Poor Communication in Cancer Care

Patient Perspectives on What It Is and What to Do About It

Sally Thorne, PhD, RN, FAAN, FCAHS; John L. Oliffe, PhD, RN; Kelli I. Stajduhar, PhD, RN; Valerie Oglov, BSW, MA; Charmaine Kim-Sing, MD, FRCPC; T. Gregory Hislop, MDCM, MSc

Disclosures

Cancer Nurs. 2013;36(6):445-453. 

In This Article

Abstract and Introduction

Abstract

Background: Communication in cancer care is a recognized problem for patients. Research to date has provided limited relevant knowledge toward solving this problem.

Objective: Our research program aims to understand helpful and unhelpful communication from the patient perspective and to document changes in patient needs and priorities over time. In this analysis, we focus on patient perceptions of poor communication.

Methods: Using a qualitative longitudinal approach informed by interpretive description methodology, we are following a cohort of adult cancer patients across their cancer journey. We used constant comparative analysis of repeated interviews to examine thematic patterns in their perceptions and interpret both commonalities and diversities.

Results: Patient accounts reveal 3 types of poor communication. "Ordinary misses" are everyday missteps for which maturation and socialization may be an adequate solution. "Systemic misunderstandings" are assumptive gaps between patients and professionals, which may be addressed through qualitative research. "Repeat offenders" are a subset of clinicians whose communication patterns become a particular source of patient distress.

Conclusions: This typology offers a novel way to conceptualize the problem of poor communication in cancer care toward more effective solutions for the communication problem. Managing the communication of a problematic subset of clinicians will likely require strategic interventions at the level of organizational culture and models of care.

Implications for Practice: Nurses can play a meaningful role in detecting and buffering sources of poor communication in the practice context. Addressing poor communication may be a further reason to advocate for interprofessional team-based care models.

Introduction

Despite a generation of psychosocial care guidelines, sensitivity training approaches, and well-intended patient-centered mission statements, preventing and managing poor communication between cancer patients and their healthcare providers remain a high-priority concern. It is well documented that both excellent communication and poor communication influence quality of life for cancer patients and their clinical outcomes.[1] Most oncology clinicians are committed to facilitating sensitive and informed communication.[2] Effective communication is universally acknowledged as a core value within health professional training and care delivery systems.[3] However, far too many patients still suffer the adverse consequences of exposure to poor communication at some point in their cancer trajectory.[4,5]

Clinical communication can be defined as the dynamic, interpersonal process of mutual influence that occurs during the exchange of verbal and nonverbal messages between patients and healthcare providers.[6] In a seminal review, Ong and colleagues[7] signaled the scope of this influence. They noted 3 basic communicative functions in the cancer setting: creating effective interpersonal processes, exchanging information, and facilitating appropriate treatment-related decisions. A recent comprehensive narrative review further confirms the role of communication in regulating patients' emotions, enhancing their psychological adjustment, and improving their mental health.[8] Thus, effective (also termed good or helpful) communication during oncology consultations is well recognized as a highly relevant factor in both care quality and patient outcomes. Recent analyses of the available literature confirm links between ineffective (also termed poor, unhelpful, or problematic) communication in cancer care and a range of adverse outcomes associated with reduced patient quality of life, clinical decision making, and system effectiveness.[5,9] Well-documented untoward consequences include unmet emotional needs,[10] heightened uncertainty,[11] hopelessness,[12] impaired informed consent,[13] ineffective use of information services,[14] and generally poor care coordination.[1]

Across the spectrum of the cancer care communication literature, we can see an increasing awareness of the impact of everyday communication on the illness experience and quality of life of cancer patients[6] as well as recognition of the complexity and multidimensionality it entails.[8] Although a considerable body of empirical findings helps inform our approaches to communication in such highly sensitive contexts as the delivery of "bad news" and the transition from curative to palliative care,[15,16] the communication that takes place between cancer patients and the nurses, physicians, and allied health professionals with whom they interact in the course of their routine care is less well understood.[17] While psychosocial support is identified as essential to a high-quality cancer care service, it is often interpreted as access to the specialized services of psychologists, psychiatrists, or social workers by the subset of patients who have serious psychosocial distress, and not as a component of everyday care.[18,19] Because of this, much of the communication research emphasis in cancer care has arisen from the specialized psychosocial support domain, rather than the general oncology care context. However, patient-centered research consistently reveals that encounters with the clinicians who manage and deliver their routine care have a profound influence on patients' emotional well-being, decision making, and quality of life throughout the course of their cancer journey.[4,20] Clearly, cancer communication is a complex problem, and effective solutions will require multifaceted approaches.[4,21]

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