Communication

1. Communication Panel Discussion First National Workshop on Cross Cultural Cancer Research and Care: Building Collaborative Communities Sally Thorne, RN, PhD, Professor and Director University of British Columbia School of Nursing

2. The “Problem” of Communication • Public expectations increasing • Noted in every recent cancer consumer forum as an ongoing problem • Evolving role in knowledge transfer, interpretation of information

3. Increasing recognition of the multiple impacts of of communication breakdown (psychosocial, legal, economic) • Implications for all aspects of the care process • Inherent complexity: presumption of infinite variation

4. What Can Communication Research Tell Us? • Communication is important • Some common patterns in communication dynamics can be described • Communication can be correlated to specific outcomes (quality of life; patient satisfaction) • We can evaluate the relative effectiveness of different communication interventions

5. Example of the Problem: Cochrane Review on Effect of Communication Skills Training • 4238 studies retrieved • 1417 considered duplicates • 2508 variations on target variables • of 48 remaining, 46 excluded (measures more oriented to attitude than skills; no control groups; subjective evaluation)

6. Conclusions • In standardized videotaped role playing, trained oncology nurses more ‘in control” of the interview • In clinical consultations, trained oncologists used more “emotion focused” words (Fallowfield, 2002; Razavi et al, 1993; 2002)

7. Current Knowledge “Blind Spots”(Mostly) untested but entrenched assumptions • Patients hate you when you give them bad news • If you show interest in patients, you can’t control time with them • All patients are concerned about is whether or not you can cure them • Western biomedical science is the only rational approach to cancer • Lay persons can’t understand medical science

8. People can’t hold two mutually exclusive truths in their minds at the same time • Non-compliance is a result of irrational thinking, stupidity, or psychological problems • Providing options creates anxiety for patients • Professional uncertainty creates anxiety for patients • Unrealistic hope is dangerous • All other professionals are as caring as I am

9. What we Still Don’t Know and Why? • The problem of evidence • What assumptions are we operating from? • How can ethical principles and moral convictions compete with evidence claims? • What are the implications of human variation (are there any universals?)

10. The constructive power of positive communication

11. The toxic effect of negative communication

12. If communication were a drug……..

13. Domain Effective Communication Problematic Communication Courtesy Office practices, listening, acknowledgement, sincerity Rudeness, patronizing Respect Recognition of expertise, recognition of social context, empathy, offering information Insulting intelligence, withholding info, discounting, failure to appreciate limits of western science Engagement Coaching, teamwork, shared decision-making Dismissing, blocking access, distancing

14. Across Cultures • The Meaning of “Being Known” • Hope and Probability • Why Cancer Communication Matters

15. The Impact of Communication: Cultural Safety Everyone was so nice and explained every step of the way and made sure you were secure and not scared. The care was like a big, beautiful family.” “And then I went to the cancer clinic. Now I’ve never been to anything nicer in my life. I loved everything!