Don’t just train the doctor in communication skills but the patient as well
Most doctors are trained in communication skills for consultations with their patients. To make communication even more effective it seems relevant to train patients as well. Patients with malignant lymphoma (Hodgkin’s and non-Hodgkin lymphoma) put the blame for less good communication during consultations partly on their own lack of skills and capabilities. They feel they could benefit from training in communication skills. Researchers from the Netherlands Institute for Health Services Research (NIVEL), Radboud University Nijmegen Medical Centre and the VU Medical Centre examined communication issues experienced by these patients and developed an online training course based on these results. The results are published in the journal Psycho-Oncology.
The researchers studied what patients find difficult (barriers) and what can help them (facilitators) to have a good consultation with their doctor. “We can train doctors but perhaps it would be beneficial to train patients too before the medical consultation with their doctor,” argues NIVEL researcher Inge van Bruinessen.
Effective communication between the provider and the patient is essential for achieving optimal care in cancer patients and it helps them to cope more effectively with their disease on a daily basis. The responsibility for effective communication lies with the care provider as well as with the patient. Patients must give the care provider detailed information about their condition, ask questions and check whether the care provider has understood them properly. They also have to be able to express their worries. “A patient who takes an active role in the consultation is expected to be better informed and is more able to deal with the disease itself.”
Three communication phases
It frequently occurs that patients only think of the question they wanted to ask after they have left the consultation room. The researchers tried to gain information about how patients were progressing with their communication skills and divided these into three phases. In the first phase patients blame their limited skills largely on their own incompetence; they feel overwhelmed and passive and passively absorb everything that is happening. In the next phase, they become more proactive and motivated – ‘this is about my life’ – they ask more questions and ask for more information. In the final phase, patients are aware of the importance of their own communication; they know what is relevant to them and are able to ask focused questions.
Barriers and facilitators
The researchers tried to find out which factors act as barriers and which are facilitators during the three phases. In the first phase, the patients are hindered by emotions, which results in explanations and information not getting through to them. In the second phase, a patient requires a lot of information. If the doctor then sticks to more general issues, this becomes a barrier to an effective consultation. In the third phase, patients are more able to be in control and can indicate what they need. But in this phase external factors such as waiting times can represent a barrier to concentration.
Inge van Bruinessen explains further: “Based on the communication phases that we identified in this study, we have developed an online training programme for patients called PatientTIME that we are testing on effectiveness. We need patients to take part in this study. We will divide the participants into three groups, and the people in one of those groups will be asked to record their consultation with an audio device that we provide. These patients have to explicitly ask the doctor, “May I record the consultation?” so that they can listen back to it at home. This helps patients to retain important information. Making an analysis of the anonymous audio recordings will also enable the researchers to see whether our intervention helps patients to take a more active role in the consultation with the doctor.”
“We want patients to prepare themselves well for a consultation and we also want them to take time during the consultation to ask questions that matter to them,” she continues. “This is in line with the Medical Treatment Act (WGBO) and is a condition for informed decision-making. In our study, patients take control - they determine the content of the Internet training and supply data on which we can evaluate the training.”
Patients who would like to help us test the training programme on the Internet can register here http://www.patienttime.nl/ The training programme is only in Dutch.
The study is being carried out by the Netherlands Institute for Health Services Research (NIVEL). In addition, the Radboud University Nijmegen Medical Centre and the VU Medical Centre and the Dutch patient organization for lymph node cancer are also involved. The project has received funding from the Alpe d’HuZes programme ‘Living with Cancer’ from The Dutch Cancer Society (KWF).