Effectively Communicating with Older Adults with Cancer

TON - May 2017, Vol 10, No 3 - Best Practices
Meg Barbor, MPH

Orlando, FL—According to the Institute of Medicine, 20% of the population will be aged >65 years by the year 2030, and currently approximately 67% of cancer survivors in the United States are elderly. When interacting with older adults with cancer, using appropriate communication skills is essential to achieving the intended outcome of a conversation, according to Smita C. Banerjee, PhD, and Ruth Manna, MPH, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York.

Dr Banerjee, a behavioral scientist, and Ms Manna, Manager of the Communication Skills Research and Training Program Laboratory, Memorial Sloan Kettering Cancer Center, co-facilitated a communication workshop at the American Psychosocial Oncology Society 14th Annual Conference. In this workshop, Ms Manna outlined 5 skill categories that can be used to improve communication with elderly patients and their families in an oncology setting.

Agenda Setting

First, declare the agenda items, or state what you would like to accomplish in the conversation, she said. Next, invite agenda items by asking the patient what he or she would like to discuss. Negotiate by acknowledging the patient’s agenda items and noting when they can be addressed during the conversation, and, finally, take stock by pausing in the dialogue to review the previous discussion.

“This ensures you stay with the patient during a complicated discussion or explanation,” Ms Manna added.

Checking

Ask the patient about his or her understanding of previously conveyed information or the current situation.

“This allows you to fill in any blanks and correct misunderstanding, and also allows for patient engagement,” said Ms Manna.

Second, check the patient’s preference for receiving information. Ask questions such as, “Would you like me to describe your postsurgical care now, or when your daughter is here?” This helps cater information to the patient, she noted.

Questioning

Ask open-ended questions that allow the patient to respond in any manner he or she chooses, and clarify what the patient is saying by asking follow-up questions.

“Next, restate in your own words what you think the patient is saying. This comes in handy when the patient says something you might not have expected. It’s a gentle way to say ‘I’m not quite clear,’” Ms Manna advised.

Finally, endorse question-asking at any time during the conversation, and invite questions by directly giving that space to the patient.

“Ask, ‘What questions do you have for me?’ Because not all patients will interrupt you,” she explained.

Information Organization

Information organization helps the provider organize his or her own thoughts, which, in turn, increases patient understanding. First, preview information by giving an overview of the main points to be discussed, and summarize by recapping the main details conveyed.

“This is so important when a patient is undergoing complicated treatment,” Ms Manna said.

Transition the conversation by stating to the patient that the conversation about one topic is ending and that another topic will now be discussed.

“Some people really need that segue,” Ms Manna added. Finally, review the next steps at the end of the consultation by telling the patient what he or she can expect to happen next, such as scheduling a follow-up appointment.

Empathic Communication

Encourage expression of feelings by asking the patient to discuss how he or she feels about something, such as, “How are you doing emotionally?”

Next, acknowledge and validate the patient’s emotional response. For example, “It sounds like this has been a tough time for you,” or “It’s understandable that you are feeling anxious.”

“If you tell a patient they seem stressed but they explain to you it’s actually fear, this gives them an opportunity to correct you. Once that emotion is named, there’s usually a fruitful discussion after that,” said Ms Manna.

Normalize the patient’s emotions by making a comparative statement that expresses that a particular emotional response is not out of the ordinary. Patients may not have friends, family, or co-workers with cancer, so comparing them with other patients can help them to feel less isolated. Finally, praise the patient’s efforts. Validate the patient’s attempts to cope with treatment or adverse effects, to make positive lifestyle changes, or to be adherent to a treatment regimen.

“This is a way to continue the conversation and connect on a different level,” Ms Manna said.­

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Last modified: June 8, 2017