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Surviving the Stresses of Clinical Oncology by Improving Communication

Surviving the Stresses of Clinical Oncology by Improving Communication

In their article, Armstrong and Holland briefly review many of the reasons why the practice of oncology is likely to be stressful, including the factors that lead to burnout or feelings of being overwhelmed. The article then goes on to focus on ways to enhance communication in the clinical setting as an important approach to dealing with the stress of clinical practice and the symptoms of burnout. The scenarios described are familiar, and the authors do a good job highlighting the challenges of these situations by providing examples of strategies that can enhance communication and potentially reduce distress. Limits of Effective Communication
Effective communication may assist the patient and the doctor through difficult moments in their relationship; however, it may do little to reduce the stress that is unavoidable and integral to taking care of seriously ill people. Unfortunately, just the wear and tear of repeatedly communicating bad news or even communicating relatively good news about a favorable prognosis, can become emotionally draining. In specialized practices that focus on patients who are almost always seriously ill (eg, pancreatic cancer, metastatic lung cancer), the need to distance and depersonalize may, at times, be a necessary coping strategy, just to get through the day. The examples and suggestions provided by the authors will be valuable to the less experienced oncologist or to those who may lack insight into the psychosocial issues associated with these common situations; however, experienced oncologists who have mastered these communication techniques may need additional strategies to help them address the daily stresses of practice. There is a need for better therapies-treatment oriented and supportive-in the armamentarium when initial treatments do not work. Patients and the public need to be educated to have realistic expectations about the limitations of medical care and the important role of palliative care as part of cancer management. No matter how effective we are in communicating bad news, we will feel the pain, suffering, and emotional distress of our patients and their families. It is simplistic to think that effective communication will eliminate those feelings. The Team Approach
What would have been helpful to readers is a description of models of care in oncology settings that have been successful in diffusing the stress associated with the delivery of bad news and the challenges of coordinating care. What models are in place at Memorial Sloan-Kettering or other cancer centers? How have experienced oncologists organized their practices to help them cope with the stresses mentioned in the article? Some examples that come to mind include multidisciplinary breast centers, where care is provided by a team of oncology clinicians (surgeons, radiation and medical oncologists, nurses) and other support staff (social workers, psychologists, physical therapists). In this way, the patient's educational, psychological, and medical needs are comprehensively met, and one clinician is not responsible for addressing all of the patient's needs. In the treatment of childhood cancer, this type of coordinated and family- centered care is standard at most treatment referral centers. In many clinical oncology practices, astute clinicians have incorporated social support services or physician extenders (nurse practitioners, physician assistants) into their practice, as a way to effectively manage the delivery of care, so that it does not fall on only one oncology clinician's shoulders. Using a team approach in the care of oncology patients also means that all of those involved can share the burden by communicating with each other about specific challenges as well as accomplishments (eg, managing a good death). This can provide important support and buffering in everyday practice and may be a critical component of clinical practices with low burnout rates and good morale. Transitions in Cancer Care
It would also be interesting to know how many oncologists can maintain a full-time clinical practice across the span of a career. My own observations in both academic and clinical settings suggest that often there is a transition from full-time practice to more limited involvement in clinical care after about 2 decades (eg, administrative leadership positions in a clinical setting, running clinical trials, or limited practice as an academic clinician). These transitions may reflect the natural professional evolution of midcareer physicians or could be related to the difficulties in sustaining a clinical practice with seriously ill patients over a career in medicine. Understanding workforce patterns in oncology, as well as effective organizational strategies for the delivery of oncology care, could go a long way toward ensuring that we will have an adequate and skilled cadre of oncology clinicians now and in the future. This will be increasingly important with the aging of the population and the broadening involvement of oncologists in the prevention and treatment of cancer.

Disclosures

The author(s) have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
 
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