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t m c » p u l s e | n o v e m b e r 2 0 1 7 14 Let's Talk Psychiatrist Walter Baile aims to improve the way doctors deliver bad news to patients C ancer treatment is advancing quickly, thanks to innovations like personalized medicine and immunotherapy, but some doctors are working to improve treatment through a decidedly low-tech tech- nique: stronger communication. A growing body of evidence shows patients do better when they feel their doctor is a true partner in their treat- ment. One way doctors can show that connection is by taking a more deliber- ate approach to the way they speak and interact with patients, said Walter Baile, M.D., a psychiatrist at The University of Texas MD Anderson Cancer Center. "In times of crisis," Baile said, "that relationship counts as much as a clini- cian's technical ability." Baile directs MD Anderson's Interpersonal Communication and Relationship Enhancement (I*CARE) program, which aims to train health care providers in managing their inter- actions with patients and their families. Though one might assume cancer doctors would be expert communi- cators—particularly when it comes to delivering bad news—many of them aren't, and most have not had special- ized training to handle such pivotal moments, Baile and other experts said. Doctors need training in how to have difficult conversations with patients—such as explaining a patient's cancer has had a recurrence—and how to interact with patients who are having strong emotional reactions, such as crying or getting angry, Baile said. He recently co-chaired an expert panel convened by the American Society of Clinical Oncology that developed national guidelines to improve the way doctors communicate with patients. "The relationship between the clinician and the patient can be a very therapeutic one," Baile said. "When we provide appropriate hope and we're honest, in the context of that relation- ship, the patient can feel supported." In recent years, health care providers have worked to improve communication in a more direct sense, by making sure patients understand which medicines to take or how to follow post-surgery recovery instructions. But Baile and his ilk are focusing on the nuances of more personal exchanges. Nationwide, those efforts are increasing—and they extend beyond oncology. The trend is driven largely by evidence that communication has a huge impact on health care outcomes and patient satisfaction, said James Tulsky, M.D., who chairs the department of psychosocial oncology and pallia- tive care at the Dana-Farber Cancer Institute in Boston. "It's just a very different way of approaching a conversation," said Tulsky, who co-founded VITALtalk, a nonprofit that aims to improve the way clinicians communicate with patients about serious illness. "Physicians realize the patients will open up more. They feel connected to the patient, and they realize the conver- sations are easier." The trend coincides with growing recognition of the value of palliative care, but in some cases it is also tied to funding. The federal Centers for Medicare and Medicaid Services, for example, use consumer surveys to measure how patients perceive their hospital experience. That information plays a role in determining how hospi- tals are paid, so health care providers have a stake in ensuring patients feel their doctors are valued partners. Locally, Baile has provided B y R y a n H o l e y w e l l The relationship between the clinician and the patient can be a very therapeutic one. When we provide appropriate hope and we're honest, in the context of that relationship, the patient can feel supported. — WALTER BAILE, M.D. Professor of behavioral science and psychiatry at The University of Texas MD Anderson Cancer Center