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Thorne S. Communication in cancer care: An ongoing knowledge translation challenge. Asia Pac J Oncol Nurs 2024; 11:100489. [PMID: 38800492 PMCID: PMC11127213 DOI: 10.1016/j.apjon.2024.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Keij SM, Stiggelbout AM, Pieterse AH. Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready SDM. Health Expect 2024; 27:e13995. [PMID: 38400633 PMCID: PMC10891436 DOI: 10.1111/hex.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. METHODS We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM ) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision-making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. RESULTS A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self-awareness; (5) consideration skills; (6) self-efficacy; (7) emotional distress; and (8) experienced time. We developed the 20-item ReadySDM to retrospectively measure these elements in an oncological setting. CONCLUSION We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM . The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. PATIENT OR PUBLIC CONTRIBUTION Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.
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Affiliation(s)
- Sascha M. Keij
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. PATIENT EDUCATION AND COUNSELING 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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Moskalewicz M, Kordel P, Wiertlewska-Bielarz J. Chemotherapy, clocks, and the awareness of death: A quantitative phenomenological study. Front Psychol 2023; 14:1097928. [PMID: 36998375 PMCID: PMC10043210 DOI: 10.3389/fpsyg.2023.1097928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Following a previous phenomenological study of lived time in ovarian cancer, this research aims to find how the frequency of chemotherapy affects orientation in time (the so-called “chemo-clock”) and the awareness of mortality of service users with various cancers. For this purpose, a variation of a front-loaded phenomenological method that combines scientific hypothesis testing with phenomenological insights of both conceptual and qualitative nature was developed. The study is based on a purposive quota sample of 440 participants representative of the Polish cancer population in terms of sex (m:f ratio 1:1) and age (m > 65 = 61%; f > 65 = 53%) and undergoing chemotherapy for at least a month. The exposure environmental factors of interest are temporal: the frequency of chemotherapy [weekly (N = 150), biweekly (N = 146), and triweekly (N = 144)] and time since the beginning of treatment. The study confirms the relevance of the “chemo-clock”—participants use the pace of hospital appointments for orientation in time, and significantly more often when in triweekly treatments (weekly 38%; biweekly 61%; triweekly 69.4%; V = 0.242, p < 0.001, while neither age nor time since the beginning of treatment differentiate the usage of calendar categories and the “chemo-clock”). Simultaneously, chemotherapy increases their awareness of finitude, which again correlates neither with age nor time since the beginning of treatment but is significantly stronger in those with lower chemotherapy frequencies. Lower treatment frequencies are thus associated with its increased significance in terms of its impact on how people with cancer measure time and whether they increasingly consider their mortality.
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Affiliation(s)
- Marcin Moskalewicz
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, University of Heidelberg, Heidelberg, Germany
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
- Institute of Philosophy, Marie Curie-Sklodowska University, Lublin, Poland
- *Correspondence: Marcin Moskalewicz,
| | - Piotr Kordel
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
| | - Jadwiga Wiertlewska-Bielarz
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
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Bayadinova JA, Sardo LA, Penton L, Jenkins S. 'Spot the CLOT': Awareness of cancer-associated thrombosis in healthcare providers. Can Oncol Nurs J 2022; 32:325-330. [PMID: 35582246 PMCID: PMC9040792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Julia A Bayadinova
