Improving Communication Between Doctors and Breast Cancer Patients

I read seven themes in the welcomed comments by three separate colleagues: Fallowfield, Carney and Shockney.

The dose-response of the education approaches that have been studied is evident. The three day sessions show effects through to the clinic and after lengthy follow-up, as Fallowfield has found. But for those for whom three days is not feasible, it is heartening to learn that the 6 hour program can show effects into the clinic altough no follow-up at 3 or 18 months was done.

All outcomes were found to differ between the intervention and control groups in the hypothesized direction i.e. of all the signifiant findings shown in Tables 3 and 4, none differed in the opposite direction. The finding on patients psychological distress was in the opposite direction but was small and not statistically significant (line 3 Table 4 ). Table 4 shows the findings relevant to transfer of learnings to the clinical setting, an important feature of this education evaluation.

With regard to internet access that patents are increasingly participating in, in the qualitative study that was part of this research program on communicating with breast cancer patients this acivity was found to be a constructive engagement. McWilliam et al. found that internet searching was part of the patients' activity to enhance their regaining control over their health and health care. The diagnosis was seen as a spiral of loss of control over their trust in their body. The need to try to regain control ought not to be minimized by professionals. This was one of the important messages during the "Patients Perspectives" component of the education intervention.

I interpret the comment about translation of knowledge to be referring to knowledge tansfer and exchange reaching out not only to policy-makers and providers but also to patients. There is an increasing interest in conceptalizng the communication between patients and providers as knowledge transfer and exchange. This is likely to be a fruitful area of future research and development.

With regard to the comment about the need for tailored education for different medical providers, I see two sides to the argument. I think there are general principles of patient-provider communication that are common to all medical specialties and indeed to the other heath professionals as well. However, it is also true that we had a great deal of difficulty creating video and other teaching tools that would suit all three medical specialties in the education inervention.

I am so happy to read the comment about non-verbal communication because I feel it is a topic that deserves to be the focus of a longterm and well orchestrated research program. I encourage researchers to continue to build on past work and move that research agenda forward.

The ways that providers present the diagnosis of breast cancer needs to ecourage paients' hope. This was a major findng of McWilliams et al.'s qualitative study that preceeded the education and trial reported in the paper we are commenting on. I concur with Shockney's exampes and recommend them to other educators.

I thank the contributors for their comments. I welcome furher discussion.

Competing interests:   None declared