Bolstering Patient Relationships

Bolstering Patient Relationships

Every successful interaction between healthcare providers and patients can be credited to strong relationships, in which the patient can trust their providers and the cancer care team listens to and is considerate of the patient. Patients may be seen by their care team over many months or even years, depending on their cancer type, so developing and maintaining good relationships is critical to achieve high-quality personalized care.

No checklist or clinical practice guideline exists for building strong relationships with patients based on mutual respect and trust. There is much to be learned, however, through candid discussions with colleagues and mentors.

The ASCO Connection features blog posts by ASCO members and leaders, many of whom share insights about physician-patient relationships based on their personal and often poignant experiences in clinical environments. Some of the lessons they have learned from their patients about effective communication, empathy, and whole-person care are summarized below.

Put Yourself in Their Shoes

Empathy should be at the heart of every relationship between a patient with cancer and their care team, according to Don S. Dizon, MD, FACP, of Lifespan Cancer Institute. Based, in part, on an experience in which one of his patients seemed to be in remission, but suddenly her cancer progressed, Dr. Dizon wanted to tell her that she had done well on treatment in spite of her disease’s progression. However, he then recognized “at least you had another couple of months” was an empty comfort, because as people, we all want more, not just “at least.”

In another instance, Dr. Dizon helped a patient who believed that because her cancer was not in remission, it would ultimately kill her. Dr. Dizon explained that a lack of remission no longer means death by disease; instead, there is the possibility of living with disease without progression.

Listen to Your Patients

Much can be gained simply by listening to your patients. Everything from financial concerns to personal relationships can have a significant impact on a person’s care and treatment, but patients may not share these concerns unprompted. When they do share them, however, itis vital as a provider to listen and incorporate their concerns into their care plan.

For example, Prateek Mendiratta, MD, of the Cleveland Clinic Taussig Cancer Center, discussed a patient who expressed concerns early on with emergency room fees and the cost of future visits with the oncologist. Rather than addressing this concern outright, Dr. Mendiratta focused on the therapy his patient was eligible to start for his form of lung cancer. When the patient didn’t show up to his follow-up appointments or collect his medication, Dr. Mendiratta realized that something was amiss and that he hadn’t understood the full picture his patient’s concerns regarding treatment.

“Writing a prescription is the easiest part of we do in clinic. The harder part is truly understanding the financial burden a cancer diagnosis inflicts on patients and their families,” said Dr. Mendiratta.

In addition, if a patient seems angry or nervous during an appointment, there’s almost always an underlying reason. No patient exists in a vacuum, so it is critical for providers to ask patients about what is going on in their lives outside of the clinic. Understanding the challenges a patient is facing in other aspects of their life has the potential to improve the manner in which you care for them.

Context is illuminating and I believe it is central to our patients’ ability to cope with their illness and their adherence to our treatment plans,” said Anne Katz, PhD, RN, FAAN, of CancerCare Manitoba. “Every day I am reminded of this and every day I am grateful that I asked about the context of my patients’ lives because it tends to explain so much.”

Adjust Attention Based on Individual Patient Needs

Some patients may have more anxiety about treatment than others, as Dr. Katz notes. To help, the cancer care team may want to consider approaches to help mitigate anxiety, such as sharing results as soon as possible to patients who have exhibited extreme anxiety during prior follow-up visits.

“During every new visit, I make an effort to ask the patient how they want to be notified about their results,” wrote Dr. Mendiratta in his blog about a patient who was upset that he didn’t share the results of her scans (which showed improvement) immediately after he received them. “Taking a couple of minutes to have this conversation can spare you and your patient a lot of future stress and angst when it comes to results.”

Clear Communication is Effective Communication

A cancer diagnosis can be a confusing time for patients, so effective communication is a critical skill for members of the oncology care team. Care providers need to be prepared to answer common questions, such as “Are we going to cure the cancer?” and “If this were you, what treatment would you choose?”

Findings from a study published in the Journal of Oncology Practice suggest that even brief conversations between oncologists and patients about cancer costs may help reduce treatment expenses. Dr. Richard Schilsky, chief medical officer of ASCO, said, “I am hopeful that as doctors read about studies like this they realize that it’s feasible to discuss cost in patient encounters. This study is encouraging because it documents real doctor-patient encounters that were meaningful and demonstrated that doctors are knowledgeable about how to identify alternatives for patients that are less costly.”

Dr. Mendiratta recommends several resources to help physicians—and oncologists, in particular—communicate more effectively with patients. Simply being present with the patient is the most important first step, he writes: “Turning the computer off, listening, following your patients’ cues, and reacting to their emotions demonstrate that you sincerely mean the words you’re saying.”

In addition to the words you choose, the way you say them can make a huge difference in your relationship with your patients, as James R. Hillard, MD, of Michigan State University, wrote in a post about communicating uncertainty. While it never is easy to tell a patient that you simply don’t know what is going to happen prior to starting a new regimen, Dr. Hilliard notes that the assurance that you are there with them and will do your best to explain what is happening can provide comfort.

For More Information

See ASCO’s guideline on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being.