Apprendre à communiquer en oncologie : médecins-résidents à l’écoute de patients partenaires

Learning to communicate in oncology: Residents’ experience of listening to patients   Purpose : Over the last few decades, many types of cancers have become chronic diseases. Affected patients can expect to have long-term monitoring by their oncologists. Although patients wish to establish a strong therapeutic alliance with their physicians in the context of ongoing follow-up, they find that oncologists’ communication skills are deficient. This is unsurprising in light of the fact that few postgraduate training programs offer formal opportunities for residents to develop communication skills, including the ability to listen effectively to patients. The emergence of narrative medicine has increased sensitivity to the importance of the patient’s subjective experience and its role in healing. The aim of our study is to explore how residents and patients experience a educational intervention focused on narrative competence whose purpose is to expose oncology residents to the story of "life with the disease "as told by patients who have been diagnosed with cancer.  Methods : Inspired by the principles of grounded theory and phenomenology, we conducted a qualitative study of the experience of oncology residents and patients of an intervention designed to foster physicians’ narrative competence. Using theoretical sampling, we recruited 6 residents in oncological specialties at the University of Montreal as well as 4 patients trained by the patient-partner program of the Faculty of Medicine of the University of Montreal. The recruits participated in 6 dyads for the narrative competence intervention, followed by semi-structured interviews with all participants to explore their perceptions and experiences in using the method.  The interviews were audiorecorded, transcribed and analyzed to reveal emerging themes. When informational saturation was obtained, the recruitment was stopped.  Results and Analysis : Our analysis focused on four emergent themes: 1) residents were untrained in communication, including narrative competence, and wanted tools to develop this skill; 2) participants identified several barriers to effective communication in clinical practice; 3) patient partners were empathic about the challenges faced by residents in communicating about the experience of illness; and 4) the intervention provocked diverse emotional and cognitive reactions (some patients considered it therapeutic, some residents appreciated the pedagogical value, some residents and patients found it difficult to be aware of  the subjective and emotional experiences of the patient).  Conclusions : An educational intervention to promote narrative competence amongst oncology residents led to various reactions among the participants. Through their experience, residents became aware about the challenges of communicating with patients with cancer. Future research should focus on the pedagogical value of this type of intervention and the precautions needed to create a safe environment both for learning communication skills and tolerating patients’ emotional burden of living with cancer. The impact and effectiveness of the participation of patient partners in postgraduate training in oncology should also be investigated further.

Keyphrases: Illness narrative, Communication, McGill Illness Narrative Interview, Medical education, Oncology, Patient partner, Post-graduate training, Residency in oncology