ASCO Releases Guidelines on Patient—Clinician Communication

The American Society of Clinical Oncology (ASCO) has published a set of guidelines and best practices that can help clinicians improve how they communicate with patients and families receiving cancer therapy.

Despite research demonstrating that optimal communication can improve outcomes in healthcare, clinicians are often ill-prepared to clearly deliver oncology information, due in part to the complexity of this information and the lack of communication skills training. Published as a special article in the Journal of Clinical Oncology, the new guidelines aim to fill that gap by offering suggestions and strategies for oncologists caring for adult patients.

According to the article, the guidelines were developed after a systematic literature review meant to address 9 important questions about communication in the oncology setting. These questions range from broad (eg, “What core communication skills and tasks apply at every visit, across the cancer continuum?”) to more specific (eg, “Should clinicians discuss cost of care with patients?”).

Based on the results of the review, part of ASCO’s multidisciplinary Expert Panel drafted recommendations around these 9 questions. The recommendations, which had to be approved by the larger Consensus Panel to be accepted, include strategies for implementation and indicate the strength of the recommendation. Only 1 set of recommendations were considered evidence-based, while the rest were developed by formal consensus.

The key recommendations in response to each of the 9 guiding questions were presented in a “bottom line” box accompanying the article, and the strategies for implementation were explained in further detail within the text. Each of the recommendations were determined strong. For the sole evidence-based recommendation, clinician training in communication skills, the quality of evidence supporting it was deemed intermediate by the Expert Panel.

A summary of the communication topics and recommendations is as follows:

1. Core communication skills: build a trusting and empathetic relationship with patients.
2. Discussing goals of care and prognosis: tailor information to patient needs, goals, and responses.
3. Discussing treatment options and clinical trials: provide realistic information on likely outcomes as they relate to patient goals.
4. Discussing end-of-life (EOL) care: address EOL care based on patient preferences and provide support to patients and families coping with loss.
5. Using communication to facilitate family involvement in care: incorporate families and caregivers in discussions, when appropriate.
6. Communicating effectively when there are barriers to communication: ensure accurate delivery of information to patients speaking another language or with low health literacy.
7. Discussing cost of care: explore whether patients have financial concerns about their care.
8. Meeting the needs of underserved populations: act with sensitivity towards the needs and experiences of all patients, particularly members of marginalized groups.
9. Clinician training in communication skills: practice communication skills under the guidance of experienced training-exercise leaders.

The guideline authors identified 2 important themes that reappeared throughout the recommendations: building an empathetic clinician­—patient relationship based on understanding, and communicating information so that patients understand and retain it. They also acknowledged that further research is needed to strengthen these recommendations.

“In the meantime, the available evidence, coupled with the experience and training of the Expert Panel, helped to identify a number of best practices as reflected in these recommendations,” they concluded.