REVIEW QUESTION

Can communication skills training (CST) improve the communication skills of health care professionals (HCPs) who work with cancer patients?

TYPE OF REVIEW

A systematic review of 17 randomized controlled trials (RCTs).

RELEVANCE FOR NURSING

It's well known that people living with cancer will experience some level of psychological distress associated with their cancer diagnosis and the effects of the disease and its treatment. This may cause a reduced quality of life and may even negatively impact survival. Good communication between HCPs and cancer patients is central to quality health care and has been linked to patients' well-being.

CST generally focuses on communication between HCPs and patients during interactions and includes an emphasis on relationship-building skills, providing structure to and initiating the interaction, gathering information, explaining, planning, and closure. Most approaches to teaching communication in health care incorporate cognitive, affective, and behavioral components, with the aim of promoting greater self-awareness in the HCP.

CHARACTERISTICS OF THE EVIDENCE

The objective of the review was to assess whether CST is effective in changing the behavior of HCPs working in cancer care and in improving HCP well-being, as well as patient health status and satisfaction. Inclusion criteria were RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. The primary outcome was change in HCP communication skills as measured by interactions with real or simulated people with cancer or both, using objective scales.

Seventeen RCTs conducted mainly in outpatient settings were included in the review, for a total of 1,240 participants, and included oncologists and other physicians, residents, nurses, and mixed HCPs. Eleven trials compared CST with no CST; three trials compared the effect of a follow-up CST after initial CST; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST.

Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely than those in the control groups to use open questions (very low-certainty evidence), more likely to show empathy toward their patients (moderate-certainty evidence), and less likely to give facts only (low-certainty evidence). Moderate-certainty evidence found no difference between CST and no CST in HCPs' eliciting patient concerns and providing appropriate information. There was also no evidence of differences in other communication skills, including clarifying and/or summarizing information, and negotiation. No difference between physicians and nurses were noted.

BEST PRACTICE RECOMMENDATIONS

The analysis suggests CST improves some aspects of HCPs' communication skills and ability to empathize with people living with cancer, both of which may lead to improved patient outcomes. Owing to lengths of follow-up, evidence supports only short-term change, and longer-term benefit is unknown.

RESEARCH RECOMMENDATIONS

Studies designed to identify which components of CST are most effective, the length of training required, the value of follow-up, and the long-term efficacy of training would assist in evaluating the value of CST, which programs may be most beneficial, and how often training should occur. It may be preferable to use real patients for measurement of HCP communication to ensure clinically meaningful results.

REFERENCE