Walter Baile

• Professor (Full) at University of Texas MD Anderson Cancer Center

Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) ve...

191 Background: There is limited evidence on the perception of medical marijuana (MM) among cancer patients in a legalized vs. a non-legalized state. In this study, we compared the attitudes of cancer patients in a legalized (Arizona) vs. a non-legalized state (Texas) on legalizing marijuana for medical use and their perception of its medical usefu...

Oncology training focuses primarily on biomedical content rather than psychosocial content, which is not surprising in light of the enormous volume of technical information that oncology fellows assimilate in a short time. Nonetheless, the human connection, and specifically communication skills, remains as important as ever in caring for highly vul...

(Abstracted from J Clin Oncol 2017;35(31):3618–3632) Clinicians who treat cancer are faced with many challenges when communicating diagnostic, treatment, and prognostic information to patients and their families. The limited training of many oncologists does not prepare them to deliver effective information.

Background: In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the impact of the clinical outcome of the patient on patient's perception of physician's level of compassion and professionalism has not been previously studied. Our aim was...

27 Background: In a previous randomized cross-over study, patients perceived a physician delivering a more optimistic message as more compassionate and professional. However, the impact of the clinical outcome of patient on patients’ perception of physician’s level of compassion and professionalism has not been previously studied. Our aim was to de...

Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health dis...

e21694 Background: We previously found in a RCT video study that patients perceived a physician delivering a more optimistic message as more compassionate and professional. The primary objective of this study was to determine if the clinical outcome modifies the patient’s perception of physician compassion. Methods: 128 patients were randomized to...

Background: When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. Methods: A prospective...

27 Background: Oncologists engage in emotionally charged conversations with patients and families about prognosis, goals of care, and end of life transitions. Many oncologists lack key skills for guiding patients through such conversations. Key skills include posing open ended questions to elicit the patient’s perspective, using silence effectively...

In the practice of oncology, a number of clinical situations require bad news to be given to patients and families. SPIKES (setting, perception, invitation for information, knowledge, empathy, summarize and strategize) is a skills-based, best-practices approach to giving bad news. ••Although not formally tested in clinical trials, the communication...

Information regarding treatment options and prognosis is essential for patient decision making. Patient perception of physicians as being less compassionate when they deliver bad news might be a contributor to physicians' reluctance in delivering these types of communication. To compare patients' perception of physician compassion after watching vi...

Serious medical errors occur commonly in medicine. Although there has been traditionally a failure to inform patients and families of actual error occurances, the benefits of error disclosure have recently been emphasized and movement toward honest communication with patients and families is taking place. In fact prompt disclosure of errors is not...

88 Background: Information regarding treatment options and prognosis is essential for patient decision making near end of life. However, physicians are frequently reluctant to deliver bad news due to multiple factors, including fear of being perceived as less compassionate. This randomized controlled double blind trial aimed to examine the patient’...

Communication is the essential component for good clinical practice within a patient-centered approach, with guidelines empathizing the role of communication and the mandatory need to train physicians in communication in order to assure optimal psychosocial care of cancer patients, including the psychosocial interview patient assessment, prescripti...

The authors describe how sociodramatic methods were applied to teaching communication skills to professionals in a comprehensive cancer center. The article briefly reviews the importance of communication skills in oncology and the challenges in teaching key skills such as empathy and addressing emotions. It indicates how action methods can be appli...

Empathy is a core feature of patient-centered care. It enables practitioners to better understand the patient and family concerns that are key to patient and family satisfaction, prevention of anxiety and depression, and provider empowerment. Current methods of teaching communication skills do not specifically focus on enhancing the ability to “sta...

Summary statement: Role-play is a method of simulation used commonly to teach communication skills. Role-play methods can be enhanced by techniques that are not widely used in medical teaching, including warm-ups, role-creation, doubling, and role reversal. The purposes of these techniques are to prepare learners to take on the role of others in a...

Difficult conversations about prognosis, end of life, and goals of care arise commonly in medical oncology practice. These conversations are often highly emotional. Medical oncologists need outstanding, patient-centered communication skills to build trust and rapport with their patients and help them make well-informed decisions. Key skills include...

