Enhancing communication in oncology outpatient consultations: critical reflections from doctors

Lynn Furber1, Roger Murphy2, Karen Cox3 and William Steward4

1Department of Oncology, University Hospitals of Leicester, United Kingdom

2School of Education, The University of Nottingham, United Kingdom

3School of Nursing, The University of Nottingham, United Kingdom

4Department of Cancer Studies and Molecular Medicine, University of Leicester, United Kingdom

Submitted: 18/08/2011; Accepted: 09/12/2011; Published: 16/12/2011

Int J Med Educ. 2011; 2:159-169; doi: 10.5116/ijme.4ee2.0dc3

© 2011 Lynn Furber et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

The experiences of patients diagnosed with advanced incurable cancer and the doctors who conducted their medical consultations were studied in order to improve the understanding of what happens in consultations, when bad news is disclosed. The major objective of the study was to critically reflect upon doctor-patient communication, in such situations, with a view to considering future strategies for doctors' continuing professional development.

Methods: Sixteen patients and sixteen Oncologists, from a cancer centre in the UK were recruited into this ethno-graphic study. One hundred and fifteen episodes of data were collected from audio recorded consultations; inter-views with doctors and patients and their relatives and observations of consultations. These data were analysed using a constant comparison method.

Results: Interactions between doctors and patients are complex and consultations can be challenging for both of them. Some doctors spoke openly about their need for additional support to enhance their communication related competencies within Oncology consultations. These doctors wanted to observe their peers conducting consultations. They also wanted to receive feedback about their own clinical practices. These doctors stated that they wanted an open culture whereby they could talk freely about difficult and emotionally challenging consultations without fear of being considered incompetent by their Consultants, who act in a clinical supervisory role.

Conclusions: To help practitioners consolidate their practice in such settings it is necessary to develop better collaborations among practitioners within clinical practice. Providing individual supervisory sessions or group workshops can facilitate reflective learning and provide an open and supportive learning culture.