How effective is your communication with cancer patients?

Patient-doctor communication is critical to creating trust, developing shared decision-making, and optimizing patient quality of life and outcomes. Yet the literature is sparse on providing specifics for the content of such communication. A multidisciplinary ASCO panel convened in 2017 was charged with defining effective communication which would “optimize the patient-clinician relationship, patient and clinician well-being, and family well-being.” Their literature search on this topic found only 47 publications. They concluded: “With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited;”¹ guidance on the content of discussions was sparser still. Li et al in a 2020 article² found 24 studies covering “the communication content needs of patients/caregivers” and documented content needs in 6 categories: disease-related information, emotional support, daily life, sex/fertility, death, and how to communicate with health professionals. Specific guidance on that content was not provided.

While co-editing a seminar in radiation oncology for an oncology journal, Dr Timur Mitin and Dr Ananya Choudhury requested an article that would present the patient perspective on trimodal therapy for muscle-invasive bladder cancer. In follow-up discussion with Dr Mitin to determine his vision for the unique focus and value that this article would provide, he suggested that a clinician checklist could be developed for this context. The checklist would, as he described it, be like the checklist that a pilot might use prior to takeoff, underscoring the most critical elements for success.

That guidance and the gaps noted above provided the necessary underpinnings for the work which ended up focused on communication. The perspectives of a sample of patients and clinicians in the bladder cancer context, specifically the trimodal therapy context, were solicited and leveraged to create a checklist for patient communication. Patient input focused on highest priority items that medical professionals should discuss with patients and caregivers, things not discussed but should have been, and issues discussed that could have been communicated more effectively. A small group of respected radiation oncologists participated in the review.

The resulting checklist,³ published in Clinical Oncology, provides a set of communication standards for clinicians in the urology space–doctors, nurses, and medical staff– to leverage as they support shared decision-making, provide necessary inputs to decisions and answers to questions, and set expectations for the patient journey. The checklist was purposely restricted to 10 items to motivate adoption, recognizing that a longer list would likely not be remembered or used.

Guiding principles for the checklist included the following:

• Sharing of relevant information and validation of comprehension so that patient and practitioner can jointly make informed decisions.
• Alignment between practitioners as well as patient, caregivers, and partners.
• Proactive management of expectations for short, intermediate, and long term.
• Inclusion of resources at both clinic and advocacy levels.

The final checklist proposed these 10 actions:

1. Ensure adequate time for the patient to ask questions and receive answers.
2. Introduce the patient to their entire care team and make sure the team agrees on the proposed treatment plan.
3. Confirm the patient’s understanding of their bladder cancer diagnosis, including stage, grade, and the impact on prognosis.
4. Discuss all treatment options for the stage and grade of patient’s bladder cancer.
5. If the patient is not eligible for one or more of the treatment options, explain why.
6. Explain the risks and benefits of each treatment option, including potential side effects.
7. Describe the patient’s experience during treatment and the potential impact on the daily quality of life both during and after treatment.
8. Explain how the patient will know when and whether the treatment has worked, including the types and timing of tests that will be required.
9. Describe any long-term impacts of each treatment option, including potential limitations on subsequent treatment alternatives if the initial treatment is not successful.
10. Provide the patient with access to educational and support resources for bladder cancer, including those offered by the Bladder Cancer Advocacy Network, American Cancer Society, and other advocacy organizations.

While the context for the developed checklist was bladder preservation/bladder cancer, the guidance is generally applicable to prostate, kidney, penile, and testicular cancers along with other cancers by removing the trimodal therapy/bladder cancer context from within the checklist. Use and testing of the checklist in the clinical setting would provide data on adoption and stimulate improvements in the checklist itself.

Acknowledgments

We thank Dr Timur Mitin and Dr Ananya Choudhury for inspiration and support and Clinical Oncology for publishing the checklist and supporting article.