Background: Code status discussions are important in cancer care, but the best modality for such discussions has not been established. The objective of this study was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscit...

Just as communication is a skill that must be learned, teaching ­communication skills requires a methodology based upon known educational principles. “Positive psychology,” which emphasizes skills needed to produce results; adult learning theory, which emphasizes the “activation” and motivation of learners; and social learning theory, which promote...

We introduce the technique of sociodrama, describe its key components, and illustrate how this simulation method was applied in a workshop format to address the challenge of discussing transition to palliative care. We describe how warm-up exercises prepared 15 learners who provide direct clinical care to patients with cancer for a dramatic portray...

Abstract End-of-life discussions can be stressful and can elicit strong emotions in the provider as well as the patient and family. In palliative care, understanding and effectively addressing emotions is a key skill that can enhance professional competency and patient/family satisfaction with care. We illustrate how in coursework for a Master's de...

IntroductionWhy is communication important?Relevance of medical communication to psycho-oncologyWhat are the critical tasks in communication?Cultural issues in communicationCommunication skills trainingConclusions Suggested further readingReferences

9049 Background: Code status discussions are important in cancer care. The best modality for such discussions has not been established. Our objective was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients’ do-not-resuscitate (DNR) pref...

Cancer is the plague of our generation. The leading cause of death worldwide, cancer accounted for 7.6 million deaths or 13% of all deaths in 2008 (World Health Organization (WHO), Cancer (fact sheet #297), Geneva: Author). Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths). In 2012, 577,190...

The evolution of the healthcare system over the past few decades has resulted in shorter hospital stays and greater numbers of invasive, out-patient procedures for most patients. This change in healthcare delivery has resulted in more family members being thrust into the role of caregiver.

Changes in healthcare delivery in the United States have left their mark on oncology services, the most significant being the shift in patient care from inpatient to outpatient and ambulatory settings. As a result, the family and other caregivers must now assume an expanded role in providing assistance for cancer patients especially at home (Given...

Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on bro...

The relationship between oncologists and their cancer patients is rapidly evolving. Oncologists and other cancer professionals master new anticancer and supportive treatment options, while working under increasing economic pressure and time constraints, and are often unprepared to deal with all the challenges of their new position in a therapeutic...

Patients with serious illness derive a sense of security by forming strong, healing relationships with their providers. These bonds are particularly strong in life-threatening illnesses, such as cancer, which carry the stigma of death and suffering. These strong relationships create expectations in patients that are not necessarily shared by their...

Many practitioners in oncology receive no or little training in how to effectively communicate with patients and families who are dealing with cancer. Moreover medical teachers are not always aware of the pedagogy of teaching communication skills in a way that results in performance improvement in this area. In this paper a method of small group te...

e19695 Background: Expression and perception of empathy are associated with favorable outcomes. It is important to determine if speech prosody influences those results independently of verbal content. This study measured differences in speaking rate and pitch of 12 oncologists discussing bad news versus neutral topics and assessed listeners’ abilit...

This study was designed to determine if differences exist in the speaking rate and pitch of healthcare providers when discussing bad news versus neutral topics, and to assess listeners' ability to perceive voice differences in the absence of speech content. Participants were oncology healthcare providers seeing patients with cancer of unknown prima...

Patients in the palliative care setting have a number of concerns not necessarily connected to their medical problems, such as spiritual and relationship issues. When these problems are not properly assessed and addressed, they may become a significant source of distress for patients and families. The aims of the present study were to assess the co...

LENZI R., BAILE W.F., COSTANTINI A., GRASSI L. & PARKER P.A. (2010) European Journal of Cancer Care20, 196–203 Communication training in oncology: results of intensive communication workshops for Italian oncologists The primary aim of this study was to evaluate the efficacy of a 3-day communication course model for senior Italian oncologists. The c...

Recommendations for communicating bad or serious news are based on limited evidence. This study was designed to understand patient perspectives on what patients value when oncologists communicate news of cancer recurrence. Participants were 23 patients treated for a gastrointestinal cancer at a tertiary U.S. cancer center within the past 2 years, w...

The importance of the topic of 'breaking bad news' to cancer patients is underscored by a recent Medline search, which revealed close to 500 articles published on this subject in the past ten years, and by the fact that the cancer clinician is likely to give bad news many thousands of times during the course of his or her career. Paradoxically, how...

