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Published by American Society of Clinical Oncology (ASCO) · GRADE
Effective health care communication is associated with improvements in patient health outcomes. This guideline updates the 2017 ASCO communication guideline by providing oncology clinicians with evidence-based practices for effective communication across the continuum of care, while addressing new challenges such as telehealth, interprofessional communication, and boundary setting.
This document serves as an update to ASCO’s first guideline on patient communication, published in 2017, and expands the scope to include three new topics: communication during telehealth encounters, interprofessional communication, and boundary setting during clinical encounters.
Prior to each conversation, clinicians should review the patient’s medical information, establish goals for the conversation, and anticipate the needs and responses of the patient and members of their support network.
After inquiring what the patient and members of the patient’s support network wish to address and explaining what the clinician wishes to address, clinicians should collaboratively set an agenda with the patient and key members of their support network.
During patient visits, clinicians should engage in behaviors that actively foster trust, confidence in the clinician, and collaboration.
Clinicians should provide information that is timely and oriented to the patient’s concerns and preferences for information. After providing information, clinicians should check for patient understanding and document important discussions in the health record.
When a patient displays emotion through verbal or nonverbal behavior, clinicians should respond empathically.
Clinicians may use telehealth modalities to replace or supplement traditional in-person communication and care in many instances. Telehealth may be delivered via telephone, video, text messaging, mobile apps, patient portals, and wearable monitors. In addition, secure messaging can complement traditional forms of communication.
Ensure telehealth communication safeguards are in place to protect confidential sharing of health information.
Adapt exemplary communication skills from in-person meetings to telehealth settings.
Given the increased volume of telehealth encounters, organizations must construct and maintain systems to support and enhance clinician well-being.
Health care teams should establish a structure and system to support high-quality communication across the different members of the care team.
Implement strategies that foster a sense of belonging among team members and ensure that all team members are treated with respect.
After a patient death or another emotionally upsetting event occurs, health care teams should have a process for debriefing the event.
Clinicians should provide diagnostic and prognostic information that is tailored to the patient’s needs and that provides hope and reassurance without misleading the patient.
Clinicians should reassess a patient’s goals, priorities, and desire for information whenever a significant change in the patient’s care is being considered.
Clinicians should provide information in simple and direct terms.
When providing bad news, clinicians should take additional steps to address the needs and responses of the patient.
When appropriate, discuss with the patient the roles and availability of palliative care.
Prior to discussing specific treatment options with the patient, forecast the discussion by setting a shared agenda of the topics that will be covered. Start by assessing the patient’s current understanding of the disease status and treatment options; review symptom stress and changes in disease status and options; contextualize and adapt to the patient’s goals and values.
When reviewing treatment options with the patient, clinicians should provide information about the potential benefits and harms of any treatment and check the patient’s understanding of these benefits and harms.
Discuss treatment options in a way that balances patient hope with a realistic assessment of likely outcomes, promotes autonomy, and facilitates understanding.
Clinicians should make the patient aware of all treatment options, including established standard of care, clinical studies, and a focus on palliative care. If clinical studies are available, clinicians should start treatment discussions with standard treatments available off trial and then move to a discussion of applicable clinical studies if the patient is interested.
Clinicians should use an organized framework to guide the bidirectional communication about end-of-life care with the patient and members of their support network.
Clinicians should initiate conversations about the patient’s end-of-life preferences early in the course of incurable illness and readdress this topic periodically based on clinical events or preferences.
Clinicians should explore how a patient’s culture, religion, or spiritual belief system impacts their end-of-life decision making or care preferences.
Health care teams should identify and suggest local resources to provide robust support to the patient, and members of the patient’s support network when the patient transitions to end-of-life care.
Clinicians should recognize and respond empathically to grief and loss among the patient, the patient’s support network, and the health care team. Clinicians should refer the patient and members of their support network to psychosocial team members (eg, social workers, counselors, psychologists, psychiatrists, and clergy) when appropriate.
Clinicians should inquire about the desirability of involving the patient’s support network in discussions about cancer and cancer treatment early in the course of the illness.
Determine if a formal family meeting in a hospital or outpatient setting is indicated at important junctures in care. When possible, ensure that the patient, their designated surrogates, and desired medical professionals are present.
If the patient or their support system do not share a common language with the clinician, use a medical interpreter rather than a family interpreter.
Focus on the most important points, use plain language, use a multimedia approach, and check frequently for understanding (see Recommendation 5.3).
For a patient with physical limitations that may affect communication, incorporate strategies appropriate for physical abilities.
Clinicians should explore whether cost of care, or nonmedical costs (eg, loss of income) are concerns for the patient.
Clinicians should inquire if patients have difficulty with medical bills and if so, refer patients to reliable sources.
Clinicians should be prepared to discuss the magnitude of benefit associated with tests and treatments they order so that patients can assess value based on the relationship between benefits and costs.
Enter clinical encounters with a sense of respectful curiosity, aware that any person, regardless of their background, may have beliefs, experiences, understandings, and expectations that differ from the clinician’s.
Assess potential barriers to care for the patient, utilizing support as needed.
Remain aware that many patients have experienced adverse childhood events, as well as negative past health care and life experiences, including feeling disrespected, alienated, or unsafe, and respond with trauma-informed care.
Ensure that information needs are met and that the patient has the opportunity to participate in the decision-making process.
Recognize that when patients appear aggressive or respond with intensity, it could be a signal of unmet expectations, incomplete involvement in decision making, high emotional or care needs, or merely the inherent difficulty of the situation, and respond accordingly if able to do so while ensuring your own physical and emotional safety.
For boundary crossings by a patient, whether with the clinician themselves or observed with another team member (eg, clinical colleague, trainee), communicate clear expectations and set clear limits.
Evaluate the ethical permissibility of one’s own actions through an ethical framework.
As part of their professional responsibility to continuously develop and improve their communication skills, clinicians should seek communication skills training that emphasizes sound educational principles including skills practice and experiential learning using role-play scenarios, and direct observation of patient encounters with coaching.
For communication skills training to be most effective, it should foster practitioner self-awareness and situational awareness related to emotions, attitudes, and underlying beliefs and assumptions that may affect communication, as well as awareness of implicit biases that may affect interpersonal behaviors and decision making.
Facilitators of communication skills training should have sufficient training and experience to effectively model and teach the desired communication skills and facilitate experiential learning exercises.
Clinical Topic
Patient-Clinician Communication
Objectives
To provide guidance to oncology clinicians on using effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and caregiver well-being.
Target Patient Population
Adults with cancer and members of their support network.
Target Providers
Therapeutic Area
OncologyGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: GRADE
Evidence Levels
Recommendation Strength
Difficulty
intermediate
Learning Paths