Interacting with cancer patients: the significance of physicians’ communication behavior

Abstract

A diagnosis of cancer typically results in patients experiencing uncertainty about and loss of control over their situation, which in turn has a negative influence on their health outcomes. Cancer treatment further disrupts patients’ quality of life. Throughout their cancer journey patients often rely on their physicians to provide them with social/interpersonal, informational, and decisional support. A growing body of research shows that physicians’ communication behavior does indeed have a positive impact on patient health outcomes. Thus, the patient–physician interaction assumes great significance in the cancer care delivery process. It is encouraging to note that research in this area, largely dominated by studies conducted in primary care, is attracting the attention of cancer researchers. In an attempt to encourage and aid future research on patient–physician communication in cancer care, this paper presents a critical evaluation of existing literature on key elements of physicians’ communication behavior (i.e., interpersonal communication, information exchange, and facilitation of patient involvement in decision-making). Different approaches to assessing physician behavior are discussed followed by a review of key findings linking physician behavior with cancer patient health outcomes. Finally, potential limitations of existing research are highlighted and areas for future research are identified.

Introduction

“You have cancer,” these words almost always cause devastation in the lives of their recipients. Feelings of uncertainty about and loss of control over one's life are common reactions (McWilliam, Brown, & Stewart, 2000; Molleman, Krabbendam, & Annyas, 1984). Over time, cancer patients face several situations that further disrupt their quality of life (QOL). Examples include: making sense of complex medical information; making difficult treatment decisions; dealing with treatment side effects; living with the fear of recurrence; and for some facing the possibility of impending death. In addition to prolonging survival, a key goal of cancer care thus, is to minimize the impact of the disease and treatment on patients’ functioning and well-being (Arora et al., 2001; Gotay, & Muraoka, 1998).

At every stage of their journey, patients look towards their healthcare providers to meet several of their information and support needs, which if met, are likely to reduce the disruption in their QOL (Rose, 1990; Schain, 1990). The patient–physician interaction, a central component of the care delivery process, thus assumes an even greater significance in the cancer setting. As Siminoff, Ravdin, Colabianchi, and Sauders-Sturm (2000) observe, while the communication process between physicians and cancer patients shares most of the general features of standard patient–physician interactions, the stigma and fear associated with a cancer diagnosis, the complexity of medical information, and uncertainty regarding the course of the disease and treatment benefits adds a greater emotional dimension to the interaction. The manner in which physicians communicate with their cancer patients can thus have a significant impact on patients’ QOL. Indeed, a growing body of literature has shown a significant association between physicians’ communication behavior and patient health outcomes. These studies are discussed later in this paper.

Given the significance of the cancer patient–physician interaction, it is encouraging to see that research in this area is attracting the attention of cancer researchers (e.g., Blanchard, Labrecque, Ruckdeschel, & Blanchard, 1990; Butow, Dunn, Tattersall, & Jones, 1995; Ford, Fallowfield, & Lewis, 1996; Maguire, Faulkner, Booth, Elliott, & Hillier, 1996; Ong et al., 1999). In an attempt to encourage and aid additional research on patient–physician communication in cancer, this paper presents a critical evaluation of the literature on physicians’ communication behavior. Following detailed description of key elements of physician behavior, the paper highlights two important aspects of research in this area: (1) Methods of assessment of physicians’ communication behavior and (2) Relationship of physicians’ communication behavior with cancer patient health outcomes. Finally, the paper identifies limitations of existing studies and presents recommendations for future research. Given that significant literature in this area exists in primary care that may also have relevance in a cancer setting, findings from studies conducted in non-cancer settings are discussed, as appropriate. Conversely, while the cancer context is emphasized throughout the paper, the discussion on limitations and future directions is applicable to other illness settings as well.

I acknowledge that physicians’ communication behavior does not get generated in isolation and is likely to be influenced by a number of factors including patients’ communication patterns. Indeed, several studies have focused on determinants of physician behavior including patient factors and have also specifically examined patients’ communication behavior (e.g., Hall, Roter, Milburn, & Daltroy, 1996; Ishikawa et al., 2002; Street, 1991); however, evaluation of such studies was considered to be beyond the scope of this review. Similarly, studies focusing on interventions for improving patient–physician communication were also considered to be beyond the scope of this review; interested readers may refer to Anderson and Sharpe (1991) for a review of such studies. Finally, I also acknowledge that over the course of their cancer journey, besides physicians, patients interact with several other healthcare providers (e.g., nurses, social workers, nutritionists, pharmacists) who are as likely to impact patients’ care experience as well as their health outcomes. While a majority of studies on patient–provider communication have focused on the patient–physician dyad, research on the interaction between non-physicians and patients is relatively limited and needs to be encouraged.