The psychology of cancer health communication

One of my favorite features in the Journal of Clinical Oncology is the running series, entitled "The Art of Oncology: When the Tumor Is Not the Target." In the November 10th JCO, Dr. Philip Gerretsen and Dr. Jeff Myers tell the story of Mr. Irving, an elderly man with metastatic cancer who calls the on-call physician with concerns related to his ability to manage his severe abdominal pain with his home medications. They describe the clinician's response, which includes the key elements of reassurance and a promise of availability over the course of the weekend. Ironically, these assurances and promises of availability so significantly lessened the patient's anxiety that his pain was well managed and he did not need to call again through the remainder of the weekend. In their ensuing discussion, the authors describe the application of attachment theory to the physician-patient relationship, and the parallel between the relationship of a parent and child to the relationship between a physician and patient. They describe adult insecure attachment styles, using the categories of anxious-preoccupied, dismissive-avoidant and fearful-avoidant. And they theorize that the patient's comfort stemmed from his "awareness and resultant internalized perception of physician availability that provided him with the security that comes with feeling one is not alone."

I also read an intriguing article in the October 25th issue of The Oncology Times by Andrew Holtz, former CNN medical correspondent, that looked at the tobacco industry's targeting of unwitting young would-be smokers as "Goody-Goodies," "Preps," "Rockers," "Party-Parties," and "Burnouts." He goes on to draw a parallel with pharmaceutical marketing to consumers, who fall into the categories of "Proactives," "Faithful Patients," "Trusting Believers," and "Informed Avoiders."

As I reflected upon these two articles, I began to wonder about the enhancements to effective cancer communication that would result if treating oncologists had a more nuanced understanding of their patients' psyches. Some would argue that good doctors who know their patients well communicate in such a manner all the time. But is it possible that there is actually a science behind the understanding of patient psychology that could further inform this communication? And could it be that translating this science into practice might yield a more "personalized" cancer care delivery just as the translation of pharmacogenomic insights leads to "personalized" cancer drugs?

Gathering from a speech I recently heard by John Leonard, MD, Professor of Hematology and Medical Oncology at Cornell, there are some who are beginning to think that the answers to these questions are "yes." Dr. Leonard described his developing relationship with the Cornell school of communication, and his efforts to use some of these strategies to help with clinical trials enrollment, for example.

It seems to me that these kinds of relationships — where academic oncologists seek to formally learn from experts in the psychology of medical communication — will yield valuable dividends in terms of satisfaction wtih care and perhaps even outcomes. I look forward to seeing further developments in this field as it matures.