Recognising and responding to emotional cues in cancer care

Melissa Judd’s work involves a lot of listening. As a Registered Nurse within Barwon Health’s palliative team, she supports people with terminal illnesses who have decided to carry out their end-of-life care at home, while simultaneously helping loved ones navigate their own emotions and concerns. 

“In my role, you’re often encountering people at the worst point in their lives,” she said. “There’s always a lot of tense and trying conversations involved, and so having confidence and keeping open lines of communication is critical. 

“I think a person’s ability, particularly as a health professional, to build a very therapeutic relationship quickly with clients and families is hugely important, and I know a fair few people struggle with that.”  

Melissa’s reflections on communication is echoed throughout the medical field – such critical skills have not been prioritised, leading to poorer health outcomes and unsatisfied patient needs. Some health professionals find it difficult to build rapport with people, recognise and respond to emotional cues and struggle to deliver bad news. 

In fact, the very act of delivering bad news has been found to more than double a doctor’s heart rate.  

Effective and open communication is a critical skill for healthcare professionals.
 

Gagan Cheema, Coordinator of the Education and Training Program at Cancer Council Victoria said that despite research proving that effective and empathic interactions not only improve patient outcomes, but also increases the wellbeing of health care professionals, there is a clear gap in effective communication training.  

“Communication skills don’t simply improve with age and experience, these skills need to be learnt,” said Gagan.

“The quality of conversations of health care staff ultimately impacts patient experience and clinical outcomes and unfortunately, many people don’t feel adequately trained or prepared to manage difficult discussions.” 

Poor communication has a significant impact on people receiving medical care, including those affected by cancer, which is a leading cause of disease in Australia. One in two Australians will be diagnosed with cancer by the age of 85 – and in 2020 alone, there were just under 150,000 new diagnoses of cancer and 50,000 deaths. 

Despite its prevalence and the resources dedicated to cancer treatment and management, Cancer Council’s nurses often receive feedback from patients who report feeling rushed when first given their diagnosis, having critical questions left unanswered and feeling confused and overwhelmed at an emotionally vulnerable time.  

Recognising the significance of effective and open communication lead Melissa to undertake Cancer Council Victoria’s Responding to Emotions in Cancer course, which helps health professionals, non-clinical staff and volunteers to communicate effectively and build supportive relationships with cancer patients and their families. 

The evidence-based training has been running since 2004 and through small group experiential learning with a simulated patient, participants explore and receive feedback on personal communication challenges in a safe environment.  

“I learnt that moments of silence don't have to be uncomfortable,” Melissa said. 

“I find a lot of people feel like they need to fill the air with words. Surprisingly, allowing those longer moments of silence gives the person that you're speaking to the opportunity to think about what they want to say next, and they'll tell you more. Sometimes, your presence is enough.” 

Responding to Emotions in Cancer is tailored to the specific needs of participants, which are assessed in a pre-learning survey and then integrated into teachings throughout the course.  

“When staff fail to meet the emotional needs of patients in an appropriate manner, such as by ignoring their wellbeing while discussing a treatment plan, this is often associated with distress and anxiety in patients, and dissatisfaction in staff,” added Gagan, who is also a trained facilitator of the course.  

“The patients will often give verbal and non-verbal cues to invite healthcare staff to address their emotions. It’s up to the staff to recognise and address these cues while also communicating their own message.” 

For junior Surgical Registrar, Alice Thomson, participating in Responding to Emotions in Cancer provided much-needed space to practice and workshop situations without the pressure of it being a real patient interaction. It has enabled Alice to develop more trusting relationships to support both her colleagues and patients.  

“When not enough is done to establish rapport with patients, which often has to be done quickly, you can get off on the wrong foot and that makes it really hard to get your point across and to develop a treatment plan that they're on board with,” explained Alice.  

“But if you’re able to build a trusting relationship, helping to direct their care becomes quite easy. Your patients trust that you’re acting in their best interests and giving the best advice. They also feel they’re in control of their own health care, because they know what’s going on. 

“I've seen a lot of different communication situations, and I’ve often been the observer in them. I've seen them done well, and I've seen them done poorly. And I would really like to end up on the side of things where they're done well.” 

Both Alice and Melissa recommend the course to anyone who wants to enhance their communications skills and learn from professionals experienced in cancer care. 

“No matter how good you think you may be at communication, there's always something that you haven't thought of or something you can put into practice that improves your ability to communicate with health professionals or patients and clients,” said Melissa.