Back to Basics: Communication 101

I was struck by the recent Jane Brody column in The New York Times entitled “Law on End-of-Life Care Rankles Doctors.”[1] It addressed legislation passed in New York State last summer that took effect in February of this year. Similar to a bill passed in California in 2009, New York State's Palliative Care Information Act dictates that when a terminal illness or condition is diagnosed, information and counsel about palliative and end-of-life care must be offered to patients. Brody's piece included a back-and-forth volley of commentary. Physicians lamented the law's “heavy-handed intrusion into the doctor-patient relationship,” while David C. Leven, JD, Executive Director of Compassion and Choices of New York and a key sponsor of the Act, responded, “The law simply requires physicians to do what should be required of them.”

Brody noted that doctors are notorious death-deniers and frequently disappear when curative therapeutic options have been exhausted. Based on my nearly four-decade tenure as an oncology nurse, I found myself agreeing with her observations. From a personal perspective as a daughter and wife whose father and husband died of metastatic cancer, I found this to be my reality as well.

If it takes legislation to force communication with patients and their loved ones, then so be it. This paradigm of silence and limited disclosure has gone on far too long. The science and sophistication of cancer care are not just physiologically based but are also—if not more so—emotively charged. The Times editorial acknowledges that few physicians trained more than a decade ago received instruction on how to communicate “bad news.” As nurses we, too, have historically lacked skills training in communication savvy. Both disciplines are long overdue for some in-depth help when it comes to talking with patients and families during times of personal tragedy. As baby boomers continue to age and our longevity portends increased health risk, we will become the majority of patients requiring health and cancer care. Physicians' and nurses' ability to talk with us about our waning health will not be perceived as a sought-after luxury, but rather as a necessity.

The contemporary concept of emotional intelligence has great relevance in cancer care. This paradigm reflects one's ability to correctly identify, use, understand, and manage emotions.[2] It has significant implications for understanding our own internal emotional self and how we handle interpersonal conflict and extend caring practices to others.[3] I have noted previously that our future will not look like today's reality.[4] Collectively we have personal decisions to make. We can plan for and embrace change or we can wait or resist, potentially allowing rigid constructs to dictate practice. I hear what our patients and families are saying about the kind of dialogue in which we should be engaged together—I've even said those things about healthcare providers myself. The gaps are glaring. I, for one, am signing up for the advanced version of Communication 101.