• Communication skills of health-care professionals working in oncology--can they be improved?

      Schofield, Nicola G; Green, Claire; Creed, Francis; Psychological Medicine Group, The University of Manchester, Stanley House, The Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK. nicola.schofield@christie-tr.nwest.nhs.uk (2008-02)
      Communication skills' training has been placed high on the agenda by the National Institute of Clinical Excellence guidelines and the National Health Service in the UK. The paper reviews the importance of good communication skills in cancer care for the patient and describes research that has identified ways in which health-care professionals (HCP) can improve their communication with patients. The evidence as to why there is a lack of facilitative skills is reviewed along with what skills are required in order to improve communication with patients. The paper describes evidence of increased facilitative skills post-training, discusses whether there is evidence of transfer of these skills into clinical practice and how this might be best achieved. To conclude, research evidence would support the fact that training in communication skills needs to provide the best possible outcomes for HCP and their patients. Patient concerns, needs and preferences need to be elicited and the impact of concerns identified, so that the HCP can appropriately tailor their information giving, advice, treatment and plan of care.
    • Improve the counselling skills of doctors and nurses in cancer care.

      Maguire, Peter; Faulkner, A; Cancer Research Campaign Psychological Medicine Group, Christie Hospital, Manchester. (1988-10-01)
    • Patient group directions: training practitioners for competency.

      Flint, Helen; Scott, Linda J; Christie Hospital NHS Trust, Manchester. (2003-06)
      Since the mid-1990s, three new initiatives have been introduced by the government to allow the prescribing of medicines by practitioners other than doctors: extended nurse prescribing, supplementary prescribing and patient group directions. Professional education and assessment is vital to ensure that these systems operate safely. After the implementation of patient group directions within a regional cancer centre, a training programme was developed, incorporating an assessment framework for competency development.
    • Training hospice nurses to elicit patient concerns.

      Heaven, Cathy; Maguire, Peter; Psychological Medicine Group, Christie Hospital, Manchester, England. (1996-02)
      Patient assessment underpins every aspect of nursing care. However, there is much evidence to suggest that many nurses lack the skills necessary to communicate effectively with their patients, and so assess their individual problems and concerns. Communication studies to date have been descriptive, or have concentrated on acquisition of skills without addressing the impact this has on patient care. This paper reviews a study of 44 hospice nurses who were taught assessment skills. It discusses the impact of training not only on their skill level, but also on their ability to elicit their patients' concerns. It concludes that simple skills training is insufficient to change clinical behavior, and discusses other factors which should be addressed in future training programmes.
    • Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

      Heaven, Cathy; Clegg, Jenny; Maguire, Peter; Cancer Research UK Psychological Medicine Group, Manchester, UK. cathy.heaven@christie-tr.nwest.nhs.uk (2006-03)
      OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.