Communication skills are well-recognized as an essential competency in practicing medicine, with increased acknowledgment of the need for formal training in this domain in both undergraduate and graduate medical education over the last several years. The importance of these skills is amplified in oncologic specialties given the frequent need to communicate emotionally challenging and complex medical information regarding patients’ disease courses. Moreover, the interdisciplinary and multidisciplinary nature of radiation oncology in particular necessitates effective communication strategies to ensure successful functioning of a dynamic oncologic team. While these skills can be observed in the clinical setting from working with attending role models, there is a significant benefit to formal training in this area during residency. While some curricula in communication in oncology have been developed, there is heterogeneity in the integration of these skills in radiation oncology residency. Standardization of formal communication training in residency as it relates to both patient care and interprofessional collaboration is essential and has the potential to improve care delivery and patient outcomes.

Empathetic and effective patient-physician communication has been linked to a number of positive outcomes including improved patient compliance and satisfaction, decreased risk of medical errors and malpractice lawsuits, and less physician burnout.^1-3 This benefit is reflected in the Accreditation Council for Graduate Medical Education’s (ACGME) inclusion of communication skills as an educational requirement for residency and fellowship programs. Oncology residents overwhelmingly recognize that communication skills are integral for their practice and generally feel comfortable in these skills overall.⁴However, several areas of communication in oncologic care have been identified as especially challenging and likely warrant greater attention during training. These include shared decision making, code status discussion, discussion of complementary or alternative treatments, and challenging aspects of illness trajectory including disease progression, poor prognosis, and maintaining hope.^2,5 For example, it has been shown that while oncology residents and program directors believe code status communication to be particularly important in oncology, only a minority of residents report receiving formal evaluation in this area, with lack of evaluation tools, time, and resources identified as barriers to teaching this skill.⁶ In a survey analysis, only slightly over half of oncology residents responded that they were familiar with the term “shared decision making” while less than a third knew its meaning.⁴

Some formal communication skills courses in oncology have been developed, although their integration into radiation oncology residency training has not yet been standardized. For example, an 8-module course on communication in oncology practice for palliative and oncology fellows and radiation oncology residents was shown to significantly improve global communication skills. Delivered over 2 months, the course consisted of objective structured clinical exams (OSCEs) on breaking bad news using standardized patients, weekly didactics and role play.² Additionally, ASTRO has offered a course in improving doctor-patient communication skills, which covered breaking bad news and empathetically discussing transitions in care among other challenging topics in communicating with patients with serious illness; participants learned how to apply specific communication skill sets including the use of NURSE statements (Naming, Understanding, Respect, Support, Empathy), SPIKES approach (Setting, Perception, Invitation, Knowledge, Emotion/Empathy, Summary/Strategy), and REMAP (Reframe, Expect emotion, Map the future, Align with values, Plan for the future).¹ Efforts have also been made in training faculty members to teach communication skills to trainees. Oncotalk Teach was created as a faculty development program to provide expertise in teaching communication skills to oncology fellows. Consisting of small-group practice sessions with simulations, reflective teaching exercises, and videotaped teaching encounters, the course focused on goal setting, trainee engagement, and reflective feedback.⁷

Training in communication skills is also essential for optimal functioning of the interdisciplinary team, with important implications for healthcare delivery. The value of interprofessional training in radiation oncology is being increasingly recognized, with efforts being undertaken to provide these experiences for different members of the radiation oncology team. For example, participation in interprofessional conferences including daily peer review by radiation therapy and medical dosimetry students has been shown to increase comfort in speaking with other team members including resident and attending physicians and physicists.⁸ Similarly, an interprofessional education curriculum for medical assistants led by radiation oncology residents was shown to improve clinical understanding and perceived empathy for patients.⁹ While such interprofessional experiences exist for nonphysician members of the radiation oncology team—including nurses, dosimetrists, radiation therapists, and medical physicists—evidence suggests there are limited opportunities for physicians to learn formally about other professions in a similar way.¹⁰ Given that inefficiency in clinic and disorganized patient care can result from misunderstanding of team members’ roles, such interprofessional experiences have important implications for quality and safety. Expansion of existing interprofessional workshops and development of formal shadowing programs for residents would facilitate ease of communication with other members of the radiation oncology team.^11,12 Moreover, these skills may be taught using standardized tools such as simulations aimed at improving interprofessional communication skills.¹³ Leadership training—an area garnering increased attention in radiation oncology residency training—may also cover competencies essential to interprofessional communication such as self-awareness, social awareness, and conflict management.¹⁴

