Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55 S47

for cancer patients in order to restore their life crisis and Method. A pilot-study was conducted at the Universityto enhance the quality of life. Information about facilities Hospital of Louvain in collaboration with the multi-for counseling and education is strongly required.The disciplinary oncological staff in order to explore theconsequences of these types of communication areas in determinants of communicative behavior in the presenta-communication in cancer care for the patient’s career will tion of a breast cancer diagnosis. Consultations werebe discussed at the symposium in four presentations. audiotaped and a qualitative and quantitative analyses

was performed on the transcripts. On the basis of theCommunication in cancer care. Education: workshop results of this pilot-study hypotheses were formulatedon breaking bad news regarding the following research questions:

a) How stressful is the bad news consultation from theA. Faulkner. The Mount, Causeway Head Road, Sheffielddoctor’s point of view? What is specifically stressful forS17 3DY, UK.the doctor in terms of patient characteristics, disease andprognosis characteristics and situational variables?Breaking bad news is an area of increasing concern inb) How do doctors react to or handle the stressfulCancer Care. Patients and relatives remember theircomponents of the bad news consultation?distress when news is broken badly (Faulkner et al 1995)Results. A research model is presented regarding theand health professionals feel that they have been poorlydeterminants of the doctor’s behavior in the presentationprepared to handle bad news situations.This workshopof threatening medical information. Based on thesewill present a model of breaking bad news which has

been developed and evaluated.Participants will be en- findings implications for training in medicine and oncolo-couraged to share ideas of concern in the process of gy are discussed.breaking bad newsand to consider strategies for handlingbad news situations. These will include: Patient Education psychosocial support on an oncolo-– assessing the patient’s knowledge of, and fears for the gy ward: implications for quality of life and coping in

potential bad news cancer patients– warning the recipients of bad news

1 2 1 3– giving bad news at the patient’s pace and in a form J.Elshout , A.Visser , W.Rietdijk , M.Wijsmans ,1 1 1 2that can be absorbed S.Konijn , J.Vleer Medical Centre Alkmaar, Helen

3– handling the aftermath of bad news Dowling Institute, Rotterdam, Maia Foundation, Rotter-– helping the patient to relay the bad news to other dam, The Netherlands

family members– handling the process of continuing bad news through Introduction. Improvement of the supportive care for

the illness trajectory cancer patients gets growing attention in the DutchAll examples will be linked with the participants’ reality. hospitals. The Medical Centre Alkmaar and the Maia

Foundation started an intervention project to develop theDeterminants of communicative behaviour of oncolog-care for the care givers by offering training in copingists in breaking bad news about breast cancerwith death and dying, training in communication andinter disciplinary cooperation. The effects are studied onDe Valck, C., Vinck,J. Health Psychology Department,patient’s side in a survey about the satisfaction of theLimburg University Centre, 3590 Diepenbeek, Belgiumpatients on the received education and psychosocial

Introduction. The last three decades have seen a signifi- support, their perceived quality of life and the copingcant change in the attitudes of doctors to the disclosure of with cancer.bad news. The literature reveals basically three models, Methods. The survey has been held among 166 ex-each reflecting a different doctor-patient relationship. The patients. 100 Questionnaires were returned by post (ratetraditional model prescribes ’non-disclosure’ presumably 60%). The questionnaires about satisfaction with thebecause of the fear and anxiety associated with the patient education and psychosocial support, quality ofdisease. The ’full-disclosure’ model implies giving full life and coping with cancer showed to be very reliableinformation to every patient as soon as the diagnosis is (mean alpha-efficient .80).known. The ’individualized disclosure’ model recognizes Results. The patients express more dissatisfaction aboutthat the amount of information disclosed should best be the psychosocial support (20%) than about the infor-tailored to the individual information preferences of the mation supply about their treatment (10%). The strongestpatient. complaints were concerning the information on possi-Although doctors agree that an individualised disclosure bilities for psychosocial support (30%). About 40-45% ofmodel is preferable, their actual behavior in communicat- the patients require changes in the information on theiring with their patients is very variable. Basically two disease and treatment, the emotional support and in-consultation styles can be distinguished: patient-centred formation on psychosocial support facilities elsewhere.versus doctor-centred communication. The quality of life score is significant correlated else-