- Nurse Practitioner, Thrombosis Program, St. Joseph's Healthcare, 50 Charlton Ave. E., Rm G727, Hamilton, ON L8N 4A6, 905-522-1155 ext. 33755; ;
| | - Laurie A Sardo
- Nurse Practitioner, Thrombosis Program, St. Joseph's Healthcare, 50 Charlton Ave. E., Rm G727, Hamilton, ON L8N 4A6; McMaster University School of Nursing, 905-522-1155 ext. 33754; ;
| | - Lynne Penton
- Adult Oncology, Humber River Hospital, Clinical Co-Lead Palliative Care Central LHIN, 416-242-1000 ext. 21521; Mobile: 416-575-4504; ;
| | - Susan Jenkins
- Adult Nurse Practitioner, Thrombosis and Hemostasis Program, University Health Network. 200 Elizabeth St, 7N -705, Toronto, ON M5G 2C4 905-751-7059; ;
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Bayadinova JA, Sardo LA, Penton L, Jenkins S. Série « Prévenir la thrombose »: Sensibiliser les professionnels de la santé à la thrombose liée au cancer. Can Oncol Nurs J 2022; 32:331-336. [PMID: 35582263 PMCID: PMC9040777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Julia A Bayadinova
- doctorante en sciences infirmières Infirmière praticienne, programme sur la thrombose, St. Joseph's Healthcare, 50 Charlton Avenue E., bureau G727, Hamilton (Ontario) L8N 4A6. Téléphone: 905-522-1155, poste 33755; téléc.: 905-521-6105. Courriel:
| | - Laurie A Sardo
- doctorante en sciences infirmières Infirmière praticienne, programme sur la thrombose, St. Joseph's Healthcare, 50 Charlton Avenue E., bureau G727, Hamilton (Ontario) L8N 4A6. Téléphone (École de sciences infirmières, Université McMaster): 905-522-1155, poste 33754; téléc.: 905-521-6105. Courriel:
| | - Lynne Penton
- Oncologie adulte, Humber River Hospital, Clinical Co-Lead Palliative Care Central LHIN. Téléphone: 416-242-1000, poste 21521; cellulaire: 416-575-4504; téléc.: 416-242-1068. Courriel:
| | - Susan Jenkins
- Infirmière praticienne (soins aux adultes), programme sur la thrombose et l'hémostase, Réseau universitaire de santé. 200 Elizabeth Street, 7N -705, Toronto (Ontario), M5G 2C4. Téléphone: 905-751-7059; téléc.: 416-340-5682. Courriel:
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Structuring times and activities in the oncology visit. Soc Sci Med 2019; 228:211-222. [DOI: 10.1016/j.socscimed.2019.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022]
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Chan EA, Wong F, Cheung MY, Lam W. Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. PLoS One 2018; 13:e0199183. [PMID: 29912967 PMCID: PMC6005521 DOI: 10.1371/journal.pone.0199183] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/01/2018] [Indexed: 11/19/2022] Open
Abstract
Background The nursing shortage and its impact on patient care are well-documented global issues. Patients living with cancer as a chronic illness have many psychosocial problems and often lack adequate support as a result of ineffective nurse-patient communication. A review of the literature on factors influencing the delivery of psychosocial care to cancer patients indicates that the delivery of psychosocial care in routine cancer nursing within a biomedical healthcare system has not been widely explored. Objective To explore patients’ perceptions of their experiences with nurse-patient communication in an oncological clinical environment. Method A focused ethnographic study was undertaken in two oncology wards of a hospital in Hong Kong. Data were collected through observations of the ward environment, the activities and instances of nurse-patient communication, semi-structured interviews with patients, and a review of nursing documents. Results Two main themes were identified: 1. Nurses’ workload and the environment and 2. Nurse-patient partnership and role expectations. Within these two themes were related subthemes on: Sympathy for the busy nurses; Prioritizing calls to the nurses; Partnership through relationship; Nurses’ role in psychosocial care; and Reduction of psychosocial concerns through physical care. Conclusions Many cancer patients do not expect to receive psychosocial care in the form of emotional talks or counseling from busy nurses, but appreciate the attention paid by nurses to their physiological and physical needs. Nurse-patient partnerships in cancer care may reduce the potential workload of nurses. The psychosocial needs of cancer patients could be optimized by providing good physical care through effective communication within a time-constrained oncology setting.
