Patient perceptions of helpful communication in the context of advanced cancer (original) (raw)
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Journal of Clinical Nursing, 2009
Aims and objectives. Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers?Background. Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices.Design. Secondary analysis of qualitative interview data.Methods. Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis.Results. Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase – respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information.Conclusions. Communication is an important element in the provision of advanced cancer care.Relevance to clinical practice. Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication.
Cancer care communication: The power to harm and the power to heal?
Patient Education and Counseling, 2008
Objective: This study was designed to examine the belief held by many cancer patients that communication with their care providers has a meaningful part to play in shaping their disease outcomes. Methods: From a large qualitative interview data set in which cancer patients described their perceptions of helpful and unhelpful heath care communication; we extracted the accounts of 69 patients and 13 focus group participants who specifically articulated a perceived relationship between communication and cancer outcomes. Through secondary analysis of that subset, we generated an interpretive description of patterns and themes within their accounts of a relationship between communication and cancer survivorship. Results: Our findings document patient perceptions of the mechanisms involved in indirect and, some instances, direct relationships between communication encounters and cancer outcomes. Conclusion: Some cancer patients believe that, by virtue of its influence upon comfort, inclusion, clarity and hope, communication can influence cancer outcomes. Practice implications: While competing discourses exist within the patient population with regard to such associations, the perception that communication may influence clinical outcomes seems sufficiently pervasive and persistent that it warrants serious attention within care systems and by the psychosocial cancer research community.
The communication goals and needs of cancer patients: a review
Psycho-Oncology, 2005
The aim of this review paper is to critique the empirical literature pertaining to the communication needs and goals of cancer patients, and to provide direction for research in this area. According to the conceptual framework of Feldman-Stewart et al., patient-physician communication occurs for the fundamental purpose of addressing each participant's goal(s). This review is divided into two categories of goals: (a) optimal medical management of the cancer, and (b) optimal attention to the patient's psychosocial response to cancer. Optimal medical management includes discussions about disease status and the treatment plan, and the effectiveness of these discussions is frequently determined by assessing patient understanding, satisfaction, and well-being. The literature suggests that cancer patients continue to have unmet communication needs, and communication outcomes are enhanced when physicians attend to the emotional needs of patients. Research gaps in communication research are highlighted, including the need for additional study of several external factors affecting the patient and provider.
Journal of Cancer Survivorship, 2012
Introduction Although high quality professional-patient communication is recognized as fundamental to effective cancer care, less attention has been paid to developing an evidence basis for communications surrounding the stage of the cancer journey when primary cancer treatment concludes, management responsibilities shift from oncology specialist services into the generalist care domain, and the patient transitions beyond patienthood and into survivorship. Methods Using applied qualitative methodology, we analyzed a database of multiple interviews with 14 Canadian cancer patients from a larger study of changing communication needs and preferences across the cancer trajectory. Through constant comparative analysis, we generated a thematic summary of interpretive understandings from the patient perspective of communication patterns across the transition from active treatment to survivorship. Results The accounts illuminate the complexities of the communication environment in which the transition to survivorship occurs. Communication gaps and misinterpretations by clinicians contributed to the confusion, insecurity, vulnerability, loss, and abandonment associated with this transition when they failed to accurately and sensitively respond to individual conditions. Discussion/conclusions Despite increasing recognition of the importance of this transition, communication gaps occur in relation to attending to cues, giving prior warning, avoiding avoidance, sensitivity to context, managing relationships, surfacing anxieties, and clarifying roles and responsibilities. These findings expand upon previous reports to explain mechanisms whereby interactions between clinicians and patients may significantly shape the transitional experience and set the stage for survivorship. Implications for cancer survivors From the perspective of cancer survivors, the transition beyond initial treatment warrants well-informed anticipatory and supportive healthcare communications.
New Challenges in Communication with Cancer Patients
2013
Direct observation shows how traditional narrow biomedical conceptions of truth in medicine, coupled with increasing technological sophistication and the consequent fragmentation of care practiced under major economic constraints, run parallel to a loss of humanism and of satisfaction for both partners in the patientdoctor relationship. A new conceptualization of truth in medicine, and of communication about it, is needed to restore the integrity of clinical practice, medical education, training, and health care policy. Multiple truths are at stake in clinical medicine, different and yet interrelated. These truths are shared by both partners within the patient-doctor relationship, rather than being simply discovered or imposed by health professionals. A nuanced understanding of the truths at stake in clinical medicine as essentially relational, dynamic, provisional, and situated gives raise to a paradigm shift from truth telling to truth making. This can not only improve communication between patients and their oncologists, but also affect perceptions, attitudes, and practices of education and training, as well as public perceptions of emerging aspects of cancer care and policy making with regard to minority cancer patients and survivors, elderly cancer patients, or mutation carriers.
Communication about cancer near the end of life
Cancer, 2008
Cancer communication near the end of life has a growing evidence base, and requires clinicians to draw on a distinct set of communication skills. Patients with advanced and incurable cancers are dealing with the emotional impact of a life-limiting illness, treatment decisions that are complex and frequently involve consideration of clinical trials, and the challenges of sustaining hope while also having realistic goals. In this review, the authors sought to provide a guide to important evidence about communication for patients with advanced cancer regarding communication at diagnosis, discussing prognosis, decision making about palliative anticancer therapy and phase 1 trials, advance care planning, transitions in focus from anticancer to palliative care, and preparing patients and families for dying and death. Cancer 2008;113(7 suppl):1897-910.
Nurses’ Perceptions of Prognosis-Related Communication
Asian Pacific Journal of Cancer Prevention
Effective communication is an important aspect of quality in providing health care. high quality communications optimize the patient-physician relationship and improve patient care, family, and physician's welfare. In the context of a serious illness, communication about values are very important to ensure that patient care is in accordance with the patients and families' wishes (Sanders et al., 2017). Furthermore, an appropriate treatment has been associated with improved quality of life and dying (Curtis et al., 2018). Health care provider has the responsibility for educating cancer patients and their parents on the cancer diagnosis and treatment. One of the most important conversations for oncologists and patients with cancer is prognostic disclosure. Discussion about prognosis is very important in helping older people with treatment-related decisions and overcoming their disease (Nyborn et al., 2016; Kästel et al., 2011; Mack et al., 2006). Disclosure of patient disease progress and prognosis is considered as one of the responsibilities of doctors, however, nurses are also involved in such discussions. Parents of critically ill children and cancer patients recourse to nurses to improve their understanding of the prognosis and to seek support and guidance (Madrigal et al., 2016; Sisk et al., 2017).
Patient-centered communication in cancer care: Promoting healing and reducing suffering
PsycEXTRA Dataset, 2007
While patient-centered care and the reduction of suffering due to cancer are primary goals of the NCI, improvement in the delivery of patient-centered communication has been identified as a key NCI research priority. As research on patient-centered communication evolves, the potential contributions of programs such as the National Cancer Institute's (NCI) Cancer Information Service (CIS) cannot be overlooked. The purpose of this paper is to describe how the six core functions of patient-clinician communication described in the literature (fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions and enabling patient-self management) are embedded in the work of the CIS. The communication process used by the CIS to extend the patient-centered communication role of the clinician will be discussed. CIS training and quality management systems will be described. Lastly, suggestions for the role of CIS in future health information delivery and research will be explored.