Physicians' communication with a cancer patient and a relative

A randomized study assessing the efficacy of consolidation workshops

Authors

  • Nicole Delvaux Ph.D.,

    1. Service de Psychologie, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
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  • Isabelle Merckaert M.A.,

    1. Unité de Recherche en Psychosomatique et Psycho-oncologie, Université Libre de Bruxelles, Bruxelles, Belgium
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  • Serge Marchal M.A.,

    1. Centre d'aide aux mourants, Training and Research Group (C.A.M.), Bruxelles, Belgium
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  • Yves Libert Ph.D.,

    1. Service de Psychologie, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
    2. Service de Médicine Interne, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
    3. Faculté de Psychologie et des Sciences de l'Education, Université Catholique de Louvain, Louvain-la-neuve, Belgium
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  • Sandrine Conradt M.A.,

    1. Faculté de Psychologie et des Sciences de l'Education, Université de Liège, Liège, Belgium
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  • Jacques Boniver M.D., Ph.D.,

    1. Département des sciences précliniques MI, Université de Liège, Liège, Belgium
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  • Anne-Marie Etienne Ph.D.,

    1. Faculté de Psychologie et des Sciences de l'Education, Université de Liège, Liège, Belgium
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  • Ovide Fontaine M.D., Ph.D.,

    1. Faculté de Psychologie et des Sciences de l'Education, Université de Liège, Liège, Belgium
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  • Pascal Janne Ph.D.,

    1. Unité de Psychologie, Médicale, Université Catholique de Louvain, Louvain-la-neuve, Belgium
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  • Jean Klastersky M.D., Ph.D.,

    1. Service de Médicine Interne, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
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  • Christian Mélot M.D., Ph.D., M.Sci.Biostat.,

    1. Service des Soins Intensifs, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
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  • Christine Reynaert M.D., Ph.D.,

    1. Unité de Psychologie, Médicale, Université Catholique de Louvain, Louvain-la-neuve, Belgium
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  • Pierre Scalliet M.D., Ph.D.,

    1. Départment de Médicine Interne, Université Catholique de Louvain, Louvaiin-la-neuve, Belgium
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  • Jean-Louis Slachmuylder M.A.,

    1. Centre d'aide aux mourants, Training and Research Group (C.A.M.), Bruxelles, Belgium
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  • Darius Razavi M.D., Ph.D.

    Corresponding author
    1. Unité de Recherche en Psychosomatique et Psycho-oncologie, Université Libre de Bruxelles, Bruxelles, Belgium
    2. Service de Médicine Interne, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
    • Unité de Recherche en Psychosomatique et Psycho-Oncologie, Université Libre de Bruxelles, Av. F. Roosevelt, 50-CP 191, B-1050 Bruxelles, Belgium
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    • Fax: (011) 32 26502209


Abstract

BACKGROUND

Although patients with cancer are often accompanied by a relative during medical interviews, to the authors' knowledge little is known regarding the efficacy of communication skills training programs on physicians' communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program.

METHODS

After attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' perceptions of and satisfaction with physicians' communication performance were assessed using a 15-item questionnaire.

RESULTS

Sixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022).

CONCLUSIONS

Six 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives' concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews. Cancer 2005. © 2005 American Cancer Society.

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