Communication Skills Training in Japan

In 2006, the Cancer Control Act was approved in Japan. Through this legislation, the Japanese government has greatly expanded a number of national initiatives to promote cancer control programs, to enhance efforts in cancer prevention and early detection and to disseminate information about palliative care and promote excellence in this area and to promote cancer research. In 2007, the basic plan to promote a cancer-control program now approved by the Japanese cabinet also provided opportunities for basic palliative care training for physicians who engaged in the treatment of cancer patients. This effort also addressed the issue of improving physician’s communication skills in the areas of disclosing the cancer diagnosis and other communication aspects of supporting the patient and families affected by cancer.

In cooperation with the JPOS and the Japanese Ministry of Health, Labor and Welfare, the SHARE-CST Working Practice Group of the JSPM have also conducted advanced communication skills workshops for highly motivated oncologists since 2007. The workshop is learner-centered and focuses on building enhancing the strengths of each participate in communicating with cancer patients. Each cohort of learners consists of 16-40 oncologists who learn breaking bad news, discussing refractory cancer, informing of disease recurrence and stopping anti-cancer treatment. Based on our communication skills research, empathy skills are especially emphasized (1-5).

The SHARE -CST program adopted the conceptual communication skills model consisting of four dimensions, referred to as SHARE: S, setting up a supportive environment for the interview; H, considering how to deliver the bad news; A, discussing various additional information that patients would like to know; and RE, providing reassurance and addressing the patient’s emotions with empathic responses, in accordance with our previous surveys of the preferences of Japanese cancer patients regarding the disclosure of bad news(3-4). The program particularly emphasized the RE component because it has been shown to be the most important for patients and also to be one of the most difficult communication skills for oncologists. The program is a participant-centered approach and a total of two days, consists of an icebreaking discussion, a one-hour computer-aided didactic lecture with text and video, eight hours of role-playing with simulated patients, and discussions on this role-playing. The lecture provided during this program cited evidence of the most important and common patient preferences regarding the communication of bad news, such as empathic responses and encouragement to ask questions, as well as variability of patients’ preferences, such as discussion of prognosis and being dispassionate, and showed how to check and elicit patient preferences. After this lecture, the oncologists were divided into groups of four with two facilitators each, for role-plays and discussions. During these role-plays and discussions, the participants were required to consider a patient’s emotions and concerns caused by bad news, their cognition of their disease, their social situation, and information that they would want to know, by empathizing with the patient. Facilitators led the role-playing and the discussion on the potential communication-related preferences and emotions of the patient. The facilitators were psychiatrists, psychologists, and oncologists, all of whom had three or more years of clinical experience in oncology and had participated in specialized 30-hour training workshops for facilitating communication skills in oncology. The SP, individuals who had three or more years of experience in medical school, also participated in the 30-hour training workshops. For the role-playing, many scenarios were drawn up tailored to each oncologist’s specialty in three different situations that required the sharing of bad news with a patient: diagnosis of advanced cancer, recurrence of cancer, and the cessation of anti-cancer treatment. In a previous study, these situations were found to be difficult to deal with in practice by oncologists.

The Japan Cancer Control Act (2007) supports the SHARE-CST program for 100 physicians/y; however, only 1,048 physicians participated and 156 became facilitators. The expected outcome is an increase in the number of the physicians participating in both workshops during the subsequent ten-year period. We are looking forward to reporting the results of our efforts in the future.

References

1. Uchitomi Y. Psycho-oncology in Japan: history, current problems and future aspect. Jpn J Clin Oncol. 29:411-2, 1999.
2. Uchitomi Y, Mikami I, Kugaya A, Nakano T, Okuyama T, Akechi T, Okamura H. Physician support and patientpsychologic responses after surgery for nonsmall cell lung carcinoma: a prospective observational study. Cancer 92:1926-35, 2001.
3. Fujimori M., Parker P.A., Akechi T., Sakano Y., Baile W.F., Uchitomi Y. Japanese cancer patients' communication style preferences when receiving bad news. Psycho-Oncology. 16:617-25, 2007.
4. Fujimori M., Akechi T., Morita T., Inagaki M., Akizuki N., Sakano Y., Uchitomi Y. Preferences of cancer patients regarding the disclosure of bad news. Psycho-Oncology. 16:573-81, 2007.
5. Fujimori M, Shirai Y, Asai M, Kubota K, Katsumata N, Uchitomi Y.: Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial. Journal of Clinical Oncology 32:2166-72, 2014

March 8th, 2016