In recent years, patient information and satisfaction have begun to receive more attention. Indeed, the American Society for Clinical Onocology (ASCO) has published Patient Guides with recommendations for a variety of cancers. These guides are summaries based on ASCO Clinical Practice Guidelines that are written in an accessible format, and offer patient-oriented information, providing background information on the disease, an explanation and discussion of the recommendations, and a list of questions to aid patients in their discussions with their doctors. The National Cancer Institute and the American Cancer Society have developed similar pamphlets. However, as the best system of delivery has not yet been developed, efforts need to be made to establish structures that would optimize physician discussions with their patients.
Programs do currently exist that could be used as models for patient communication, to ensure that physicians be more proactive about providing patients with relevant information, before the patient asks for it. It could be helpful to look at one successful model of a predictable, manualized health experience such as childbirth, a process in which the provision of information and support is written into state and federal law, and encompasses a variety of health care providers.
Currently, women who are pregnant (and have access to, and are able to participate in, regular health care) are automatically directed to education programs about nutrition, pre- and post-natal care. Commonly offered classes for expectant parents include Lamaze techniques, breastfeeding, sibling preparation, and infant care. Social support through social workers and lactation specialists is often available. Nurses, who are primarily responsible for a patient’s care, are available to answer any questions after the baby is born, concerning the mother’s health or the infant’s care. This type of education is generally covered by most insurance plans. For those who are eligible for Medicaid, childbirth education also may be covered, depending on the state. For example, in Washington State, the 1989 Maternity Care Access Act, known as the First Steps program, provides maternity care before and after pregnancy and health care for infants. This includes obstetrical care and case management, as well as supportive services such as community health nursing, nutrition, behavioral health visits, and childbirth education classes.
Although not all elements of this highly successful program might be transferable into the cancer context it nevertheless could serve as a blueprint for managing the information needs of cancer patients. The complexities of a cancer diagnosis and its treatment make an optimal patient-physician communication process even more important and call for the development of new educational models that go beyond the traditional patient education approach. The challenges for health communication presented by a cancer diagnosis requires the collaboration of a multidisciplinary team consisting of doctors, psychologists, social workers, and nurses all working together to enhance understanding, adaptation and ensure survival and optimal quality of life.