Communication skills are essential to navigating the emotionally nuanced and complex patient conversations in radiation oncology. Both the content and delivery of information to patients with cancer can profoundly influence their treatment decisions. At the same time, effective communication is necessary for efficient functioning of the interdisciplinary radiation oncology team. Formal integration of communication skills training through implementation of existing interventions and expansion of communication curricula during residency can improve preparedness in this fundamental competency and significantly impact patient care.

References

1. ASTRO Academy. Dharmarajan K, Tulsky J. Improving Doctor-Patient Communication Skills in Radiation Oncology. February 7, 2017. Accessed March 4, 2022. https://academy.astro.org/content/improving-doctor-patient-communication-skills-radiation-oncology#group-tabs-node-course-default1
2. Cannone D, Atlas M, Fornari A, Barilla-LaBarca ML, Hoffman M. Delivering challenging news: an illness-trajectory communication curriculum for multispecialty oncology residents and fellows. MedEdPORTAL. 2019;15:10819.
3. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Proc (Bayl Univ Med Cent). 2003;16(2):157-161.
4. Samant R, Aivas I, Bourque JM, Tucker T. Oncology residents’ perspectives on communication skills and shared decision making. J Cancer Educ. 2010;25(4):474-477.
5. Roberts C, Benjamin H, Chen L, et al. Assessing communication between oncology professionals and their patients. J Cancer Educ. 2005;20(2):113-118.
6. Levine OH, Dhesy-Thind SK, McConnell MM, Brouwers MC, Mukherjee SD. Code status communication training in postgraduate oncology programs: a needs assessment. Curr Oncol.2020;27(6):e607-e613.
7. Back AL, Arnold RM, Baile WF, et al. Faculty development to change the paradigm of communication skills teaching in oncology. J Clin Oncol. 2009;27(7):1137-1141.
8. Lavender C, Miller S, Church J, Chen RC, Muresan PA, Adams RD. Fostering a culture of interprofessional education for radiation therapy and medical dosimetry students. Med Dosim.2014;39(1):50-53.
9. Sinha S, Xu MJ, Yee E, Buckmeier T, Park C, Braunstein SE. Interprofessional education curriculum for medical assistants in radiation oncology: a single institution pilot program. Adv Radiat Oncol. 2021;6(6):100800.
10. Schultz OA, Hight RS, Gutiontov S, Chandra R, Farnan J, Golden DW. Qualitative study of interprofessional collaboration in radiation oncology clinics: Is there a need for further education? Int J Radiat Oncol Biol Phys. 2021;109(3):661-669.
11. Padilla L, Burmeister JW, Burnett OL, et al. Interprofessional image verification workshop for physician and physics residents: a multi-institutional experience. Int J Radiat Oncol Biol Phys.2021;111(4):1058-1065.
12. Tan K, Bolderston A, Palmer C, Millar BA. “We Are All Students:” An interprofessional education approach to teaching radiation oncology residents. J Med Imaging Radiat Sci. 2011;42(4):183-188.
13. Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: an integrative review. Nurse Educ Pract. 2016;19:36-40.
14. Song EY, Chuang J, Frakes JM, et al. Developing a dedicated leadership curriculum for radiation oncology residents [published online ahead of print, 2021 Feb 22]. J Cancer Educ.2021;10.1007/s13187-021-01980-w