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Affiliation(s)
- Engle Angela Chan
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
- * E-mail: (EA)
| | - Fiona Wong
- School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Man Yin Cheung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Winsome Lam
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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Carolan C, Smith A, Davies G, Forbat L. Seeking, accepting and declining help for emotional distress in cancer: A systematic review and thematic synthesis of qualitative evidence. Eur J Cancer Care (Engl) 2017; 27:e12720. [DOI: 10.1111/ecc.12720] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.M. Carolan
- Faculty of Health Sciences and Sport; University of Stirling (Western Isles Campus); Stornoway UK
- NHS Western Isles; Stornoway UK
| | - A. Smith
- Faculty of Health Sciences and Sport; University of Stirling (Western Isles Campus); Stornoway UK
| | - G.R. Davies
- PGT Tertiary & Higher Education; Faculty of Arts, Humanities and Business; Lews Castle College UHI; Stornoway UK
| | - L. Forbat
- Palliative Care; Australian Catholic University and Calvary Health Care; Australian Catholic University; Canberra ACT Australia
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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Hagan T, Rosenzweig M, Zorn K, van Londen J, Donovan H. Perspectives on Self-Advocacy: Comparing Perceived Uses, Benefits, and Drawbacks Among Survivors and Providers. Oncol Nurs Forum 2017; 44:52-59. [PMID: 28060470 DOI: 10.1188/17.onf.52-59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose/Objectives To describe and compare survivors' and providers' views of the uses of and perceived benefits and drawbacks of survivor self-advocacy. Design A cross-sectional, two-group, mixed-methods survey. Setting Survivors were recruited from local and national registries and advocacy organizations. Providers were recruited from the University of Pittsburgh Medical Center Cancer Center and a regional Oncology Nursing Society chapter. Sample 122 female cancer survivors and 39 providers involved in their direct care. Methods Quantitative survey data were summarized using descriptive statistics, including means and frequencies. Qualitative survey data were collected and analyzed using content analysis techniques, and main themes were counted and summarized. Main Research Variables Perceptions of the uses, benefits, and drawbacks of female cancer survivor self-advocacy. Findings Survivors and providers perceived similar but distinct uses of self-advocacy. Survivors and providers generally agreed on the potential benefits of self-advocacy but had different views of the potential drawbacks. Survivors were most concerned with finding and making sense of information, that their questions would not be answered, and having a worse relationship with their provider; providers were concerned with increases in clinic time and difficulties developing treatment plans. Conclusions Although survivors and providers recognized similar benefits to survivor self-advocacy, they had different views of the uses and drawbacks of female cancer survivor self-advocacy. Implications for Nursing Attempts to increase self-advocacy among female cancer survivors must address survivors’ and providers’ views and apprehensions about self-advocacy.
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Shim EJ, Park JE, Yi M, Jung D, Lee KM, Hahm BJ. Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients. BMC WOMENS HEALTH 2016; 16:65. [PMID: 27756287 PMCID: PMC5069888 DOI: 10.1186/s12905-016-0347-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/11/2016] [Indexed: 12/04/2022]
Abstract
Background Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. Methods In-depth interviews with seven breast cancer patients were carried out. Results Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as ‘a disease of the mind’, which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. Conclusion Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0347-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Korea
| | - Jee Eun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Myungsun Yi
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Dooyoung Jung
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kwang-Min Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Integrated Cancer Care Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Högberg KM, Stockelberg D, Sandman L, Broström A, Nyström M. The meaning of web-based communication for support: from the patients' perspective within a hematological healthcare setting. Cancer Nurs 2016; 38:145-54. [PMID: 24831039 DOI: 10.1097/ncc.0000000000000145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Being critically ill with a hematological disease is a challenge, sometimes causing a need for support in the adjustment to the stressful life situation. By providing Web-based communication for support from a nurse, patients get access to an alternative and untraditional way to communicate their issues. OBJECTIVE The aim was to describe the meaning of using Web-based communication for support from a patient perspective. METHODS A comprehensive randomized pilot study (n = 30) was conducted, allowing 15 patients in the experimental group to have access to the Web-based communication, to evaluate feasibility. Of these 15 participants, 10 were interviewed, focusing on their experiences. An empirical hermeneutical approach was used and the interpretive analysis focused on the meanings. RESULTS Web-based communication for support means a space for patients to have their say, consolidation of a matter, an extended caring relationship, access to individual medical assessment, and an opportunity for emotional processing. The main interpretation indicates that the patient's influence on the communication strengthens according to the asynchronous, faceless, and written communication. The increased, and in some sense constant, access to an individual medical and caring assessment, in turn, implies a feeling of safety. CONCLUSION Web-based communication for support seems to have the potential to enhance patients' participation on their own terms. IMPLICATIONS FOR PRACTICE To achieve the possible advantages of Web-based communication for support, nurses must acquire knowledge about caring writing. It requires respect for the patient and articulated accuracy and attention in the response given.
