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Commentary
“The single biggest problem in communication is the illusion et al6 described barriers related to suboptimal conflict resolution
that it has taken place.” and interpersonal communications skills. Other findings go on
—George Bernard Shaw to identify status, authority, responsibilities, gender, training,
and nurse/physician cultures as factors that influence effective
The article by Weaver et al1 in this issue of Journal of Oncol-
communication.5,6,12 Colleagues in these dynamic domains
ogy Practice provides an important reminder to oncologists who
have led the way in studying communication barriers and im-
lead interprofessional teams that opportunities to improve team
plementing changes to improve patient safety. These studies
communication remain. Studies in a variety of settings have
report that miscommunication is frequently among the causes
concluded that communication affects the quality of patient
care, team satisfaction, and nursing turnover rates.2 The discon- of error and often the leading cause.4,10 Intensive care unit data6
nect in perception of communication between physicians and reveal that nurses find it difficult to speak up, disagreements are
their nursing colleagues is significant and well documented in not appropriately resolved, and nursing input is not well re-
the literature,3-6 so much so that it is surprising that studies are ceived. Both Awad et al4 and Makary et al5 confirmed a differ-
still taking place. As Weaver et al describe, strong team collab- ence in communication ratings between nurses and surgeons in
oration supports patient safety on many levels. The challenge the operating room, with physicians believing communication
for researchers in this field is to replicate the results of interven- was not flawed. Janss et al12 reviewed communication research
tions already implemented at a few institutions in a multicenter and its impact on teamwork from the domain of social and orga-
study. Other potential research could examine questions re- nizational psychology. Their conclusions were that power and con-
lated to the types and breadth of communication. In the past flict influenced individual communication styles, and they
10 years, tools such as texting, Vocera, and electronic med- recommended training interventions to help teams improve col-
ical records (EMRs) have added to the complexity of team laboration.
communication. In the oncology setting, unique challenges underscore the
Fifteen years ago, the Institute of Medicine challenged pro- need for strong communication among team members, includ-
viders to embrace the need to radically improve how patient ing intricate diagnostic procedures, patient populations with
care is delivered by “hard wiring” safety into our culture.7 Ini- multiple comorbidities, and complex and potentially dangerous
tiatives such as checklists, rapid response teams, medication treatments. Oncology patients continually transition from in-
reconciliation, and hand-off procedures all contribute to im- patient to outpatient status. Multiple hand-offs for surgery,
proving patient safety outcomes.8 An example of a national procedures, radiation, and outpatient infusion create multiple
effort is the Agency for Healthcare Research and Quality pro- opportunities for miscommunication. Most oncology profes-
gram, “On the Cusp: Stop BSI Project,” which was able to show sionals would agree that this setting could also be appropriately
a 44% decrease in central line blood stream infections.8 Yet we categorized as a “dynamic domain.”11
continue to witness communication breakdowns that adversely In an attempt to reduce the number of communication-
affect patient outcomes. Most recently, the highly publicized based errors, health care has looked to other industries such as
Ebola outbreak brought to light a gap in communication when aviation for solutions. After air crashes, investigators frequently
a nurse asked all the right questions and documented the an- found communication errors between airline staff to be the root
swers in the EMR, yet a patient who should have been flagged as of the problem. Training and system changes implemented
potentially infected was allowed to leave the emergency room specifically to improve communication have significantly re-
before the Ebola risk was noted.9 Most nurses and physicians duced near misses and crashes.2 These changes involved intro-
would not be surprised by this event; electronic records are not duction of checklists and redundant safety technology, thereby
always supportive of interdisciplinary communication. reducing the possibility and influence of human error.13 With
As Weaver et al1 point out, the impact of poor interprofes- this knowledge, health care interventions to improve commu-
sional team communication on an oncology inpatient unit and nication among teams have included preoperative briefings,
the resulting quality outcomes are less understood. Although hand-off improvements such as SBARQ tools, check-off lists,
research in the specialty of inpatient oncology is still needed, and medication reconciliation procedures.4,8 The SBARQ tool
studies in a wide range of “dynamic domain” specialties such as has been shown to significantly improve satisfaction with nurse-
operating rooms, intensive care and trauma units, and emergency physician communication.14 The use of surgical checklists re-
departments have produced a body of literature that identifies sulted in reducing major surgical complications by 36% in the
some specific barriers to effective communication.4-6,10,11 Thomas preoperative setting.15 Medication errors were decreased by
References
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https://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/ 16. Agrawal A, Wu WY: Reducing medication errors and improving systems
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24 JOURNAL OF ONCOLOGY PRACTICE • V O L . 11, I S S U E 1 Copyright © 2015 by American Society of Clinical Oncology
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Copyright © 2017 American Society of Clinical Oncology. All rights reserved.
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Susan B. Childress
No relationship to disclose
JOURNAL OF ONCOLOGY PRACTICE • V O L . 11, I S S U E 1 Copyright © 2015 by American Society of Clinical Oncology
Downloaded from ascopubs.org by 120.188.65.118 on May 6, 2017 from 120.188.065.118
Copyright © 2017 American Society of Clinical Oncology. All rights reserved.