SEVEN QUESTIONS TO: WALTER F.BAILE
by Luigi Grassi and Anna Costantini
Walter F. Baile graduated in Medicine at the Medical School University of Pavia, Italy in 1972 (cum laude) and complete his Residency in Psychiatry at the Johns Hopkins Hospital, Baltimore in 1976. He was Research Fellow at the National Institute on Aging, USPHS, Baltimore, in 1977 and, from 1978 to 1983, as an Assistant Professor of Psychiatry and Medicine, at the Johns Hopkins School of Medicine, Baltimore, he was Director of the Consultation/Liaison Service, Department of Psychiatry, Baltimore City Hospitals, Baltimore,. In 1983 he took the position of Associate Professor of Psychiatry, University of Maryland Medical School, Baltimore, and he founded and directed the Maryland Center for Pain Management, University of Maryland School of Medicine, Baltimore, until 1987. Then, as an Associate Professor of Psychiatry, he has been Chief of Psychosocial Oncology Service, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, FL, from 1987 to 1993. In 1994 he took the position of Professor of Psychiatry, University of South Florida College of Medicine, Tampa, FL, then he moved to the University of Texas M.D. Anderson Cancer Center, Houston, where he is now Professor of Psychiatry and Chief of the Section of Psychiatry.
He was President of American Society of Psychiatric Oncology/AIDS in 1995 and chairman of the Task Force on Physician-Patient Communication del National Comprehensive Cancer Network. He is member of the American Society of Clinical Oncology, Subcommittee on Physician-Patient Communication. He conducted several workshops and courses on Communication Skills in oncology in the USA and around the world, such as Germany, Italy, Portugal and Japan. He co-worked within the Southern European Psycho-Oncology Study (2001) on a module on Training the Trainers course, and, more recently, on the workshop project for Medical Director of Oncology in Italy (2004). He is also conductor and chair of the Course and Workshop in Native Language organized by the European (www.cancerworld.org) on Communication Skills in oncology (Ferrara, September 1-3, 2005), co-sponsored by the International Society of Psycho-Oncology (IPOS) and the Italian Society of Psycho-Oncology. He published a number of papers in peer-reviewed journals and multi-media material (VIDEO-CD) with Robert Buckman on Communication Skills. A recent contribution on this theme is available in the webcast Multilanguage Psycho-oncology core-curriculum developed by the International Psycho-Oncology Society (IPOS) and the European School of Oncology (ESO) (www.ipos-society.org e www.cancerworld.org). This lecture, available in English, Spanish, German, Hungarian, has been also translated and adapted into Italian in cooperation with Italian Society of Psycho-Oncology (www.siponazionale.it).
Question (Q): What is the general experience in the literature on communication in oncology, specifically in the curricula on communication for oncologists? What does the literature say about the training of oncologists in communication skills?
Answer (A): Oncologists in many countries realize that communication skills are important and that they need more training in this area but there is little time in fellowship curricula devoted to this important area. A recent study published by our group( J Cancer Educ 2004;19(4):220-224) indicated that fewer than one third of oncology training programs had any kind of education in communication skills and most of these did not seem to incorporate the most effective teaching techniques. Communication skills competency will now be required of oncology fellows by the major accrediting agency the ACGME, although this is controversial among oncology training directors. In the US most communication skills training occurs in medical school when students have not yet been exposed to the communication and interpersonal challenges they will later face.
Q.: Which are the advantages of a good training in communication from theoncologists and the patient/family point of views?
A.: There are clear positive clinical outcomes to good communication skills which include increased patient satisfaction, better informed patients about their illness, and in some cases increased accrual to clinical trials. Doctors who have taken our courses in communication skills feel much more confident in handling patient emotions, in transitioning patients to palliative care and in developing a partnership with the patient and family by understanding their goals and values.
Q.: What are the barriers to the learning and teaching of communication skills?
Doctors have less and less time to spend with patients and there are few faculty to teach these skills. Oncology is still very medical treatment oriented despite the huge psychosocial issues and the important role of the practitioner in supporting the patient through good communication and relationship skills.
I medici hanno pochissimo tempo da dedicare ai loro pazienti e ci sono pochi professori che possono insegnare queste capacità. Loncologo è ancora orientato verso un trattamento di tipo esclusivamente medico a scapito degli aspetti psicosociale e dellimportante ruolo che ha la pratica nel supportare il paziente attraverso una buona comunicazione e capacità relazionali.
Q.: What is your experience within the ASCO about this issue? Are there any efforts to promote training in communication skills by the American Society of Clinical Oncology?
A.: I can't speak for ASCO directly but ASCO does have an education committee which is interested in this issue. They have published some communication guidelines in their publication on symptom management and almost every year they have had several educational opportunities in this area at their annual meeting. Last year they conducted a very successful but limited two day workshop for ASCO members on oncologist-patient communication. Because of this there is some discussion of expanding the workshops to regional offerings.
Q.: You have a significant experience in teaching communication skills since you have conducted workshops in several parts of the world, including Japan, Germany and Italy. What kind of cultural differences did you find between the different countries? What is the general level of preparation in communication among the oncologists of these various countries?
A.: In North America legal and ethical mandates dictate complete information disclosure to the patient and for the most part that happens. Gaps in communication occur in the areas of discussing prognosis and shared decision-making. In many other countries patient care is culturally more "family-centered" resulting in practices of telling the family first ( especially in the case of very bad news).I think that this presents an added challenge to oncology practitioners.
Q.: What challenges did you find in using the method of small group teaching in the workshops in our Italian culture and what strengths did you find in the Italian participants?
A.: I have had limited experience in teaching communication skills using actors and small groups which is the main method we use in our workshops to Italian doctors. The Italian oncologists I did work with were highly motivated and enthusiastic about learning communication skills. Italians in my opinion are very individualistic and used to expressing their opinion so we did struggle a bit with adapting small group problem solving to the normal culture of the group.
Q.: What adaptation to the teaching techniques you usually use would you like to implement to improve them, given the cultural and other issues?
A.: For me making sure that we respect and fully respect the cultural issues and find ways to empower the patient within the context of "family-centered" oncology. Giving doctors an opportunity to reflect on their own feelings about giving bad news and providing them with words or phrases they can use in giving bad news might also be helpful.
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