SDSU Professor Wayne Beach believes in the restorative power of communication among cancer patients, their doctors, families and friends.

The cancer journey often begins with a single devastating phone call. The calls rapidly multiply, not unlike cancer cells, into dozens of conversations between patients, doctors, family and friends.

Inevitably, communication about cancer is charged with fear and uncertainty. Yet, communication can transform the difficult battle against cancer into a meaningful experience for cancer patients and those who make the journey with them - all of whom are cancer survivors.

Consider the story of San Diego State Communication Professor Wayne Beach. His mother was diagnosed with lung cancer in 1998.

Wayne Beach, SDSU communication professor

"Once I was in that situation, I realized that the phone calls and communication with family were central to understanding and navigating through the cancer," said Beach, a conversation analyst.

His mother passed away four short months after being diagnosed. Fresh off the emotional roller coaster, Beach began working on a series of audio recordings he had received from a former graduate student whose mother had succumbed to cancer 10 years earlier.

Those cassettes captured 61 phone calls between the son and his family over the 13-month course of her illness.

In the first call, the father informed his son that biopsies revealed a malignant tumor in his mother. The final call occurred just hours prior to her death, as the son updated a long-distance friend of his mother's impending demise.

Beach recognized the value of these tapes - the first recorded history in the social and medical sciences of a family talking through cancer diagnosis, treatment and prognosis. Initially funded by a grant from the American Cancer Society, Beach's detailed analysis of the 61 taped phone calls is to be published this summer in a lengthy volume entitled "A Natural History of Family Cancer: Interactional Resources for Managing Illness" (Hampton Press Inc.).

Getting doctors to listen

Cancer remains the second most common cause of death in this country, exceeded only by heart disease. The American Cancer Society predicts that nearly 560,000 Americans will die of cancer this year. In San Diego alone, 200 to 300 people are diagnosed weekly.

Not surprising, then, that Beach's work has been extended beyond family phone calls to clinical encounters. His research has been recognized by the National Institutes of Health (NIH). In a new twist on cancer research, Beach is the first investigator funded by the NIH to examine the details of interactions between cancer patients and their physicians.

As principal investigator, Beach collaborates with researchers and doctors at the Moores Cancer Center at the University of California, San Diego (UCSD). The project involves video recording interactions between new cancer patients and their oncologists to discover how patients display uncertainties, fears and hopes, and how doctors respond to patients' concerns.

In his book, Beach analyzes a family talking
through cancer diagnosis, treatment
and prognosis.

Eventually, these basic research findings can be used to design innovative educational opportunities - anchored in digitized video clips and transcriptions of "delicate" moments - for refining the communication skills of patients and their providers.

Dr. David Easter, a surgical oncologist who teaches surgeons during internship and residency, said the skill of learning to communicate with patients isn't explicitly addressed during medical training.

"I try to get my residents to keep from looking at the chart first," Dr. Easter said. "These are people, not paper. Doctors get attached to what a chart says; it keeps them from really hearing what the patient is saying."

Preliminary research by Beach and co-investigator Wayne Bardwell (UCSD) has turned up several insights into doctor-patient interaction based on the central tenets of conversation analysis.

"Gaze, gestures, touch, body position - we see things on the video that the doctors often miss," Beach said. "When we look back at the tapes, we can point them out and make suggestions as to how to improve responses."

Cycle of despair and hope

Though each cancer diagnosis is different, patients seem to have similar ways of talking through the experience.

"It's amazing because the chaos a family goes through, despite how caught up they get in it, seems to be ordered and structured," Beach said. "Bad news is countered with good news; difficult times are balanced with hope and optimism."

That cycle of despair and hope plays out in the 61 telephone calls Beach analyzed, and is at the core of "A Natural History of Family Cancer."

But Beach wanted the emotional power and life affirmation of the taped exchanges to reach a larger audience.

He and Lanie Lockwood, a communication lecturer, produced a theatrical script with language from the naturally occurring conversations between family members. They involved SDSU theatre instructor and playwright, Patricia Loughrey.

Loughrey penned "Blue Ducks: Conversations about Cancer," a full-length script written from the dialogue in those 61 phone calls. It was presented as a staged reading on the SDSU campus in March 2006. A second Loughrey script, "listen," incorporating audience response from the "Blue Ducks" reading, was staged at SDSU's Experimental Theatre last fall.

Beach is now working with theatre professionals in San Diego to produce a new script based on actual recorded conversations and transcriptions between family members experiencing cancer of a loved one.

He also continues to refine undergraduate and graduate curricula examining how patients, family members and health professionals communicate about cancer.

In this way - through research, books, lectures, plays and readings - the dialogue continues. Each new diagnosis will bring another family and network of health professionals into the conversation about cancer. Wayne Beach wants them to know that they are not alone.

Related information

• SDSU School of Communication
• Wayne Beach home page
• American Cancer Society
• SDSU Theater: "listen"

Credits

• Story by Gina Speciale
• Graphics by Lori Padelford
• Edited by Coleen Geraghty