S48 Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55

where. The quality of life score is significant correlated introduction of the VRS on the evaluation of the qualitywith the positive coping with the disease (.54), and the and communication with the helpline.positive coping is significant correlated with the satisfac- Conclusions. For patients and relatives / friends the com-tion (.28), as shown in regression analysis. municational aspects of the helpline were very important.Conclusions. A survey among ex-patients seems to be a Conclusions with respect to the impact of the VRS on thereliable and valid method to study the satisfaction of evaluation of the quality and communication of thecancer patients in hospitals as well as their quality of life helpline will be presented.and coping with the cancer. Improvement of the satisfac-tion by organizational development of patient-centered 6 symposiumcare may influence patients’ quality of life and their FACILITATING PATIENT OUTCOMESpositive attitudes towards their illness and its conse- THROUGH IMPROVING PATIENT-DOCTORquence for their lives.

COMMUNICATION

Communicating with cancer patients and significantThe symposium will address the findings of research

others: evaluating the dutch cancer information hel-conducted by the Royal Australian College of GeneralplinePractitioners’ (RACGP) Training Program and Client-Focused Evaluations Program, Inc. The research focusesL. Lechner, H. De Vries. Department of Health Educa-on the teaching of interpersonal skills within a generaltion & Promotion, University of Maastricht, P.O. Boxpractice training program and the evaluation of this616, 6200 MD Maastricht, The Netherlands.training using patient-based assessments, as well asresearch on patient evaluations of interpersonal skillsIntroduction. Since 1982, the Dutch Cancer Societywithin the wider medical profession and across threeoffers cancer patients and relatives / friends the possibilitydifferent countries.to contact an information telephone helpline with ques-The speakers will describe a number of educationaltions and problems that people experience concerningstrategies developed by the RACGP Training Programcancer. Via this helpline people can obtain informationfor teaching interpersonal / communication skills, in-about cancer or psychosocial support from trained oncol-cluding the use of Triads and Distance Education Learn-ogy educators. Recently, a computer-assisted Voice Re-ing Modules. Patient outcomes will be highlighted,sponse System (VRS) was implemented in the helpline.including the cultural and methodological difficulties ofThis VRS shifts out general informational questions soimplementing patient-based assessments in the evaluationthat cancer patients and significant others can be helpedof interpersonal skills. The symposium will also outlinemore intensely with less waiting time. This study wasthe findings of assessments of the quality of the patient-performed to evaluate the experience and impact of thedoctor relationship for Australian, Irish and New Zealandhelpline and the influence of the introduction of the VRSGPs.on the evaluation of the helpline.

Methods. To compare the evaluation of the helplinebefore and after the implementation of the VRS, during 2 Triads as a tool for teaching active listening skillssimilar periods (in the fall of 1993 en 1997) all callerswere asked to fill in a structured postal questionnaire Dr John Buckley(response 1993 5 73%). Different characteristics of thehelpline were evaluated: the overall quality of the Introduction. Effective listening is a vital part of theinformation given, the communication skills of the medical consultation. It is important to the outcomes foreducators and the telephone as a channel for getting both doctor and patient. Are good listening skills innateinformation concerning cancer. Also, several outcomes or can they be taught? The authors have devised awere measured: the overall satisfaction with the helpline, teaching module on listening skills for General Practicethe impact on anxiety and the impact on meeting (GP) Registrars in the RACGP Training Program. Theexpectations that subjects had. module contextualises and demonstrates good listeningResults. The 1993 measurement showed that relatives / skills as applied to General Practice. The key element offriends and patients seemed much in need of communica- the teaching is the use of ‘‘triads’’ (groups of threetional feedback from the educators. For patients, not the Registrars and one facilitator) to practice and experienceinformation itself was the most important determinant of ‘‘active listening’’ skills.satisfaction with the helpline, but their evaluation of the Methods. In their first three months of General Practicecommunicational skills of the educators (like respect, experience GP Registrars were taught for five hours oversincerity, supportiveness and reassurance). To this date a five-week period, including two ‘‘triad’’ sessions of onewe only have the data of the 1993 measurement. At the hour each. Focus groups of Registrars provided input intoconference data from both 1993 and 1997 will be the design of the teaching module.presented. Results will be presented of the impact of the Results. Further focus groups were used to evaluate the