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

State of the Science

At least 18 published systematic reviews exist on various aspects of cancer communication, attesting to the major effort that has been directed toward trying to understand this problem. Systematic reviews focusing on evidence for the effectiveness of various approaches to the communication of information to cancer patients have generally produced inconclusive results. Although they confirm that patients have information needs across the continuum of care,[22] they conclude that the diversity among patients in terms of their needs and preferences means that it is impossible to confirm that any one method of communicating information is necessarily guaranteed to be superior.[23] Attempts to compare specific approaches, such as audio- or video-taped recordings versus written information summaries,[24] or to confirm a relationship between information provision mechanisms and various psychosocial outcome measures[25] have also proven inconclusive.

Results are also inconclusive in relation to several other key components of the cancer communication challenge. Reviews of approaches to communicating prognostic information reveal little evidence as to the best method of approaching these communications or on the impact of this information on patient outcomes either in early-stage cancer[26] or in late-stage or end-of-life discussions.[27] However, it does seem clear that patients want information communicated to them and prefer that the context and extensiveness are negotiated with individuals who understand their needs. Although consensus exists around the need to balance hope with honesty during prognostic and end-of-life care discussions with patients, there seems little agreement among researchers as to how to accomplish this.[28] The potential benefit of decision aids to facilitate various aspects of communication in cancer care has also been a focus of systematic inquiry. To date, there is little evidence of their improving communication[23] or of their impact on patient outcomes such as anxiety.[29] Systematic reviews focusing on population subgroup differences in cancer communication have concluded that there are meaningful differences between, for example, Asian and white populations.[30,31] Although there seems little evidence to explain health professional–patient communication across differences, one review did conclude that characteristics in both professionals and patients play a role in communication and that certain clinical environments are better than others in being conducive toward communications that patients find effective.[31]

Much of the research documenting problems in cancer communication concludes with recommendations relating to health provider communication skills training. However, a significant body of systematic reviews has explored the evidence with regard to its effectiveness. Although we can conclude that longer, less didactic, and more interactive training methods do seem to produce better results,[32] improvements in communication skills are modest at best.[33] Results of this kind of research have been both inconsistent and inconclusive in relation to the effectiveness of communication training on patient outcome measures such as satisfaction or distress.[34]

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