A new play highlights the issues concerning communication between healthcare professionals and their cancer patients, writes MICHELLE MCDONAGH.
EFFECTIVE COMMUNICATION is critical in the management of patients with cancer, particularly with pain, yet this important element of their care is often overlooked.
Patients may have many questions that remain unanswered, leaving them and their families more anxious than necessary during an already difficult time.
An innovative way of educating healthcare professionals on communicating with their patients about their cancer experience makes its debut in Ireland this month.
Cancer Tales– a collection of stories by author Nell Dunn and adapted for theatre – tells the stories of the real-life experiences of five different people with cancer and their families and carers. It follows each step along their cancer journey.
The production, which has received impressive reviews across Britain and Europe, highlights the need for better communication between healthcare professionals and cancer patients.
Director Trevor Walker says the play hopes to strike a chord with the medical profession across Ireland to help them stop and consider the way that they explain a diagnosis, treatment, prognosis and living with cancer to their patients.
“The dialogue in each scene from the play illustrates a particular communication issue experienced by a cancer patient and/or their family: from diagnosis to discussions about disease progression, or anxiety about examinations and treatment procedures,” he says.
Walker, who is head of drama at St Mary's University College in London, was initially contacted by Nell Dunn in 2001. The author who wrote Up The Junctionand Poor Cow– both of which were made into films by director Ken Loach – had lost her father to cancer and wanted to develop a play from transcripts of conversations she had had with cancer patients and their families.
The play was first performed in the Royal Academy of Dramatic Art (RADA) as a rehearsed reading and then, out of the blue, the theatre group was invited to perform at a Royal Society of Medicine conference.
“I never thought it would be a commercial piece because of the issues we were dealing with:death was very much a taboo subject in 2001.
“I was worried because I didn’t think people in the medical profession would be at all interested in something they were dealing with on a daily basis, but they loved it.
“People had tears rolling down their faces. It’s not a sentimental piece, it’s quite matter-of-fact but it touched them somehow,” says Walker.
Since then, Cancer Taleshas been performed at conferences and symposiums all over the UK and Europe as well as at the Soho and Greenwood theatres in London.
Pharmaceutical company Mundipharma International Ltd now funds performances for various organisations and in 2007 it republished the play as a workbook which is being rolled out as a teaching tool across Europe.
Walker, who has lost both his own parents to cancer, says most of the actors and those involved with Cancer Taleshad been affected by the disease in some way and found that working on the production had made a difference to their lives.
“We got a letter from a hospital which actually changed the protocol in its radiotherapy department as a result of a scene in the play about a person being treated in such a department,” he adds.
Recent results from the European Pain in Cancer (EPIC) survey support the need for more effective communication in the management of cancer.
The study showed that although one in two cancer patients were suffering from moderate to severe pain, most of those questioned had to proactively raise the subject of pain with their physician, with nearly a quarter stating that their physician never or only rarely asked about their pain.
Also, one in five patients in moderate to severe pain was not receiving treatment for it.
“Cancer goes beyond the clinical setting and it is important that health professionals are equipped with effective communication techniques to make for the most comfortable situation for the patient,” says Dr Dominic O Brannagain, consultant physician in palliative medicine.
“Confronting patient anxieties, concerns and fears of pain on an ongoing basis can ensure that such issues are dealt with when they arise.”
The Cancer Tales initiative is backed by several patient and medical organisations including the Irish Cancer Society, the Irish Hospice Foundation and the Irish Pain Society, all of whom support the need for educational tools of this kind.
Dr Brona Fullen, president of the Irish Pain Society, says the play recognises the importance of good communication between healthcare professionals, patients and their families in order to maximise patient care and pain relief for patients.
“This will help to reduce the impact of the disease on both the patient and their family,” she says.
The Cancer Talesworkbook can be used as practical guidance when training healthcare professionals in improving communication.
Issues are addressed in the detailed chapters which provide advice, guidance and practical exercises designed to create an understanding of the impact of communication and to improve the interaction between medics and patients. Training workshops will be available through 2009.
The performances will tour Ireland for a week, concluding in Dublin on February 20th in the Chester Beatty Library, and are open to healthcare professionals, palliative care specialists and counsellors working with patients and their families.
The first performance of Cancer Talestakes place in the Glucksman Gallery, Cork, on February 16th and will then move to the Galway Clinic on February 18th.
For more information and to receive an invitation, contact amanahan@firstmedical.ie or call 01-614 5102/607 0221.
While the February performances are for healthcare professionals, there will be a longer public premiere in March.
A copy of Cancer Tales: Communicating in Cancer Careis either available online by logging onto cancertales.org or a hard copy may be requested by sending an e-mail to info@cancertales.org