Background
Communication with cancer patients poses a variety of widely recognized challenges for physicians. Breaking bad news and explanations of complex treatments must often be relayed so that decisions can be made. It is therefore important for physicians to provide emotional support to patients and their relatives coping with a disease associated with negative outcomes such as treatment side-effects and shortened life-expectancy. It is important to underline that current cancer treatments are increasingly personalized and based on multidisciplinary approaches [
1‐
3]. Due to medical progress, cancer patients are living longer with their disease, posing new challenges in doctor-patient communication to help patients cope with uncertainty and to promote hope.
Prior studies have indicated that cancer patients have an expectation that physicians will discuss uncertainty and hope [
4] to help them adjust to their diagnosis [
1,
5,
6] and to maintain hopefulness [
7‐
9]. Moreover, patients wish for realistic, individualized, full and honest information regarding their current medical condition and prognosis [
8,
10‐
14]. These studies suggest that physicians who communicate about uncertainty and hope are meeting patient expectations.
The current models of communication in healthcare advocate the use of general uncertainty management skills during physician communication with cancer patients [
15,
16] and assumes that physicians must promote patient hope [
17]. Models of coping with cancer [
5] argue that communication between physicians and patients about uncertainty may improve patient adjustment to their illness. According to these models, communication about uncertainty and hope will benefit patient quality of life, help the patient maintain a positive outlook and will decrease conflict between physicians and patients when making decisions [
1,
17,
18]. These models underline the importance of effective communication skills between physicians and their cancer patients concerning uncertainty and hope [
17,
19].
However, due to a lack of specific medical training, physicians often report a negative perception about the outcome of discussing uncertainty and hope with cancer patients [
20]. Physicians fear these discussions will lead to unrealistic expectations leading to additional stress on the patient’s condition [
20]. In addition, physicians are leery of increasing patient concerns that will be difficult to manage. As a consequence, physicians experience difficulties and can be reluctant to communicate about uncertainty and hope with cancer patients [
21‐
24], fearing that addressing these issues will lead to increased work stress [
25].
Poor communication about uncertainty and hope in encounters with cancer patients may lead to negative outcomes for both patients and care providers [
25‐
27]. For cancer patients, poor communication may be detrimental to illness adjustment [
28] and may lead to inadequate strategies such as searching certainty, resulting in conflicts with healthcare professionals [
29]. For healthcare providers, poor communication may result in a lack of work satisfaction [
30], higher risk of burnout [
25], higher use of healthcare services [
31], increased costs, [
25] and decreased quality of care delivery [
32]. Studies assessing training methods that may help physicians overcome communication difficulties about uncertainty and hope is thus needed.
Previous studies have reported on the efficacy of communication skills training (CST) programs in the improvement of low- to middle-level communication skills of physicians such as breaking bad news to cancer patients, assessing psychosocial issues and talking with patient relatives [
33]. CST programs have used learner-centered, skill-focused and practice-oriented techniques resulting in improvements in physician communication and support skills [
34‐
37], attitudes toward psychosocial and emotional issues [
30,
38‐
41], empathy toward patients [
38,
39,
42] and work satisfaction [
36]. In addition, these programs have benefited patients by decreasing anxiety [
43] and increasing satisfaction [
44,
45]. Taken together, the results from these studies have confirmed the usefulness of CST programs offered in small groups (maximum of six participants) over the course of a minimum of 20 h.
The efficacy of CST programs aimed at improving physician communication skills on the topics of uncertainty and hope has not yet been studied [
1,
46]. These topics require specific CST. Communicating with patients about uncertainty implies a deep assessment of patient expectations about the future and informing patients about uncertainties. Communication of hope requires a deep understanding of patient wishes for the future while supporting ways needed to achieve them [
47]. This collaborative and bidirectional process of communication between physician and patient on sensitive topics associated with the patient’s medical, psychological and social future will ultimately benefit both patient and physician.
Discussion
Due to medical progress, cancer is now recognized as a long-term chronic disease necessitating optimal communication between physicians and their patients to help patients cope with uncertainty and to promote hope regarding the future. However, due to a lack of specific training in medical curriculum [
20], physicians frequently experience difficulties in communicating these issues with cancer patients.
The current paper describes a randomized controlled trial protocol assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. The CST program includes learner-centered, skills-focused, practice-oriented techniques with small groups of physicians (n = 3/group). The CST efficacy will be assessed at the communicational, psychological and physiological levels. Results from the study will provide information regarding CST techniques and content that will be beneficial in the development of programs to improve physician communication skills about uncertainty and hope with cancer patients.
The development of such CST programs will lead to positive outcomes for healthcare professionals, cancer patients and their relatives. Improving physician ability to communicate about uncertainty and hope with cancer patients may increase work satisfaction [
30], decrease risk of staff burnout [
25], improve cancer care delivery [
32], limit risk of increased costs [
25], limit use of healthcare services [
31] and reduce healthcare professional decisional conflict and regret [
8,
10‐
14]. Moreover, improving communication between physicians and patients about uncertainty and hope may increase patient satisfaction with healthcare and fulfill patient desire for information and maintenance of hope [
6,
9,
34]. In addition, effective communication may improve patient adjustment to cancer [
1,
7,
17], quality of life, maintenance of a positive outlook on future treatments and decrease decisional conflict and regret [
1,
18]. Future studies should further assess the usefulness of the CST program used in the current study on all these outcomes.
Acknowledgements
The authors would like to thank the "Fonds National de la Recherche Scientifique - Section Télévie" of Belgium and the “Centre de Psycho-Oncologie” (CPO) of Brussels that provide support for this research program.