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

Despite wide agreement about the importance of effective communication in c ancer care there is continuing evidence of the need for nurses, doctors and colleagues to be helped to improve their communication skills. Consequentl y, there has been a growing demand for effective methods for evaluation of communication training programmes. This paper discusses theoretical perspec tives in this field and describes the rationale underpinning the developmen t of a detailed objective method of assessing interviews between health pro fessionals and cancer patients. The method enables an utterance by utteranc e rating of transcribed interviews to be made which can be used to construc t profiles of interviewer and patient behaviours and interactions. All cate gories were developed from interviews drawn from a large sample of particip ants (n = 206) at counselling skills workshops. Six domains have been ident ified and these are: grammatical style; the purpose of each technique; what is being discussed, the degree of feeling expressed; explicit avoidance; a nd the use made of patients' cues. Each domain contains a mutually exclusiv e 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 interv iew can be better understood, thus enabling the most effective techniques t o be taught, the effectiveness of different teaching methods to be assessed and how changes brought about by training have the potential to make a sig nificant clinical difference to patients.