PSYCHOSOCIAL ASPECTS OF CANCER CAREPATIENT COMMUNICATION AND SURVIVORSHIP CHALLENGES BY PHILIP ODIYO MA. PhD( Cand.) UICC Fellow 2014.

The 6 Feared “D’s”

• Discomfort

• Dependency

• Disfigurement

• Disability

• Disruption

• Disengagement

• Death

(Holland et al, 2001)

Complexity of Cancer

“ The complexity and variability of psychosocial issues associated with cancer has created the demand for highly skilled practitioners who are trained to provide multilevel assessment and intervention throughout the illness continuum.”

Smith, Walsh-Burke and Cruzan, 1998

The evolution of doctor patient relationship

The relationship has undergone a transition throughout the ages from

Medical Paternalism->

Enhanced Autonomy

The CORE business of doctor patient communication

Doctor- patient communication• Enhance therapeutic nature of the medical

encounter.

• Manage problems in doctor patient communication.

• Important contribution to clinical reasoning.

• Less doctor shopping or hopping.

• Greater patient satisfaction.

• Physician satisfaction.

• Improved medication adherence.

Fact I: During doctor patient communication

• 45 % of patients concerns are not elicited.

• 50% of Psychosocial problems missed.

Fact II: Doctor –patient communication

• In 50% of visits, the patient and the doctor do not agree on the nature of the main presented problem [Starfield et al 1981]

• Only a minority of health professionals identify more than 60% of their patients' main concerns [Maguire et al 1996]

Fact III: Doctor patient Communication.

Doctors often pursue a “doctor-centred”, closed approach to information gathering that discourages patients from telling their story or voicing their concerns

[Byrne and Long 1976]

Common communication styles

Paternalistic

• Doctor centered.

• Closed questions.

• Disease centered model

Patient centered

• Patient centered.

• Open questions.

• Primacy of patient welfare.

• Patient autonomy

Patient centered communication is integral to patient centered care.

Patient centered approach

Physician tries to enter the patient’s world to see the illnessthrough the patient’s eyes.

C.A.R.E

• Cope with illness or bad news.

• Active participation in self care.

• Responsibility, self esteem, confidence.

• Empower patients own decision making

The doctor is the drug

Clinical Empathy is a Clinical Procedure

• Distress

• Empathy shifts arousal toward homeostasis: neurobiological intervention

Herbert Adler (2007) JGIM

What does the patient want from a physician

• Trust, competence, efficacy.

• Treated with dignity and respect.

• How the sickness will affect their : -Family, Friends, Finances, Future.

BATHE: A Useful Mnemonic for Eliciting the

Psychosocial Context

Background: What is going on in your life? Tell me more…

Affect: What’s that like for you? How do you feel about what is going on?"

Trouble: What about the situation troubles you the most?

Handling: How are you handling that?

Empathy: That must be very difficult for you.

Source: Stuart, M.R. and Lieberman, J.A. III. (2002). "The Fifteen Minute Hour: Practical Therapeutic Interventions in Primary Care" 3rd Edition. Philadelphia: Saunders.

“This is a short list of my main symptoms in the last week.”

Healing Relationship

• You are practicing medicine when you are listening.

• The healer can reduce suffering, even if cure is not possible.

• Be there with the patient.

How can we foster hope ?

Fostering hope is a balancing act

SPIKES

• SPIKES

• Six-step protocol

• Setting - Set the stage.

• Perception- What does the patient know?

• Invitation- How much does the patient want to know?

• Knowledge- Share the information.

• Emotion- Respond to feelings.

• Subsequent- Plan next steps and follow-up

Communication across cancer continuum

DIAGNOSISOFCANCER

ADVANCINGDISEASE;DNR; HOSPICE

RECURRENCEOFDISEASE

COMPLETIONOFTREATMENT DEATH

INITIALTREATMENT

TERMINALPALLIATIVETREATMENT

Adapted from McCormick & Conley, 1995

“I could die from this.”

“I have survived --will it Return?”

“I will likely die” --depressed; anxious

“I am dying.”

9.Interdisciplinary Team Collaboration

MD

Psychologist

Spiritual Counselor

Nursing

Social Work

Patient/Family

In conclusion

The patient is not just a group of symptoms, damaged organs and alteredemotions

The patient is a human being, at the same time worried and hopeful, who issearching for relief, help and trust

Any Questions???????