Advancing Research on Patient-Centered Cancer Communication

When faced with a cancer diagnosis, patients often experience significant emotional distress and feelings of uncertainty about their future. They have to process complex medical information and make difficult, life-altering, treatment decisions. To minimize their illness burden, such patients should ideally receive care from a health care system that provides them with an unfailing environment of ongoing support and focuses on meeting their needs as best as possible.

To facilitate the delivery of such “patient-centered” care and to reduce patient and family suffering due to cancer, the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) in the USA, has identified the “assessment, monitoring, and improvement of the delivery of patient-centered communication between patients/family and the health care delivery team(s) across the cancer control continuum” as a key research priority.

Our prior work in the area of patient-clinician communication [1,2] led us to identify the need for a comprehensive conceptual framework that would identify and define core elements of patient-centered communication that could then be operationalized into standardized measures for collecting data in diverse cancer care delivery settings. We also recognized the relative lack of understanding in the current literature on potential mechanisms by which patient-centered communication is likely to result in optimal patient health outcomes. To address these issues and to lay the foundation for future innovative research in this area, we recently published a monograph titled Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering (http://outcomes.cancer.gov/areas/pcc/communication/monograph.html) [3].

Led by the primary authors, Ronald M. Epstein, MD, and Richard L. Street, Jr., PhD, the content of the monograph has been informed by extensive input from several NCI research scientists as well as discussions with a number of experts in the area of communication, oncology, health care delivery, quality of care assessment, and patient advocacy. Highlights of the monograph include:

• Conceptualization of patient-centered communication into six inter-connected functions: fostering healing relationships, exchanging information, responding to emotions, making decisions, managing uncertainty, and enabling patient self-management; the latter includes facilitating patient navigation and patient empowerment among other tasks

• Emphasis on research that examines the relationship between patient-centered communication and patient health outcomes

• Discussion of potential mediating and moderating mechanisms of the association between communication and patient health outcomes

• Identification of specific research priorities that would guide the research community and funding agencies in planning future research initiatives in this important area

While the studies reviewed in the NCI monograph reflect the reality of existing literature which is often focused on cross-sectional analysis of the patient-physician dyad, the monograph lays the foundation for future studies to take a more longitudinal, systems approach to studying cancer communication. Future studies will need to focus on optimizing communication between health care delivery teams and the patient and family team and not just the patient-physician dyad. From the stand point of improving the quality of cancer care, it is important to understand how well the health care system as a whole, and not just a single physician, delivers patient-centered communication as patients go through different phases of their cancer journey. It is our hope that informed by the next generation of communication studies, health care delivery and population-based surveillance systems will incorporate standardized measures of patient-centered communication along with traditional clinical metrics in a more comprehensive assessment of quality of cancer care delivery.

A Call for papers for a special issue

To further build upon the conceptual foundation laid out in the NCI monograph, Patient Education and Counseling (PEC) is planning a special issue on Patient-Centered Communication in Cancer Care. The aim of this special issue is to feature high quality empirical studies that demonstrate the importance of patient-clinician communication across the cancer control continuum including primary prevention (e.g., smoking cessation, diet, physical activity), early detection/screening (including genetic testing), diagnosis, treatment (conventional and complementary/alternative therapies), post-treatment survivorship, and end-of-life care. A detailed call for papers for this special issue was published in the February issue of and is also run in the back of the current issue. Researchers interested in submitting an article for the special issue are encouraged to review the call for papers and may contact me at aroran@mail.nih.gov for clarification about the appropriateness of their study for the special issue.

By highlighting some of the best empirical work from across the world, this special issue of PEC will inform researchers, clinicians, and policy makers about the salience of patient-clinician communication at different phases of the cancer continuum. We look forward to your contributions to this important publication.