Journal of Cancer Education

, Volume 34, Issue 1, pp 73–81 | Cite as

Assessing Communication Skills in Real Medical Encounters in Oncology: Development and Validation of the ComOn-Coaching Rating Scales

  • Marcelo Niglio de FigueiredoEmail author
  • Lorena Krippeit
  • Johanna Freund
  • Gabriele Ihorst
  • Andreas Joos
  • Juergen Bengel
  • Alexander Wuensch


One of the challenges in research on teaching physician-patient communication is how to assess communication, necessary for evaluating training, the learning process, and for feedback. Few instruments have been validated for real physician-patient consultations. Real consultations involve unique contexts, different persons, and topics, and are difficult to compare. The aim of this study is to develop and validate a rating scale for assessment of such consultations. For the evaluation study of a communication skills training for physicians in oncology, real consultations were recorded in three assessment points. Based on earlier work and on current studies, a new instrument was developed for assessment of these consultations. Two psychologists were trained in using the instrument and assessed 42 consultations. For inter-rater reliability, interclass correlation (ICC) was calculated. The final version of the rating scales consists of 13 items evaluated on a 5-point scale. The items are grouped in seven areas: “Start of conversation,” “assessment of the patient’s perspective,” “structure of conversation,” “emotional issues,” “end of conversation,” “general communication skills,” and “overall evaluation.” ICC coefficients for the domains ranged from .44 to .77. An overall coefficient of all items resulted in an ICC of .66. The ComOn-Coaching Rating Scales are a short, reliable, and applicable instrument for the assessment of real physician-patient consultations in oncology. If adapted, they could be used in other areas. They were developed for research and teaching purposes and meet the required methodological criteria. Rater training should be considered more deeply by further research.


Clinical competence Communication Communication assessment Data accuracy Medical oncology/education Physician-patient relations 



The ComOn-Coaching Project was made possible by the financial support of the German Cancer Aid. The article processing charge was funded by the German Research Foundation (DFG) and the University of Freiburg in the funding program Open Access Publishing. We thank Angela Vöhringer and Christopher Koppermann for the rating work and all physicians and patients for making this project possible.

Compliance with Ethical Standards

The study was fully approved by the ethics committees of the Medical Center – University of Freiburg, Freiburg, Germany, and of the University Hospital Klinikum rechts der Isar, Munich, Germany, and is registered under DRKS00004385 in the DRKS (German Clinical Trials Register). The corresponding author (Marcelo Niglio de Figueiredo) has full control of all primary data and agrees to allow the journal to review the data if requested.

Conflict of Interest

The authors have no conflict of interests to declare.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

13187_2017_1269_MOESM1_ESM.pdf (35 kb)
ESM 1 (PDF 35 kb)


