Good communication is central to the provision of excellence in patient-centred care, especially when it underpins decisions and choices about diagnosis and treatment. Patient-centred approaches that depend on good communication are now built into the philosophy and culture and operational frameworks of the NHS and many healthcare services. NICE advises all NHS professionals to take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.1 Similarly, the Institute of Medicine states that healthcare professionals should provide 'care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions'.2 Patient-centred care is one of the seven core principles of NHS England.3 Excellence in patient-centred care requires wise decision making following good communication and provision of good-quality information.
Good communication is a feature of every aspect of cancer care. Communication skills training is now part of undergraduate education in healthcare and of continuing professional education in all oncology disciplines. Advanced communication skills in cancer professionals bring benefits to cancer patients.4,5 Many areas require training including breaking bad news6 and explaining complex treatments and clinical trials. In all clinical settings, good communication begins with an ordinary, courteous introduction. Be sure that your patient knows who you are and what you are there to do. Tell the truth and try to listen as much as you talk. Beyond these social norms, however, an organized approach to communication is helpful.
The DREAM protocol to aid communication
The DREAM five-component protocol is a good example of an established communication approach with wide applicability (Table 4.1). It illustrates how a systematic approach can improve communications and add to the confidence of cancer professionals who face these challenges.7
Table 4.1The DREAM interview: key components and skills needed. |Favorite Table|Download (.pdf) Table 4.1 The DREAM interview: key components and skills needed.
|Data || |
Collecting accurate data, i.e. taking a clear medical history needs knowledge about appropriate use of open, focused-open and closed questions, and avoidance of leading and multiple questions
Set up the interview carefully and allow adequate time; include a patient's spouse, partner or friend who will help their recall; ensure you know the patient's pre-existing knowledge - their 'starting point'
|Relationship || |
Establishing a relationship or rapport, i.e. learning more about the patient's worries and concerns and making the patient feel comfortable by giving and asking information, not interrupting too much or looking at notes
This needs awareness of verbal and non-verbal communication and the ability to engage in active listening
|Empathy || |
Being empathic, i.e. responding appropriately to patient-led cues
Acknowledge the burden of disease and treatment
Giving advice, i.e. explaining the logic and rationale for treatment, and putting complex information into layperson's ...