PURPOSE AND GOALS OF PATIENT COMMUNICATION
The clinical encounter with cancer patients and their families has four specific communication aims:
Gathering information: This is crucial not only to determining the clinical diagnosis, but also on a broader and more "patient-centered" level to determine patients' understanding of their illness, their current coping and attitude toward treatment, the role of the family and other support available to them, and factors that may present impediments to the ultimate goal of effective cancer care. Information gathering is essential not only at the initial contact with the patient and family, but also all along the cancer trajectory and especially important at milestones such as treatment failure, the development of serious complications, and transition from aggressive anticancer treatment to supportive care.
Transmitting information to the patient and family: Patients and family members rate information as possibly the most important factor in helping them cope with their cancer.1,2 It is also associated with positive effects on patient coping.2,3,4 However, it is also probably the one need that they see as least met in their encounter with the medical team.5 While information to the patient is important at any stage of cancer treatment, it is likely to be most sought out at the time of diagnosis, when there are complications of care, and at crucial transitions such as the initiation of new treatment.6 Although patients may seek the maximum amount of information about their disease around the period of diagnosis when all aspects of cancer treatment may be new to them, it is likely to lessen in situations where the disease has progressed and the medical details of the "bad news" are more likely to be shunned. In these cases, a direct explanation of a treatment plan may be more valuable to patients than their seeing a CT scan with widely metastatic disease. Providing information is best conceptualized as a dialogue in which the clinician must gauge how much information a patient can process at one time, give space to the patient to ask questions, and be careful not to use jargon or "MedSpeak" in explaining information to the patient and family.
Building a trusting relationship with the patient and family: In this case, the two key elements are the development of rapport and trust. These elements are essential in instilling patient confidence in the care provided by the clinician, achieving compliance with treatment, allowing patients to feel that the clinician has their best interest at heart and will tell them the truth about their illness, and promoting patient satisfaction with care. Paying attention to skills such as listening and attending to patient concerns is the foundation for building a relationship based on collaboration and trust.
Providing support to the patient and the family: This is directly related to communication techniques for exploring and understanding patient concerns about treatment, demonstrating empathic understanding, providing realistic hope for ...