbal and non-verbal strategies
- Actively encouraging questions and checking understanding – clarifying the message of the person affected by cancer
- Asking open ended questions – encouraging the person to talk
- Not interrupting
- Encouraging the presence of a support person (when appropriate) – can help the person’s understanding, recall and/or satisfaction
- Checking the person’s preference for receiving information – to tailor the information for the persons needs
- Using plain language – concise questions and comments without jargon
- Noticing non-verbal cues – observing a person’s body language, particularly if it is incongruent with the verbal messages
- Checking that the person understands what you have said – explaining adequately.
Health professionals can find it challenging to discuss psychological difficulties. The following general question prompts have been suggested to start a conversation about emotional well-being:4
- “In addition to looking at the physical issues, I am interested in hearing how things are going more generally for you”
- “How have you been feeling emotionally”
- “Could you tell me how your mood is?”
- “How would you say the diagnosis and treatment has affected you?”
- “I see you have ticked sadness on this tool can you tell me a little more about why you have ticked this”.
Communication skills training for health professionals has been identified as a strategy to support meeting the supportive care needs of patients. Examples of programs and resources within Australia include:
- Communication skills training, Cancer Australia34
- Communication for Cancer Clinicians, Cancer Council Victoria.35
- Managing cancer pain – communication skills for health professionals, Cancer Council NSW36
- Communication Skills Video Training Resources, Supportive Cancer Care Victoria37
- Communication skills, BMJ Learning38
|You undertake a discussion with Jane to explore her needs identified on the Distress Thermometer and Problem List.|
To begin your discussion with Jane, you clarify whether she is still comfortable to discuss the questionnaire.
“Jane, I’ve had a brief look at your responses and would like to discuss a number of issues you have raised. Is that okay with you?”
You open your discussion by looking at the Distress Thermometer and Problem List.
“Jane, I’ve noticed that you have scored a six on the distress thermometer. That tells me that you are feeling fairly distressed today. I can also see that you have ticked fear, nervousness, sadness and worry on the problem list. Can you tell me a bit more about what you are worried and scared about?”
To help Jane feel comfortable to tell her story you use some of the following probing questions:
“Tell me more about that….”
“Can you explain this further to me….”
“What do you think has led you to be worried and fearful?”
You find out from Jane that she is feeling overwhelmed with the prospect of starting chemotherapy. She is not sure what to expect from the treatment. Her mother had chemotherapy and was very nauseated and experienced intractable vomiting. She is also scared the treatment won’t work. She hopes she has made the right decision not to enter the clinical trial. It was just too hard a decision.
Jane is trying to remain positive for her two young children and husband. Whilst juggling home life and hospital is a challenge, keeping the children in their normal routine and feeling supported is a priority. She admits this is exhausting though. She hasn’t been sleeping well since her surgery. She indicates that she has had difficulty relaxing and “turning off my brain at night”. She has some ongoing pain but hasn’t been taking regular analgesia. She has been given medication but is reluctant to take it regularly.
“Jane, there are some things that I can help you with today, and I can also refer you to other people / places for assistance, can we look at some options for you today?”
Jane responds, “Yes, that would be very helpful.”
Consider approaches you could take to discuss the problems Jane identified.
- Insurance / financial
- Treatment decisions.
- Dealing with children
- Dealing with partner.
Review the EdCaN Competency Assessment Tool for Therapeutic Communication 2009.
- Reflect on an interaction you have had recently with a person you have cared for. Use the tool to rate your performance against each of the criteria.
- Develop a professional development plan to achieve competence in therapeutic communication.