Language that comforts: The power of communication in healthcare
For people who are seriously ill, an empathetic doctor can make a world of difference. Psychologist Janine Westendorp examined helpful and harmful communication in the consulting room. ‘It’s very important to stress that you are always there supporting the person, even if there’s no cure.’
At the same time as conducting her PhD research, Janine Westendorp works as a psychologist at the Helen Dowling Institute, where she provides psychological support to people with cancer and their loved ones. ‘When they’ve been diagnosed with cancer, people have contact with different care-givers who they see on a regular basis and to whom they are assigned often suddenly and involuntarily. The relationship with the care-giver has a major impact on the patient’s life. In my consulting room I saw how often patients were still going over what their doctor had said, and how they said it.’
She often also provides trauma treatment to patients who have to process an intensely upsetting bad-news discussion. ‘There’s no doubting that it’s terrifying and very sad to hear that you have cancer. But there are times when serious harm is done to the patient because of the way a healthcare professional communicates, for example, if a healthcare professional is in a hurry, or doesn’t listen properly to the patient. The patient can then feel that they are not seen or supported, which can result in them feeling helpless.’ To help improve the communication of healthcare professionals, Westendorp and her colleagues studied what helpful and harmful communication really look like. She will defend her dissertation The power of helpful and harmful communication in healthcare on 13 November.
Fly on the wall in the consulting room
Together with her colleagues, Westendorp analysed 45 recorded discussions between oncologists and their patients, women with incurable breast cancer. ‘We met the patients in the waiting room, where they filled in different questionnaires. We then went with them into the oncologist’s consulting room and put a recorder on the table. After the discussion, the patients went home, where they filled in a final questionnaire. We asked them, such questions as how afraid they felt before and after the discussion, and what they had remembered from the discussion.’
Hope beyond a cure
Westendorp and her colleagues then analysed the recordings and examined all the sentences in which the oncologists spoke of expectations about the treatment or the future. They also gave scores for how empathic the oncologist was during the discussion, using the NURSE acronym. ‘It stands for naming, understanding, respecting, supporting and exploring. Did the oncologist respond to the concerns and emotions of the patient? Did the doctor probe further if emotions were shown?’ We concluded that most doctors already generally showed empathy. Where gains could be made was with the oncologists: giving hope, by expressing positive expectations about the future. People often think that if there’s no possibility of a cure, there’s also no hope. ‘But there is always hope. For example about the right pain management or that you continue to feel well for as long as possible. It’s a very valuable experience for patients when doctors continue to communicate that hope.’
There’s nothing more we can do for you’
Westendorp also researched harmful communication: what sentences and comments should doctors absolutely avoid? She studied the literature and had 71 patients fill in a questionnaire. She consolidated the results in a large table with examples of damaging and helpful alternatives. In her analysis she distinguished four major themes where the doctor’s communication can be harmful. ‘The lack of personal information, and personal/individual decision-making, not being seen and heard, and not being kept safe and being remembered.’ She added this last theme to the literature. ‘This is about the lack of continuity in the care and support, for example if a doctor says: ‘There’s nothing more we can do for you.’ There’s always something healthcare professionals can do. It’s important that they empathise that and carry on supporting the patient, even if there’s no possibility of a cure.’
Tijdsdruk
The pressures on healthcare mean that doctors often have only a few minutes for each patient, which can result in over-hasty communication. Westendorp: ‘I sometimes hear doctors say: ‘But I already have so little time!’ They have to weigh up per patient what is and isn’t feasible. I do think it’s important to realise as a healthcare provider that building up a good relationship with a patient may take more time at the start, but it also saves time in the long run. If at the outset you already know who someone is and what is important to them, it’s easier for you to respond to their needs. Moreover, better communication doesn’t have to be difficult. Just saying: ‘We’re going to take good care of you’ doesn’t take up a lot of time, but it can result in a patient feeling less anxious and going home in a more positive frame of mind.’
Read today, act differently tomorrow
Westendorp conducted her PhD research within the Centre for Interdisciplinary Placebo Studies, which strives for a better understanding of placebo and nocebo effects, their underlying mechanisms and their possible applications in clinical practice. During her research she also worked on developing a placebo/nocebo communication training, where healthcare providers learned via e-learning and VR training how to manage the expectations of patients and how they can improve the relationship with their patients. She and her colleagues also created a clearly laid out, accessible poster that has been disseminated on social media and has been incorporated in the Guidelines for Palliative Care. ‘The step to the clinical environment is where the strength of this dissertation lies. What we have studied can be put directly into practice: what you read today, you can do tomorrow.’