In 2002, funding was recieved from the National Cancer Institute to develop a new teaching model for communication skills at the end of life, aimed at medical oncology fellows. Using this model, called Oncotalk, roughly 10% of the oncology fellows trained in the United States over a five-year period were taught. The aim of Oncotalk was to address s...

John Wooden, the legendary college basketball coach, created the "Pyramid of Success", which he constructed from 14 timeless character traits and interpersonal skills that are critical to competitive greatness. Wooden's pyramid is a powerful symbol that he and others have used for several decades as an educational tool to promote leadership and tea...

In one of our recent communication skills workshops, we were helping a physician trainee talk to the wife of a patient with relapsed lymphoma. In this teaching scenario, the patient has become septic and is off stage in the intensive care unit; the physician is talking to the patient's wife, who he knows quite well. The wife has a seemingly bottoml...

Supervising learners as they communicate often places faculty preceptors in a classic educational dilemma. What should a preceptor do when the learner is not communicating well and is not asking for help? What usually happens, in the authors' experiences, is that the preceptor decides at some point that she or he cannot stand the situation anymore-...

Physician assistants (PAs) and other midlevel practitioners have been taking on increasing clinical roles in oncology settings. Little is known about the communication needs and skills of oncology PAs. PAs working in oncology (n = 301) completed an online survey that included questions about their perceived skill and difficulty on several key commu...

A survey of oncologists was conducted in Italy to evaluate the potential problems of physician-patient discussion about hormonal switch in the adjuvant therapy of breast cancer. Materials and methods: A questionnaire, including both closed and open-ended questions, was administered to 70 oncologists. Fifty-one of them returned completely filled que...

In many countries, physicians are reluctant to disclose unfavorable medical information to patients with advanced cancer and instead give the bad news to the family. The authors modified standard communication workshops to help Italian senior oncologists overcome cultural, social, and attitudinal barriers to disclosure of diagnosis and prognosis. F...

Academic medical centers are complex organizational environments characterized by the independence of faculty and the presence of multiple and overlapping goals. Several factors including competition for resources, financial strains, leadership turnover, and a negative research funding climate, all contribute to an environment with significant pote...

The University of Texas M. D. Anderson Cancer Center provides an approach to formulating a faculty health program that may guide others in organizational structure, in relation to executive management, and in programming. In 2000, following the suicide of a faculty member, concerned faculty formed a Faculty Health Committee (FHC). The Committee sec...

Women with breast cancer have become increasingly more involved on a national and local level in advocating for resources to fight cancer. However, in the context of the relationship with their physicians and other cancer caregivers, much remains to be done in providing them with adequate support. In this paper, we highlight the difficulties in com...

Studies show that 30-50% of medical oncologists experience burnout, but little is known about burnout among surgical oncologists. We hypothesized that wide variation in burnout and career satisfaction exist among surgical oncologists. In April 2006, members of the Society of Surgical Oncology (SSO) were sent an anonymous, cross-sectional survey eva...

This study describes the communication style preferences of Japanese patients when receiving bad news, examines the factor structure of the measure for patients' preferences (MPP) in a Japanese population, and explores variables that may be associated with patients' communication style preferences. Five hundred twenty-nine cancer outpatients comple...

Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the pat...

Small-group teaching is particularly suited for complex skills such as communication. Existing work has identified the basic elements of small-group teaching, but few descriptions of higher-order teaching practices exist in the medical literature. Thus the authors developed an empirically driven and theoretically grounded model for small-group comm...

Although converging lines of evidence suggest that nicotine and mood are related at a fundamental biological level, this link has not been reliably demonstrated in laboratory studies. In this study, startle probe methodology was used to examine the effects of nicotine administration and deprivation on emotional processes associated with motivation....

Drawing upon Bloom's taxonomy of educational objectives as a theoretical framework, this study examines attitudes toward communication skills training, knowledge of appropriate provider-patient communication, and confidence communicating with patients between first-year and fourth-year medical students at a large medical school in the southern Unit...