  1. 1.
    Hack TF, Degner LF, Parker PA (2005) The communication goals and needs of cancer patients: a review. Psychooncology 14:831–845. doi: 10.1002/pon.949 CrossRefPubMedGoogle Scholar
  2. 2.
    Bensing JM, Deveugele M, Moretti F, Fletcher I, van Vliet L, Van Bogaert M, Rimondini M (2011) How to make the medical consultation more successful from a patient’s perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands. Patient Educ Couns 84:287–293. doi: 10.1016/j.pec.2011.06.008 CrossRefPubMedGoogle Scholar
  3. 3.
    Baile WF, Aaron J (2005) Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol 17:331–335CrossRefGoogle Scholar
  4. 4.
    Pham AK, Bauer MT, Balan S (2014) Closing the patient–oncologist communication gap: a review of historic and current efforts. J Cancer Educ 29:106–113. doi: 10.1007/s13187-013-0555-0 CrossRefPubMedGoogle Scholar
  5. 5.
    Epstein RM, Street RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. NIH Publication No. 07-6225. National Cancer Institute, Bethesda Online: Google Scholar
  6. 6.
    Lundberg KL (2014) What are internal medicine residents missing? A communication needs assessment of outpatient clinical encounters. Patient Educ Couns 96:376–380. doi: 10.1016/j.pec.2014.07.015 CrossRefPubMedGoogle Scholar
  7. 7.
    Thorne SE, Bultz BD, Baile WF (2005) Is there a cost to poor communication in cancer care? A critical review of the literature. Psychooncology 14:875–884 (discussion 885-886. doi: 10.1002/pon.947 CrossRefPubMedGoogle Scholar
  8. 8.
    Barth J, Lannen P (2011) Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol 22:1030–1040. doi: 10.1093/annonc/mdq441 CrossRefPubMedGoogle Scholar
  9. 9.
    Moore PM, Mercado SR, Artigues MG, Lawrie TA (2013) Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 3:CD003751. doi: 10.1002/14651858.CD003751.pub3 CrossRefGoogle Scholar
  10. 10.
    Goelz T, Wuensch A, Stubenrauch S, Ihorst G, de Figueiredo M, Bertz H, Wirsching M, Fritzsche K (2011) Specific training program improves oncologists’ palliative care communication skills in a randomized controlled trial. J Clin Oncol 29:3402–3407. doi: 10.1200/JCO.2010.31.6372 CrossRefPubMedGoogle Scholar
  11. 11.
    Wuensch A, Goelz T, Ihorst G, Terris DD, Bertz H, Juergen Bengel J, Wirsching M, Fritzsche K (2017) Effect of individualized communication skills training on physicians’ discussion of clinical trials in oncology: results from a randomized controlled trial. BMC Cancer 17:264. doi: 10.1186/s12885-017-3238-0 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cegala DJ, Broz SL (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ 36:1004–1016CrossRefGoogle Scholar
  13. 13.
    Stubenrauch S, Schneid E-M, Wünsch A, Helmes A, Bertz H, Fritzsche K, Wirsching M, Gölz T (2012) Development and evaluation of a checklist assessing communication skills of oncologists: the COM-ON-Checklist. J Eval Clin Pract 18:225–230. doi: 10.1111/j.1365-2753.2010.01556.x CrossRefPubMedGoogle Scholar
  14. 14.
    Baile WF, Buckmann R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5:302–311CrossRefGoogle Scholar
  15. 15.
    de Figueiredo N, Marcelo BR, Bylund CL, Goelz T, Heußner P, Sattel H, Fritzsche K, Wuensch A (2015) ComOn Coaching: study protocol of a randomized controlled trial to assess the effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training. BMC Cancer 15:503. doi: 10.1186/s12885-015-1454-z CrossRefGoogle Scholar
  16. 16.
    Langewitz W, Ackermann S, Heierle A, Hertwig R, Ghanim L, Bingisser R (2015) Improving patient recall of information: harnessing the power of structure. Patient Educ Couns 98:716–721. doi: 10.1016/j.pec.2015.02.003 CrossRefPubMedGoogle Scholar
  17. 17.
    Radziej, Katharina, Alexander Wuensch, Johanna Loechner, Cosima Engerer, Marcelo Niglio de Figueiredo, Johanna Freund, Heribert Sattel, Cadja Bachmann, Pascal O Berberat & Andreas Dinkel. In Review. How to assess communication skills? Development of the rating scale ComOn CheckGoogle Scholar
  18. 18.
    Landis JR, G. G. Koch GG. (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  19. 19.
    Wirtz M, Caspar F (2002) Beurteilungsübereinstimmungen und Beurteilerreliabilität. [Assessment Agreement and Rater Reliability] Hogrefe, GöttingenGoogle Scholar
  20. 20.
    Landers RN (2015) Computing intraclass correlations (ICC) as estimates of interrater reliability in SPSS. Winnower 2:e14351881744. doi: 10.15200/winn.143518.81744 CrossRefGoogle Scholar
  21. 21.
    Salmon P, Young B (2011) Creativity in clinical communication: from communication skills to skilled communication. Med Educ 45:217–226. doi: 10.1111/j.1365-2923.2010.03801.x CrossRefPubMedGoogle Scholar
  22. 22.
    Peterson EB, Calhoun AW, Rider EA (2014) The reliability of a modified Kalamazoo Consensus Statement Checklist for assessing the communication skills of multidisciplinary clinicians in the simulated environment. Patient Educ Couns 96:411–418. doi: 10.1016/j.pec.2014.07.013 CrossRefPubMedGoogle Scholar
  23. 23.
    Kroboth FJ, Hanusa BH, Parker S, Coulehan JL, Kapoor W, Brown FH, Karpf M, Levey GS (1992) The inter-rater reliability and internal consistency of a clinical evaluation exercise. J Gen Intern Med 7:174–179. doi: 10.1007/BF02598008 CrossRefPubMedGoogle Scholar
  24. 24.
    Feldman M, Lazzara EH, Vanderbilt AA, DiazGranados D (2012) Rater training to support high-stakes simulation-based assessments. J Contin Educ Heal Prof 32:279–286. doi: 10.1002/chp.21156 CrossRefGoogle Scholar
  25. 25.
    Eppich W, Nannicelli AP, Seivert NP, Sohn M-W, Rozenfeld R, Woods DM, Holl JL (2015) A rater training protocol to assess team performance. J Contin Educ Heal Prof 35:83–90. doi: 10.1002/chp.21270 CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  1. 1.Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg, Faculty of Medicine, University of FreiburgFreiburgGermany
  2. 2.Department of Dermatology and VenereologyMedical Center—University of Freiburg, Faculty of Medicine, University of FreiburgFreiburgGermany
  3. 3.Clinical Trials UnitMedical Center—University of Freiburg Faculty of Medicine, University of FreiburgFreiburgGermany
  4. 4.Rehabilitation Psychology and Psychotherapy, Department of PsychologyUniversity of FreiburgFreiburgGermany
  5. 5.Psychosomatic Medicine and Psychotherapy, Klinikum rechts der IsarTechnical University of MunichMunichGermany

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