How should patients, family members and physicians communicate?

Effective communication among patients, family members and physicians is very important during the diagnosis and treatment of oncology patients, just as it is in the treatment of all diseases.

The American Society of Clinical Oncology (American Society of Clinicial Oncology-ASCO) has developed a special guideline containing recommendations for physicians to strengthen communication with patients. We wanted to share this article, prepared within that guideline’s framework while also considering oncology practice in our country. We think reading it will help you understand what to focus on in communication.

The guideline was published on September 11 in Journal of Clinical Oncology’. It focuses on communication and was prepared according to the needs of patients and their family members.

Relationships among patients, family members and physicians in oncology are full of challenges.

If this process is not managed properly and the patient-physician relationship cannot be built on trust, it leads to dissatisfaction among patients and family members, physician burnout and an increase in medical malpractice lawsuits.

Sources of communication difficulties frequently encountered in oncology practice

• The worrying diagnostic process following a suspicious cancer finding,
• Informing a patient diagnosed with cancer and their family member about the disease,
• Discussing treatment side effects and the possible risk of death,
• Explaining the consequences of receiving or not receiving treatment,
• Sharing unfavorable treatment outcomes arising during treatment, such as failure to respond or treatment side effects,
• Discussing potentially effective treatments not approved in the country,
• Informing patients and family members about the adverse effects of alternative treatments,
• Discussing life expectancy in a situation with no chance of cure,
• Discussing and managing the dying process in a group of patients, however much we may ignore it.

As can be seen, many topics can be sources of difficulty in patient-physician relationships in everyday oncology practice.

Almost all oncology clinics in our country work under a heavy workload, and oncology physicians provide devoted service. Making physicians’ work easier may be possible if patients and family members understand the difficulties physicians face.

It should not be forgotten that helping physicians in this area facilitates communication, helps them feel secure, strengthens their bond of affection with patients and makes quality healthcare easier to provide.

Cancer is a difficult disease, and medical oncology specialists should support patients and help them cope with it. They should ensure that patients and their family members are adequately informed and make an effort to alleviate their concerns.

Most patients lack knowledge about the diagnosis and treatment of cancer, a complex disease. Physicians’ professional education focuses primarily on diagnosing and treating diseases. In fact, treating a disease and communicating well are different skills. Despite this being a very special subject, professionally prepared classes and courses in this area are extremely scarce during physicians’ training. International sources they read, everyday practical experience, experienced senior colleagues and teachers, and feedback from patients and family members are the most important resources for their development.

Research emphasizes that well-designed training programs can improve effective communication skills among oncology specialists and patients. However, patients and family members should also understand the importance of communication and make an effort in this direction.

Key recommendations for doctors for proper communication

• Oncology services should be accessible; patients should be able to provide feedback, and interactions with patients and family members should be observable.
• The cancer treatment management plan should be designed together with patients, and patients and family members should adequately understand both the diagnosis and treatment options. Medical care goals and treatment decisions should align with patients’ values and priorities.
• Patients and family members should be encouraged to discuss their concerns and participate in treatment decisions during consultations. This increases their confidence and enables them to take an active role in treatment.
• During treatment for diseases with no chance of cure, physicians should discuss life expectancy early with patients and family members; they should obtain their preferences regarding disease-related complaints, problems that may arise as the disease progresses and possible solutions.
• Additional payments and care costs that may arise during treatment should be discussed, related concerns should be alleviated as much as possible, and patients should be referred to financial counselors or social workers when necessary.
• Patients should be informed of their treatment options. These should include options such as clinical trials and palliative care. For people with incurable disease, oncology specialists should provide information about active treatment and palliative care options at the same time.

Key recommendations for patients and family members for proper communication

• Family members should not obstruct patients’ efforts to learn about their illness and should make it easier for the physician to inform them adequately.
• They should communicate in a trusting manner with the physicians responsible for treatment, ask about subjects they are curious about and share their thoughts honestly.
• They should thoroughly ask about treatment duration, expected success rates and what awaits them if treatment fails.
• Before planning treatment, they should ask whether drugs not approved in our country, compassionate early-access programs and clinical trials are suitable for them.
• They should not try to have hurried, informal conversations with their physicians, should prepare written questions before appointments and should not attempt consultations without an appointment.
• Without the treating physician’s knowledge, they should not use practices that could endanger the patient, such as alternative medicine products; they must inform the physician if additional treatment will be taken.
• One of the most common needs in oncology is obtaining a second opinion . They should not hide this from their physician, should request a discharge summary including their comprehensive medical history when necessary, and should share the recommendations they receive with their physician.
• They should help their physician throughout all medical processes and participate in the difficult decisions the physician must make.

In preparing this guideline, the American Cancer Society (ASCO) aimed to help doctors, patients and family members build relationships based on trust, empathy and honesty. In this article, by drawing on our own experience and academic publications, we wanted to shed light on your patient-physician communication.

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