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Affiliation(s)
- Karin M Högberg
- Author Affiliations: School of Health Sciences, Jönköping University (Drs Högberg and Broström); School of Health Sciences, University of Borås (Ms Högberg, and Drs Sandman and Nyström); Section for Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr Stockelberg)
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Reimer-Kirkham S, Sawatzky R, Roberts D, Cochrane M, Stajduhar K. ‘Close to’ a palliative approach: nurses' and care aides' descriptions of caring for people with advancing chronic life-limiting conditions. J Clin Nurs 2016; 25:2189-99. [DOI: 10.1111/jocn.13256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Richard Sawatzky
- School of Nursing; Trinity Western University; Langley BC Canada
| | | | | | - Kelli Stajduhar
- School of Nursing and Centre on Aging; University of Victoria; Victoria BC Canada
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Bundgaard K, Sørensen EE, Delmar C. TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay. Open Nurs J 2016; 10:15-25. [PMID: 27347251 PMCID: PMC4894942 DOI: 10.2174/1874434601610010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/02/2015] [Accepted: 06/15/2015] [Indexed: 11/22/2022] Open
Abstract
Aim: This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time. Background: Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses’ increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time. Design: Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010. Methods: Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews. Results/Findings: The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: ‘Time - making the best of it’, and the sub categories “Responsibility of time”, “Information and preparation”, and “Time wasters”. Conclusion: The study underlines the possibility of combining the health care systems, patients and the nurses’ perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient’s needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible.
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Affiliation(s)
| | - Erik E Sørensen
- Aalborg Hospital Science and Innovation Center (AHSIC), Aalborg University Hospital, Denmark
| | - Charlotte Delmar
- Department of Nursing Science, School of Public Health & Institute of Clinical Medicine Health, Aarhus, Denmark
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Manzano A, Ziegler L, Bennett M. Exploring interference from analgesia in patients with cancer pain: a longitudinal qualitative study. J Clin Nurs 2013; 23:1877-88. [DOI: 10.1111/jocn.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Manzano
- School of Healthcare; University of Leeds; Leeds UK
| | - Lucy Ziegler
- Leeds Institute of Health Sciences; University of Leeds; Leeds UK
| | - Mike Bennett
- Leeds Institute of Health Sciences; University of Leeds; Leeds UK
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Salmon P, Young B. The validity of education and guidance for clinical communication in cancer care: evidence-based practice will depend on practice-based evidence. PATIENT EDUCATION AND COUNSELING 2013; 90:193-9. [PMID: 22632737 DOI: 10.1016/j.pec.2012.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The validity of clinical communication skills education and guidance for cancer care is sometimes portrayed as self-evident. This view needs re-examination in light of critiques of the concept of communication skills. METHODS We critically examine principles that steer communication teaching and guidance in cancer care and draw on research that can inform the next generation of development in this field. RESULTS Unlike other areas of clinical skills, communication is highly contested. Any instance of communication is open to multiple interpretations; expert principles of communication are imprecise and often contradictory. The concept of communication skills will constrain development, because of its implication that universal, expert-defined components of communication are the building blocks of clinical relationships. Research on communication in practice indicates insights that could enrich future education and guidance. CONCLUSIONS Communication experts have more to learn from practitioners and patients than is commonly appreciated. Inductive, qualitative research should incorporate patient and practitioner perspectives as well as observations of communication. PRACTICE IMPLICATIONS Solutions to communication dilemmas might be found in detailed study of communication in practice, rather than in current expert principles. Incorporating such evidence will help to ensure the continued authority of communication curricula and guidance as evidence-based and patient-centred.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
