Italy Panorama

Difficult Conversations

Dr. Silvia Tanzi
Palliative Physician
Research Institute in Oncology - IRCCS - Reggio Emilia

Dr. Silvia TanziTeaching communication skills in oncology is very difficult, first of all, for the dramatic topics of conversation such as treatment failure, prognosis, transition to palliative care, end-of-life decisions and so on. Looking to the literature, formal teaching of such communication skills for health care practitioners began in the 70's and 80's when survival from malignant diseases increased and ethical norms dictated that the patient be given truthful information and encouraged to participate in decision making. Despite this, evidence-based teaching methods have not yet caught on, especially in non-Anglo countries like Italy.

In teaching communication skills, case presentations are often used to illustrate key issues. Using a videotape as a technique to present a case scenario for teaching communication in palliative care and end-of-life care has some limitations compared with other techniques like role play. Videos can be a useful component inside a more complex intervention, more effective than lectures or didactic presentations.

In Italy, there is a lack of communication skills programs and information regarding how to effectively address difficult communications in oncology. Videos in Italian language showing what should be the best practice in communication are still lacking.

Videos can suggest some immediate techniques like empathic answers, wish statements, eye contact, exploring feelings and patients' emotions and so on. Giving some suggestions to professionals is particularly important especially in Southern European countries such as Italy where openness in discussing bad news is not common and the paternalistic approach of protecting the patient is very strong. Some available data suggest that the climate is changing toward providing some essential medical information to patients and families, but unpleasant communication like disclosure of diagnosis and prognosis is often concealed.


Silvia Tanzi is a palliative physician at the Research Institute IRCCS in Reggio Emilia (Italy). She has worked in a home care program with oncologic patients and is currently working in hospice and in a palliative care unit at Reggio Emilia Hospital with oncologic and hematologic patients.

Dr. Tanzi participated in a 6-month visiting faculty program at the Palliative Care and Rehabilitation Medicine Department at The University of Texas MD Anderson Cancer Center working with Eduardo Bruera, M.D and his team where she was involved in research and designed educational programs. She wrote her Master's degree course thesis in palliative care for the Academy of Palliative Medicine and Sciences, University of Bologna discussing communication in oncology and teaching communication skills in collaboration with Walter F. Baile, M.D and the Interpersonal Communication And Relationship Enhancement (I*CARE) program of the Department of Faculty & Academic Career Enhancement (FACE), Academic Affairs. She is also involved in teaching communication in oncology to fellows, nurses and practitioners in Italy.


Difficult Conversations videos

Education in disclosing bad news is a core competency. Giving patients accurate information about diagnosis, prognosis and treatments helps them make decisions about their own care and is mandated by state and national laws and ethical obligations. However, due to cultural issues and educational gaps, doctors in some countries struggle significantly with one or more of these talks. In these videos made for Italian clinicians, Dr. Silvia Tanzi illustrates "best practices" of disclosing unfavorable medical information.

In the first video she demonstrates how to help a patient struggling with decisions about cancer treatments. The second video illustrates a situation where a family member does not want his mother to know she has cancer and in the third Dr. Tanzi demonstrates how to discuss transition to palliative care.

Video introduction by Dr. Tanzi

     English Transcript (pdf)  ||  View full-size video (opens in new window)


Scene 1 How Much Time Have I Got

     English Transcript (pdf)  ||  View full-size video  ||  Analysis (opens in new window)


Scene 2 Don’t Tell Mama

     English Transcript (pdf)  ||  View full-size video  ||  Analysis (opens in new window)


Scene 3 Transition to Palliative Care

     English Transcript (pdf)  ||  View full-size video  ||  Analysis (opens in new window)


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