Surviving the stresses of clinical oncology by improving communication.

Oncologists grapple with an element of psychological stress that relates to the suffering their patients experience. Although this stress may not be unique to oncology, it is profound. When these stresses become overwhelming, they lead to physician burnout. It is important to understand what makes an oncologist feel successful, what coping strategies help combat burnout, and what adds to the process of renewal. The doctor-patient relationship plays an important role for many oncologists in this regard, and communication skills are increasingly recognized for their importance in this arena. We outline several clinical scenarios that pose particular challenges to oncologists. These include breaking bad news and the patient's response to hearing bad news, transitions in care and offering end-of-life care, participation in investigational studies, error disclosure, complementary and alternative medicine, spirituality, family discussions, and cross-cultural issues. By highlighting the relevant psychosocial issues, we offer insight into, and tools for, an enriched dialogue between patient and oncologist. The doctor-patient relationship can be viewed as the ultimate buffer for dealing with the hassles encountered in clinical oncology.