Interest in social support as an important determinant of people’s health stemmed from a number of influential papers published in the 1970s (e.g., Cobb 1976). These early writings suggested that people’s interpersonal relationships with members of their social network can reduce the negative impact of stress on their health. The specific mechanisms by which these relationships buffer the impact of stress were collectively termed “social support” (Wortman 1984).
Four types of supportive behaviors have been commonly described as dimensions of social support (House 1981): Emotional support involves demonstration of empathy, reassurance, love, and caring. Informational support involves provision of information that individuals may find helpful in dealing with stressful situations; this typically refers to information that is useful for problem-solving. Appraisal support refers to provision of information that is more relevant for self-appraisal, including provision of constructive feedback and affirmation about the appropriateness of beliefs or acts of another individual facing a stressful situation. Instrumental support involves provision of tangible goods and services to aid individuals in need. While a majority of the literature focuses on behaviors such as helping with daily chores or assisting with transportation, instrumental support can also include assistance with problem-solving tasks such as making important decisions.
Social support is likely to have a positive impact on people’s health in a variety of situations; however, it takes on even greater significance when the stressor is a life-threatening illness such as cancer. A diagnosis of cancer often results in significant emotional trauma to the individual. Feelings of loss of control over and uncertainty about one’s future are common. Individuals in such situations have to often deal with complex medical information and make difficult treatment decisions that might have long-term implications for their quality of life (QOL). Supportive social relationships have been shown to minimize the negative impact of cancer and its treatment on patients’ QOL.
While family and friends have the potential to provide support in most stressful situations, the supportive role of formal social network members such as health-care professionals becomes important within the context of an illness like cancer. Several studies show that patients rely on clinicians for informational, decision-making, appraisal, and even emotional support at various stages of their cancer journey (Arora 2003). Thus, the clinician–patient interaction becomes a key vehicle for social support in such situations.
The field of clinician–patient communication has a rich history of more than four decades of empirical research. Studies have ranged from micro-level assessments, focusing on the actual dialogue between clinicians and patients during a single visit, to more macro-level assessments of the patient’s perception of clinicians’ communication behavior over a defined period of time. Several studies have shown significant associations between clinician–patient communication and patient outcomes including patient satisfaction, adherence to recommendations, and QOL (Arora 2003). Unfortunately, empirical work in clinician–patient communication has often been criticized as largely exploratory in nature and lacking conceptual clarity.
Conceptualizing clinician–patient communication in terms of provision of social support is likely to provide much-needed conceptual refinement to the field. Perhaps in recognition of the supportive function of communication, the term “clinician–patient communication” is evolving into “patient-centered communication” (PCC), i.e., communication that is aimed at supporting patient needs as well as possible. Epstein and Street (2007) recently conceptualized PCC as including six key functions: fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. While this was perhaps not intended by the authors, these functions significantly overlap with the four-dimension framework of social support: fostering healing relationships and responding to emotions parallel emotional support; exchanging information parallels informational support; managing uncertainty requires appraisal support; making decisions is a component of instrumental support; and enabling patient self-management requires both appraisal and instrumental support.
The social support framework and the related conceptualization by Epstein and Street (2007) thus provide an important conceptual model for future communication research. However, to maximize the impact of future studies on health-care delivery, researchers may need to follow the following recommendations. First, rigorous efforts should be made to develop psychometrically sound measures of the six functions of PCC. Second, instead of the typical cross-sectional approach to studying communication, researchers should employ longitudinal study designs that would facilitate the monitoring of PCC over time. Third, researchers should study the interactions between the health-care delivery team or teams and the patient and family team, instead of the dyad of a single doctor and a patient. Fourth, researchers should explore how advances in information technology may be leveraged to develop data-collection systems to efficiently collect PCC data in busy health-care delivery settings. Specifically, the way that realtime data-collection methods and electronic medical record and patient health record systems might be utilized to collect PCC data should be explored. Fifth, to truly understand and demonstrate the salience of PCC, researchers need to empirically identify specific mechanisms (mediators) by which PCC impacts patient health outcomes, as well as to identify factors that might facilitate or undermine (moderators) the association between PCC and patient outcomes. Finally, future studies will need to evaluate the advantages and disadvantages of provision of support to patients by clinicians in face-toface settings versus more mediated communication channels such as email.
Supportive clinician–patient interactions are vital to the delivery of patient-centered care, a key indicator of heath-care quality. However, as suggested, to make the delivery of patient-centered communication a reality in routine health-care, a new approach to research will be needed.
- Arora, N. K. (2003). Interacting with cancer patients: The significance of physicians’ communication behavior. Social Science and Medicine, 57, 791–806.
- Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38, 300–314.
- Epstein, R. M., & Street, R. L., Jr. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute.
- House, J. S. (1981). Work, stress and social support. Reading, MA: Addison Wesley.
- Wortman, C. B. (1984). Social support and the cancer patient. Cancer, 53(Suppl. 10), 2339–2360.