PSYCHO-ONCOLOGY

Psycho-Oncology 14: 859–860 (2005)Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.971

COMMENTARY ON

PATIENT INTERVENTIONS TO FACILITATECOMMUNICATION

PETER SALMON*

Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK

HELPING PATIENTS ACHIEVE THEIR OWNGOALS FOR COMMUNICATION

For many people, the trauma of cancer iscompounded by avoidable problems that arise intheir relationships with doctors, nurses and otherhealth care staff. While communication teachingfor professionals therefore offers one way to helppatients, it relies on teachers knowing how patientswant to be communicated with. Parker et al. focuson the potentially more direct strategy of strength-ening patients’ own hand in negotiating with theirclinicians so that they can achieve their owncommunication goals.

Interventions that have taken this approach, asParker et al. show, have focused on increasingpatients’ question asking in consultation. How-ever, Parker et al. remind us that many patients donot want to find out things that experts mightthink they should know. Indeed, never wanting todiscuss prognosis was associated with lowerdepression (Hagerty et al., 2004). Therefore, whilethe intervention studied by Davison et al. (2003)could be regarded as empowering patients in thatit increased their participation, might it also havedisempowered by inducing them to participatemore than they had initially wanted to? Therefore,Parker et al. help to expose the fine line betweenempowering patients by helping them achieve theirgoals and training them to fit current views of therole that patients should take.

Assumptions influence, not only interventions,but also criteria for evaluating them. To measureanxiety as the outcome of an intervention toincrease questioning (Brown et al., 1999) makessense in the context of communication theorythat links information to reduced anxiety andthat regards anxiety as destructive. But anxietymight be constructive when faced with an acutedanger (Janis, 1958), and patients might some-times receive}and even seek}information thatincreases it.

Parker et al.’s reminder is therefore veryimportant: the reason for changing patients’communication must be that their goals are bettermet. Patients’ goals for communication can,however, be more complex than the way in whichthey are sometimes represented. For example,Parker et al. evoke current emphasis on informa-tion provision in suggesting that an importantpatient goal is ‘understanding their healthsituation’. From patients’ perspective, however,understanding is a complex and heterogeneousquantity. There is understanding that helps themfeel confident about doctors’ decisions, thatreassures them that their doctors know what theyare doing or maintains hope; and there is anunderstanding that some want to avoid because itdestroys hope.

Patients’ and experts’ perspectives can divergeand recognising this can be a basis for makingsense of otherwise paradoxical results that Parkeret al. expose. Patients valued a written summary oftheir consultation, but recalled no more informa-tion about it (Damian and Tattersall, 1991).Similarly, patients valued a coaching interventionthat had no effect on their satisfaction with theconsultation on which the coaching was targeted

Copyright # 2005 John Wiley & Sons, Ltd.

*Correspondence to: Division of Clinical Psychology, Uni-versity of Liverpool, Whelan Building, Brownlow Hill, Liver-pool L69 3GB, UK. E-mail: psalmon@liv.ac.uk

(Sepucha et al., 2002). It seems that the interven-tions had functions for the patients that theirdesigners had not considered. Understanding moreabout what patients seek and gain from commu-nication will help to design the interventions thatmeet Parker et al.’s challenge}to help patientsachieve their own goals in consultation.

REFERENCES

Brown R, Butow PN, Boyer MJ, Tattersall MH. 1999.Promoting patient participation in the cancer con-sultation: Evaluation of a prompt sheet and coachingin question-asking. Br J Cancer 80: 242–248.

Damian D, Tattersall MH. 1991. Letters to patients:Improving communication in cancer care. Lancet 338:923–925.

Davison BJ, Goldenberg SL, Gleave ME, Degner LF.2003. Provision of individualized information to menand their partners to facilitate treatment decisionsmaking in prostate cancer. Oncol Nurs Forum Online30: 107–114.

Hagerty RG, Butow PN, Ellis PA et al. 2004. Cancerpatient preferences for communication of prognosis inthe metastatic setting. J Clin Oncol 22: 1721–1730.

Janis IL. 1958. Psychological Stress. Wiley: New York.Sepucha KR, Belkora JK, Mutchnick S, Esserman LJ.2002. Consultation planning to help breast cancerpatients prepare for medical consultations: Effect oncommunication and satisfaction for patients andphysicians. J Clin Oncol 20: 2695–2700.

P. SALMON860

Copyright # 2005 John Wiley & Sons, Ltd. Psycho-Oncology 14: 859–860 (2005)