Towards better communication in cancer care: a framework for developing evidence-based interventions.

Increasing recognition of the complexity and difficulty of communication in patient care has led to a burgeoning but chaotic literature that tends to be incomplete on any one topic. A co-ordinated, planned approach is required to facilitate the rapid development and implementation of evidence-based interventions in this area. We propose a seven-stage model of communication research that is designed to provide clear directions to improve communication in cancer care. The stages are: (1) identification of communication difficulties; (2) documentation of patient and clinician views; (3) identification of practices associated with better outcomes; (4) the development of evidence-based guidelines and interventions; (5) testing the effectiveness of the intervention in changing current practice and improving patient outcomes; (6) dissemination of the effective interventions; and (7) broad adoption of the intervention. Examples are provided for each stage of research to elucidate the type of study proposed.