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Approaching Difficult Communication Tasks in Oncology¹

Dr. Back is Associate Professor, University of Washington Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA.
Dr. Arnold is Professor, Section of Medical Ethics and Palliative Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Dr. Baile is Professor and Chief, Psychiatry, University of Texas MD Anderson Cancer Center, Houston, TX.
Dr. Tulsky is Associate Professor, Program on the Medical Encounter in Palliative Care, Duke University, Durham, NC.
Dr. Fryer-Edwards is Assistant Professor, Department of Medical History and Ethics, University of Washington, Seattle, WA.

Effective communication skills enable physicians to improve patients’ understanding of their illnesses, improve patient adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment. Common communication pitfalls include blocking, lecturing, depending on a routine, collusion, and premature reassurance. Fundamental communication skills include "ask-tell-ask," "tell me more," and responding empathetically. Key communication tasks that are linked to the illness trajectory include: the first visit, giving bad news, making anticancer treatment decisions, offering clinical trials, completing anticancer therapy, and discontinuing palliative chemotherapy. While enhancing or acquiring new skills ultimately requires practice and feedback over time, this article provides a cognitive map for important communication skills that physicians need over the course of caring for a person with cancer.

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