Lienard, A., Merckaert, I., Libert, Y., Delvaux, N., Marchal, S., Boniver, J., . . . Razavi, D. (2008). Factors that influence cancer patients’ and relatives’ anxiety following a three-person medical consultation: Impact of a communication skills training program for physicians. Psycho-Oncology, 17, 488–496.
To assess the impact of communication skills training programs on changes in patients’ and relatives’ anxiety following a three-person consultation
Prior to a three-person consultation (physician/patient/caregiver), physicians who had earlier completed a basic training program were randomly assigned to complete a consolidation workshop or to a wait-list for the workshop. To gain study data, patients and relatives completed an anxiety questionnaire and a physiologic distress questionnaire (depression and anxiety) the week before and repeated the anxiety questionnaire one week after the three-person consultation. Physicians chose patients with cancer and their accompanying relatives for an audiotaped consultation. Transcription of the consultations occurred to allow a measurement of quality of consultations. Trained psychologists assessed physician skills in assessment, information, and supportive skills according to a French national rating system used in three previous studies.
A pre/post-test design was used.
No statistically significant differences were found between patients’ and relatives’ sociodemographic characteristics and disease and over time with basic training consultation and the basic training added to the consolidation workshops. A multivariate analysis of variance assessment showed significant change between time in changes in patients’ anxiety following the three-person consultation (p = 0.027). Although anxiety decreased for both patients and relatives following the consultation, none of these changes was significant. There were no significant correlations between changes in patients’ and relatives’ anxiety and physician assessment, information, and supportive skills. In further analyses (mixed-effects modeling), physician communication skills had no influence on changes in patients and relatives following a three-person consultation. Only contextual variables (e.g., type of bad news, type of information transmitted by physicians and self-reported before the consultation) had an effect on changes in anxiety and distress.
The physician training program described did not diminish patient or relative anxiety about cancer following the consultation.
The concept of nurse/patient/caregiver conversations as part of routine nursing care seems appropriate in the U.S. healthcare system that seeks to increase primary care. Although relatives’ and patients’ needs may vary, nurses have strong assessment, information-gathering, and supportive skills to promote health and coping of patients, caregiver relatives, and families either in group formats or individual forums.