MAY 28, 2020 10:31 AM PDT

Oncologists need more training on how to deliver bad news

A commentary published earlier this spring in the Journal of Clinical Oncology urges for improved training for medical professionals tasked with delivering bad news. Oncologists have to deliver bad news an average of 35 times a month, says lead author Ramy Sedhom, M.D., a medical oncology fellow at the Johns Hopkins University School of Medicine. But, despite the proven importance of these words, which influence medical decision making and have implications for patient care, there is not enough training for how to conduct such crucial family meetings. 

Oncology fellows report that they are trained to be medically-oriented, not person-oriented, which means that they likely receive more training on how to perform a bone marrow biopsy and other technical procedures that how to consider the impact of their word choice with their patients.

According to Sedhom, there is explicit research that shows this impact that words have on patient preferences for treatment or palliative care.  “For example,” as the commentary describes, “patients are more risk-averse when considering gains (choosing adjuvant therapy in breast cancer) and risk-seeking when considering losses (enrolling into phase I clinical trials at the end of life).”

Framing a conversation is particularly critical as more and more patients are coming to live with cancer as a chronic disease, which requires advanced monitoring of symptoms. This is complicated by the fact that oncologists are becoming more and more specific in their scope, specializing in one or two cancers as treatment options have become more complex. 

Thomas J. Smith, M.D., professor of oncology and director of palliative medicine at the Johns Hopkins University School of Medicine commented, "As a consequence," he says, "the abilities of these doctors to predict patient outcomes becomes even more complicated and highlights the need for palliative care training."

Sedhom, Smith, and their fellow oncologists at the Johns Hopkins Kimmel Cancer Center say that of the accredited oncology training programs in the United States that they surveyed, none offered a combined or integrated medical oncology and hospice/palliative care medicine program. Instead, the programs are often offered separately, as found in 73 institutions in the survey, including Johns Hopkins Medicine. 

Photo: Pixabay

The need for such dual training extends to the responsibility of oncologists as not only doctors but educators of the next generation of doctors. Young doctors learn from experienced doctors how to facilitate physician-patient interactions when delivering bad news; Sedhom and Smith argue that there is not enough emphasis placed on training for these conversations.

“Behavioral economics reminds us that patients (and physicians) can be nudged in their decision-making. Consequently, our training has an impact not only on the words we choose in patient care, but also in advising other oncologists on career choices. Because nearly all decisions are framed in some way, the onus lies with us as educators and influencers to prepare the next wave of oncologists to value training in palliative oncology. Because the field of palliative medicine is focused on communication, prognostication, and individualizing the needs of each patient, it is time to consider opening the doors to dual training,” concludes Sedhom and Smith. 

Sources: Journal of Clinical Oncology, Eureka Alert

About the Author
  • Kathryn is a curious world-traveller interested in the intersection between nature, culture, history, and people. She has worked for environmental education non-profits and is a Spanish/English interpreter.
You May Also Like
AUG 12, 2021
Clinical & Molecular DX
Computers Pick Up the 'Sound' of Thyroid Cancer
AUG 12, 2021
Computers Pick Up the 'Sound' of Thyroid Cancer
Researchers have developed a new technology for the non-invasive diagnosis of thyroid cancer that combines photoacoustic ...
AUG 20, 2021
Drug Discovery & Development
Blood Pressure Drugs Boost Survival in Colorectal Cancer
AUG 20, 2021
Blood Pressure Drugs Boost Survival in Colorectal Cancer
Common drugs used to regulate blood pressure may improve survival rates among patients with colorectal cancer, also know ...
AUG 23, 2021
Cancer
A Safe and Effective Combination Therapy for Advanced Cancer
AUG 23, 2021
A Safe and Effective Combination Therapy for Advanced Cancer
Immunotherapies are emerging as a promising strategy for the treatment of late-stage cancers which currently have m ...
SEP 06, 2021
Cancer
A New Biomarker to Personalize Breast Cancer Therapy
SEP 06, 2021
A New Biomarker to Personalize Breast Cancer Therapy
The American Cancer Society estimates that over 280,000 women in the United States will be diagnosed with breast cancer ...
SEP 27, 2021
Cancer
Inflammation Promotes Pancreatic Cancer Progression
SEP 27, 2021
Inflammation Promotes Pancreatic Cancer Progression
Inflammation occurs when the immune response, including immune cells and mediators they produce, protect you from danger ...
OCT 28, 2021
Cancer
NF-κB: a Trick or a Treat for Cancer?
OCT 28, 2021
NF-κB: a Trick or a Treat for Cancer?
A family of proteins, known as transcription factors, regulate the biological process of converting DNA into RNA. T ...
Loading Comments...