The plan is for
me to write a series of blogs about cancer. You will read this small paragraph every time you read one
of these blogs because it is an explanation and a disclaimer. First of all, why should I do this and
what qualifies me to do so? The answer
to the second question is that I am a cancer immunologist with a PhD from the
University of Pennsylvania and have 30-years experience in not only research,
but also in the experiences of cancer patients. I have published numerous articles and a book about immunity
to cancer and have two other books about my experiences with research and
cancer patients as well as a fictional account of the final cure for the
disease. However, none of this
experience allows me to give advice or otherwise tell people what to do if they
have cancer. I can be viewed as a
participant/observer who will be relaying current and past observations about
this world called “cancer”, which many people do not understand. That’s the answer to the first
question, which is why I should do this.
The first step in overcoming anything is to understand it first. With that being said, here they are:
Number 7 Psycho-oncology and doctor patient
communications
Changes related to the psychological treatment of cancer patients due
to cancer-induced stress.
One
of the things about cancer, which is unlike many other diseases, is that cancer
is not only a physical ailment, but a mental one as well. Because cancer patients receive more
extensive treatments than ever before and more of them survive longer, there
has been the development of a relatively new field. This field is called psycho-oncology and deals exclusively
with the psychological problems caused by cancer. This field of psychology got its start in the early 1990’s
and was first recognized in Europe as a way to not only improve cancer patient
quality of life, but survival of a disease that in some respects flourishes
during stressful periods of a patient’s life. The continued survival of cancer patients due to new
therapies and the extended amount of time a cancer patient had to “live” with
their cancer was the main impetus for the creation of psycho-oncology as a
major branch of psychoanalytical study.
The field of psycho-oncology not only addresses the various emotional
stages with specific therapies, but also encompasses another branch of
psychology called psychopharmacology.
This has to do with the administration of specific psychoactive drugs to
deal with the stress of cancer.
Many of these drugs are antidepressants, but many deal with common
cancer-related problems such as sleep disorders, nauseas, vomiting, seizures,
and anxiety. Most importantly many
of the treatments associated with psycho-oncology are related to terminal illness
and aspects related to end-of-live issues. These issues not only involve the patient, but also family
members. Often this area of cancer
is never addressed until that time comes, but because of the strong emotional
impact there is a need for psychological intervention.
K. Patient/physician
communications.
Communication
associated with cancer starts immediately after a person has been diagnosed
with the disease. The first step
is the consultation between the patient and the attending physician who must
first describe the particular type of cancer (diagnosis), discuss the possible
medical consequences (prognosis), and then outline the possible treatment
options available to the patient.
This last part (treatment) is complicated and difficult to explain
because of not only the highly technical nature of cancer treatment, but also
the number of variables such as age, type of cancer, and affordability that are
involved. The results of these
discussions as far as “patient satisfaction” with the physician’s communication
style are also somewhat difficult to assess for a similar reason, which is the
number of variables involved. For
instance a patient can be very satisfied with the physicians communication
style if the medical care they received was successful, which in reality had
nothing to do with what the physician said. However, on the other hand, if the physician used an
authoritarian (dominant over confident) style vs. an affiliative
(self-association) style of communication this would lead to a negative
satisfaction rating. Clearly the
patients were paying attention to the physicians in this case, but how they
decided their satisfaction with their discussions and treatment had more to do
with “how” they were told rather than the content of what they talked about. Many physicians feel as though they are
giving patients too much information for them to understand in time to make
decisions about treatment options.
This is particularly true when patients enroll in an experimental
clinical trial. However, a study
was done that demonstrated a contrary response to the physician’s views about
that information when patients were asked that very question about too much
information. Many of the patients
(enrolled in a clinical trial) felt that they were given adequate information
and time to understand it.
Another aspect of
understanding basic communication in cancer is something that was mentioned
earlier called an affiliative style, which has to with the physician’s ability
“self-identify” with the patient.
This is a subtle part of communication that has to facial expressions,
body language and voice tone, or in other words “non-verbal
communications”. It turns out that
this is a very important aspect communication as far as patient satisfaction
with the doctor/patient interaction, which is based on basic
communications. To a certain
extent for a physician, this form of communication is an “art” and the
physicians who are very good at it tend to get the highest ratings as far as
patient satisfaction is concerned.
This form of physician/patient communication is more focused on the
patient as a person and tends to garner a sense of trust, which is needed in
order to successfully treat the patient.
Much of information offered above directly relates the patient’s
perception of the physician’s ability to communicate the information needed to
help them understand their diagnosis with cancer and the events that will
follow that diagnosis. However,
effective communication and perception of how that information was given is
central to basic communication about cancer and in part, dependent on the
educational level and emotional state of the patient. The above-mentioned studies do demonstrate that
communication between a cancer patient and their physician is based on a more
personal approach to the transfer of information. If this type of communication done correctly it can lead to
a patient that is satisfied that he or she has been given adequate and
satisfactory information about cancer in order to make the proper decisions
about their care. However, if
these information transfers are done without this “personal approach” it can
lead to improper decisions that are inconsistent with the patient’s personal
preferences because the patient feels obligated to do what the physician tells
them to do. In the end this leads
to patient dissatisfaction not only in terms of the communication style of the
physician, but the results of a treatment that the patient really didn’t want
in the first place. In this case,
the result was that the patient was unhappy about the treatment given because
it did not conform to their personal preferences. However, as mentioned above, if the initial communications
between the physician and patient are inadequate, but the treatment is, the
patient can still be unhappy about the treatment. Therefore, how this information about the patient’s cancer
is delivered is very important because this phase can affect a patient’s
perceptions of their treatment, despite the fact that the discussions and the
treatments are separate issues. It
is clear that the communication between a cancer patient and his or her
physician can be complex and fraught with misunderstandings as the patient
comes to grips with the problems associated with their cancer. Despite these difficulties new cancer
physicians are being trained to not only fully disclose the nature of the
patient’s disease, but also how to tell that person that they’re cancer is
terminal.
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