The validity of education and guidance for clinical communication in cancer care: Evidence-based practice will depend on practice-based evidence

Objective: The validity of clinical communication skills education and guidance for cancer care is sometimes portrayed as self-evident. This view needs re-examination in light of critiques of the concept of communication skills. Methods: We critically examine principles that steer communication teaching and guidance in cancer care and draw on research that can inform the next generation of development in this field. Results: Unlike other areas of clinical skills, communication is highly contested. Any instance of communication is open to multiple interpretations; expert principles of communication are imprecise and often contradictory. The concept of communication skills will constrain development, because of its implication that universal, expert-defined components of communication are the building blocks of clinical relationships. Research on communication in practice indicates insights that could enrich future education and guidance. Conclusions: Communication experts have more to learn from practitioners and patients than is commonly appreciated. Inductive, qualitative research should incorporate patient and practitioner perspectives as well as observations of communication. Practice implications: Solutions to communication dilemmas might be found in detailed study of communication in practice, rather than in current expert principles. Incorporating such evidence will help to ensure the continued authority of communication curricula and guidance as evidence-based and patient-centred. (C) 2012 Elsevier Ireland Ltd. All rights reserved.