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Chan EA, Jones A, Wong K. The relationships between communication, care and time are intertwined: a narrative inquiry exploring the impact of time on registered nurses' work. J Adv Nurs 2013; 69:2020-9. [PMID: 23311948 DOI: 10.1111/jan.12064] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/27/2022]
Abstract
AIM To report a qualitative study which explores registered nurses' views on the issue of time in the workplace. BACKGROUND There is a worldwide shortage of healthcare workers, subsequently time as a healthcare resource is both finite and scarce. As a result, increased attention is being paid to the restructuring of nursing work. However, the experience of time passing is a subjective one and there exists little research which, over a prolonged period of time, describes nurses' experiences of working in time-pressurized environments. DESIGN A narrative inquiry. METHOD Five registered nurses were individually interviewed a total of three times over a period of 12 months, amounting to a total of 15 interviews and 30 hours of data. Data were collected and analysed following a narrative enquiry approach during the period 2008-2010. FINDINGS Participants describe how attempts to work more effectively sometimes resulted in unintended negative consequences for patient care and how time pressure encourages collegiality amongst nurses. Furthermore, the registered nurses' account of how they opportunistically create time for communication with patients compels us to re-evaluate the nature of communication during procedural nursing care. CONCLUSION Increasingly nursing work is translated into quantitative data or metrics. This is an inescapable development which seeks to enhance understanding of nursing work. However, qualitative research may also offer a useful approach which captures the otherwise hidden, subjective experiences associated with time and work. Such data can exist alongside nursing metrics, and together these can build a better and more nuanced consideration of nursing practice.
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Affiliation(s)
- Engle Angela Chan
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
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20
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Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting. Cancer Nurs 2012; 34:453-63. [PMID: 21558853 DOI: 10.1097/ncc.0b013e31820f4eb7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. OBJECTIVE The objectives of the study were to assess time perception in disease-free and advanced cancer patients and examine the relation of time perception with patients' distress. METHODS A descriptive research design was used. Ninety-six disease-free and 63 advanced cancer patients filled out Cottle's Circle Test to assess time coherence and time dominance, Cottle's Line Test to assess temporal extension and Bayes' question on speed of time, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck's Depression Inventory for primary care, and Beck's Hopelessness-Scale. RESULTS In patients without evidence of disease, future dominance was most often observed, whereas in advanced cancer patients, the present was the dominant time segment. In both groups, a focus on the past was associated with distress. In contrast with patients without evidence of disease, advanced cancer patients perceived time as moving slowly, and this was correlated with distress. CONCLUSIONS The time perception of cancer patients without evidence of disease and advanced cancer patients is significantly different and is related to distress. IMPLICATIONS FOR PRACTICE The observed relation between a focus on the past and distress gives room for interventions of nurses and other healthcare professionals. Specific attention is needed for differences between cancer patients without evidence of disease and advanced cancer patients.
