In Reply

Abstract

Ethics and communication competencies are core to professional decision making with patients with advanced cancer, but it is important to distinguish between these two domains. Those involved in the teaching of professional decision making in oncology should be aware of the differences between ethics and communication and should be equipped with the competencies to teach both in an integrated manner.

We would like to thank Mannhardt et al. for presenting the interesting findings of their evaluation research on medical students' communication competencies in oncology [1]. The results of our qualitative interview study with oncologists concur with their view that ethics and communication competencies are core to professional decision making with patients with advanced cancer [2]. Although both ethics and communication skills are needed in clinical practice, it is important to distinguish between these two domains of competency. Making this distinction enables us to determine the different learning aims and methods that are needed for ethics and communication training, respectively, to support medical students and physicians making treatment decisions in oncology in a professional manner [3]. Ethical competencies relevant to treatment decision making in advanced cancer include knowledge about ethical concepts and guidance on withholding and withdrawal of treatment in advanced cancer as well as skills to identify values that underlie decisions for or against treatment in advanced cancer. The relevant communication competencies, as listed in the checklist by Mannhardt et al., cover skills related to conveying information in an understandable way and building rapport with patients and others. The differences between and the interdependencies of ethics and communication skills regarding decision making in oncology can be illustrated by item number 8 of the instrument used by Mannhardt et al., on whether goals of the conversation were achieved as viewed by the patient and the doctor [1]. From an ethical perspective, this item begs several questions: whose goals should determine decision making? Were both parties able to make their goals explicit? Was there an exchange of the values underlying the (possibly different) goals? Did they engage in a process of mutual agreement about what the goals of the conversation were?

Communication skills training without an awareness of the ethical dimension of patient-physician interaction runs the risk of missing the values that underpin our communication and creating frustration because of failure to communicate, however laudable the communication skills in use are. At the same time, teaching ethical concepts without considering how to translate and communicate such knowledge into the context of the patient-physician interaction runs the risk of having little impact on clinical practice. Against this background, we would argue that those involved in the teaching of professional decision making in oncology should be aware of the differences between ethics and communication and should be equipped with the competencies to teach both in an integrated manner [4].

Disclosures

The authors indicated no financial relationships.