In this study, 147 smokers were randomly assigned to receive either venlafaxine or placebo in conjunction with behavioral counseling (9 weekly sessions) and transdermal nicotine replacement therapy (22 mg/day). Patients began medication 2 weeks before quitting and continued for 18 weeks after quitting, with the daily dose titrated from 150 to 225 m...

In this paper, the authors engage in a critical analysis of the existing empirical literature which addresses the impact of ineffective communication between cancer patients and clinicians. It is increasingly accepted that communication plays a significant role in many aspects of the care experience, and that poor communication can have a significa...

We conducted a critical interpretive analysis of 47 studies from the Cochrane Review of the communications training literature to capture the empirical indicators used to judge provider communication competency and to describe how the indicators were characterized in the context of a cancer care system. Of the 47 studies reviewed, few showed any re...

Contemporary oncology practice acknowledges the importance of partnering with the patient and family in dealing with the illness. Patients also value their physicians as important sources of support when they provide information about the illness, encouragement, and hope, discuss treatment options, and address their concerns. For this reason outcom...

Effective communication skills enable physicians to improve patients' understanding of their illnesses, improve patient adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment. Common communication pitfalls include blocking, lecturing, depending on a routine, collusion, and premature reassurance....

This study examines the impact of hereditary nonpolyposis colorectal cancer (HNPCC) genetic test results on psychological outcomes among cancer-affected and -unaffected participants up to 1 year after results disclosure. A total of 155 persons completed study measures before HNPCC genetic testing, and at 2 weeks and 6 and 12 months after disclosure...

Training in the communication components of cancer care is necessary for the practice of oncology. We conducted a communication course for oncology fellows. Teaching methods included lectures, role playing and simulated patient interviews. We used self-reports, knowledge questionnaires and course/faculty evaluations. A total of 17 fellows participa...

The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology profes...

Effective communication with cancer patients continues to be an elusive goal for health care professionals (HCPs) and cancer educators. We posted a survey on the ConversationsInCare.com Web site to collect information from oncology HCPs regarding attitudes, effectiveness, and specific patient communication skills. The 291 respondents agreed that go...

The extent of communication skills training (CST) in American oncology fellowship programs is unknown. A survey was sent to program directors of medical oncology, radiation oncology, gynecologic oncology, and surgical oncology training programs regarding (1) the presence and method(s) of CST in their programs, (2) their attitude about mandatory CST...

We examined the acute stress response associated with having to deliver either bad or good medical news using a simulated physician-patient scenario. Twenty-five healthy medical students were randomly assigned to a bad medical news (BN), a good medical news (GN), or a control group that read magazines during the session. Self-report measures were o...

Little is known about how hereditary nonpolyposis colon cancer (HNPCC) genetic counseling and testing information is communicated within at-risk families. This article describes findings from a qualitative study of 39 adult members from five families with known HNPCC-predisposing mutations. We evaluated how information from HNPCC genetic counseling...

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the ni...

Patients with advanced cancer increasingly receive end-of-life care from a variety of health care professionals, physicians and nurses. These professionals need to be able to assess the original diagnosis and the appropriateness of patient referral, set a treatment or palliation program, and recognise and plan for the clinical problems associated w...

In recent years, there has been increasing emphasis on understanding how the cancer experience affects individuals' quality of life (QOL). The goal of this study was to assess the QOL and to identify psychosocial predictors of QOL among a large sample of patients with a variety of cancers. Specifically, we assessed the unique contribution of demogr...

Patient communication is a cornerstone of comprehensive oncology nursing care. Oncology nurses, however, do not appear to receive much advanced training in communication skills and many nurses do not feel adequately trained in this area. We designed a 33-item questionnaire to assess nurses' perceived level of difficulty and skill in a variety of co...

To examine the attitudes and practices of oncologists in disclosure of unfavorable medical information to cancer patients. A questionnaire was administered to a group of physicians who attended the 1999 Annual Meeting of the American Society of Clinical Oncology. The questionnaire assessed demographic and practice-related information and the freque...

The psychologic distress in patients with cancer may be divided into three categories; depression, anxiety and neuro-cognitive changes including delirium. The supportive interventions of health care professionals along with the use of psychotropic medications have been shown to relieve depression, anxiety, and states of confusion in oncology patien...