Measurement of communication skills in cancer care: myth or reality?

Despite wide agreement about the importance of effective communication in cancer care there is continuing evidence of the need for nurses, doctors and colleagues to be helped to improve their communication skills. Consequently, there has been a growing demand for effective methods for evaluation of communication training programmes. This paper discusses theoretical perspectives in this field and describes the rationale underpinning the development of a detailed objective method of assessing interviews between health professionals and cancer patients. The method enables an utterance by utterance rating of transcribed interviews to be made which can be used to construct profiles of interviewer and patient behaviours and interactions. All categories were developed from interviews drawn from a large sample of participants (n=206) at counselling skills workshops. Six domains have been identified and these are: grammatical style; the purpose of each technique; what is being discussed, the degree of feeling expressed; explicit avoidance; and the use made of patients' cues. Each domain contains a mutually exclusive set of categories. In addition the method enables the sequence of events to be plotted. Using these methods, examples from published studies will be given to show how the processes of interaction within a health care interview can be better understood, thus enabling the most effective techniques to be taught, the effectiveness of different teaching methods to be assessed and how changes brought about by training have the potential to make a significant clinical difference to patients.