A cancer diagnosis is a life-altering event that impacts not only the physical health of the individual but also their emotional and psychological well-being. Effective communication during this critical period is crucial, as it plays a pivotal role in how patients and their families cope with the diagnosis and make decisions regarding treatment options. However, the process of communicating a cancer diagnosis is fraught with difficulties that can hinder the exchange of information and emotional support.
The recent National Cancer Institute monograph on Patient-Centered Communication in Cancer Care identified 6 functions of patient-clinician communication: exchanging information, making decisions, fostering healing relationships, enabling patient self-management, managing uncertainty, and responding to emotions (1).
Whereas these communication functions shape communication for all patients with cancer, special skills are required for the subset of patients with advanced and incurable cancer who must face death more squarely (2).
This essay explores the various challenges and obstacles encountered in communication during cancer diagnosis and offers insights into how healthcare providers, patients, and their loved ones can address these issues.
1. The Emotional Impact of the Diagnosis
One of the primary difficulties in communication during a cancer diagnosis is the emotional turmoil experienced by both patients and their families. The shock, fear, and distress that accompany the news of cancer can overwhelm individuals, making it challenging to process and retain information.
Patient concerns have both informational and emotional components, so patients need both information and emotional support to resolve their concerns. They look to their oncologist for both (3).
2. Medical Jargon and Complex Information
Medical professionals often use specialized terminology and complex medical information when discussing cancer diagnoses and treatment plans. This poses a significant communication barrier for patients who may not have a medical background. Misunderstandings and misinterpretations can arise, leading to confusion and anxiety. Healthcare providers must be skilled in breaking down complex information into simpler terms, ensuring that patients and their families grasp the essentials without feeling overwhelmed.
3. Information Overload
The abundance of information available on the internet and through various sources can lead to information overload for patients. When individuals receive a cancer diagnosis, they may turn to the internet for information, which can be both beneficial and overwhelming. Sorting through vast amounts of information, some of which may be inaccurate or misleading, can complicate the communication process. Healthcare providers must guide patients toward reliable sources of information and help them navigate the overload to make informed decisions.
4. Cultural and Linguistic Diversity
The Ask-Tell-Ask technique ensures that the physician: 1) gives information slowly enough to ensure that the patient understands, and 2) remains sensitive to the effect the information is having on the patient and does not give too much information (4).
In an increasingly diverse society, healthcare providers may encounter patients from various cultural backgrounds with different languages and belief systems. Effective communication becomes more challenging in such cases, as language barriers, cultural norms, and beliefs about illness and treatment can affect the understanding and acceptance of a cancer diagnosis. Culturally sensitive communication strategies and interpretation services can help bridge these gaps.
5. Time Constraints
Healthcare providers often face time constraints due to heavy caseloads and busy schedules. As a result, patients may perceive rushed consultations, leaving them with unanswered questions and concerns. Effective communication requires adequate time for both information sharing and emotional support. Healthcare systems need to prioritize patient-centered care and allocate sufficient time for consultations, especially during the diagnosis phase.
6. Communication Amongst Healthcare Teams
The diagnosis and treatment of cancer often involve multiple healthcare professionals, including oncologists, surgeons, nurses, counselors, nutritionists, and support staff. Effective communication within this multidisciplinary team is essential to ensure that the patient receives coordinated care. Failures in interprofessional communication can lead to misunderstandings, delays in treatment, and confusion for the patient. Healthcare institutions must establish clear communication protocols and encourage collaboration among team members.
Effective communication during a cancer diagnosis is vital for patients and their families to cope with the emotional and practical challenges that lie ahead. The difficulties in communication, such as emotional distress, medical jargon, information overload, cultural diversity, time constraints, and interprofessional communication, must be acknowledged and addressed by healthcare providers, patients, and their loved ones. By adopting patient-centered approaches, breaking down complex information, and fostering a supportive environment, the healthcare community can improve communication during the challenging journey of a cancer diagnosis, ultimately enhancing the overall quality of care and patient outcomes.
About the Author
Dr. Omar Abdihamid is a Clinical Oncologist at Garissa Regional Cancer Center, Kenya. He is passionate about Global Oncology and cancer care equity in low- and middle-income countries. His main areas of interest are culturally based cancer care, patient education, and cancer care advocacy. Dr. Omar is a scientific writer, a published cancer researcher, and a reviewer for cancer journals. He is a fellow of the ASCO 2023 IDEA award, the recipient of the 2021 Journal of Global Oncology editorial fellowship, and the winner of ASCO Voices 2022.
- Epstein RM,Street RL. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Publication No. 07-6225. Bethesda, MD: National Institutes of Health; 2007.
- Cancer care during the last phase of life. J Clin Oncol.1998; 16: 1986‒1996.
- Wright EB,Holcombe C,Salmon P. Doctors' communication of trust, care, and respect in breast cancer: qualitative study. 2004; 328: 864.
- Back AL,Arnold RM,Baile WF,Tulsky JA,Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005; 55: 164‒177.