A new paradigm for clinical communication: critical review of literature in cancer care



Salmon, Peter ORCID: 0000-0001-6450-5209 and Young, Bridget ORCID: 0000-0001-6041-9901
(2017) A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION, 51 (3). pp. 258-268.

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Abstract

<h4>Objectives</h4>To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better.<h4>Methods</h4>A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve.<h4>Results</h4>The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education.<h4>Conclusions</h4>Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.

Item Type: Article
Uncontrolled Keywords: Humans, Neoplasms, Communication, Decision Making, Biomedical Research, Evidence-Based Practice
Depositing User: Symplectic Admin
Date Deposited: 13 Jan 2017 09:17
Last Modified: 19 Jan 2023 07:20
DOI: 10.1111/medu.13204
Open Access URL: http://onlinelibrary.wiley.com/doi/10.1111/medu.13...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3005225