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Pieters HC, Heilemann MV, Maliski S, Dornig K, Mentes J. Instrumental Relating and Treatment Decision Making Among Older Women With Early-Stage Breast Cancer. Oncol Nurs Forum 2011; 39:E10-9. [DOI: 10.1188/12.onf.e10-e19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dahm MR. Tales of time, terms, and patient information-seeking behavior-an exploratory qualitative study. HEALTH COMMUNICATION 2011; 27:682-689. [PMID: 22168486 DOI: 10.1080/10410236.2011.629411] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study explores patients' and physicians' perceptions of the use of medical terminology in patient-physician communication. Perceptions of time emerge as an overarching theme and the relationships between perceived time pressures and medical terms are analyzed. Data for this qualitative exploratory study were collected in 28 semistructured interviews with native and nonnative English-speaking physicians and patients. Interviews were recorded, transcribed and analyzed in NVivo 8, applying principles from grounded theory. Participants commonly perceived time pressures on consultations. Findings indicate that together, perceived time pressures and medical terminology influence patient participation and the development of rapport in medical encounters. Patient information-seeking behavior was reported to be lower in short, terminology-dense consultations and increased in longer, terminology-sparse consultations. Data suggest that monitoring the use of medical terms in combination with taking time to provide appropriate explanations can function as a partnership-building strategy. Physicians who adopt this strategy could foster better patient-physician relationships and facilitate increased patient information-seeking behavior.
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Affiliation(s)
- Maria R Dahm
- Department of Linguistics, Macquarie University, North Ryde, NSW 2109, Australia.
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Existential issues among health care staff in surgical cancer care – Discussions in supervision sessions. Eur J Oncol Nurs 2011; 15:447-53. [DOI: 10.1016/j.ejon.2010.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 09/20/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022]
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Waterworth S, Gott M, Raphael D, Barnes S. Older people with heart failure and general practitioners: temporal reference frameworks and implications for practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:412-419. [PMID: 21324024 DOI: 10.1111/j.1365-2524.2010.00984.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of the study was to identify the time experiences of older patients and general practitioners (GPs). Secondary analysis of qualitative data collected from two longitudinal studies, one in the United Kingdom (UK) and the other in New Zealand (NZ), was carried out. The UK study involved interviews with 44 older people with heart failure and nine focus group discussions with primary health professionals during 2004-2005. The NZ study involved 79 interviews with 25 older people with heart failure and 30 telephone interviews with GPs during 2008-2009. Temporal reference frameworks function as background expectations and influence how patients and GPs experienced time and act as time controls. The key themes identified were: clock time was evident in how it structured the consultations; both patients and GPs valued needing time and for some GPs this involved creating space for emotional time. There were also tensions between needing time and wasting time; being known over time was important to both patients and GPs. For older people with heart failure improving their quality of care is essential and time is integral to this, not only the clock time and length of consultations. Identifying temporal reference frameworks provides an understanding that there are multiple times and exposes the influence of these in the lives of both the older people and GPs.
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Sierko E, Werpachowska MT, Wojtukiewicz MZ. Psychological, physical, and social situation of Polish patients with colorectal cancer undergoing first-line palliative chemotherapy. Oncol Nurs Forum 2011; 38:E253-9. [PMID: 21708520 DOI: 10.1188/11.onf.e253-e259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the psychological, physical, and social situations and needs of patients with colorectal cancer (CRC) diagnosed at an advanced stage of the disease. DESIGN Quantitative, descriptive. SETTING An urban comprehensive cancer center in northeastern Poland. SAMPLE 50 patients undergoing first-line palliative chemo-therapy. METHODS Participants were asked to fill out an institution-developed questionnaire assessing personal, emotional, physical, and social data. MAIN RESEARCH VARIABLES Psychological, physical, and social characteristics. FINDINGS The most frequently reported side effects of chemotherapy were asthenia, loss of taste, and nausea and vomiting. In addition, about 54% of patients were unable to work during treatment. Chemotherapy administration resulted in severe or moderate impediment of activities of daily living in 74% of the patients and negatively influenced their financial situation. About 25% of the patients were reluctant to share the news of their disease with their coworkers; however, most revealed their diagnosis to friends and family. The majority (62%) of patients expected help from family members. Nurses provided emotional support to a much lesser extent than patients' immediate relatives. The majority of patients (80%) needed to express their feelings by talking, but only about 30% considered a nurse to be the preferred person with whom to discuss their disease. CONCLUSIONS Patients with CRC diagnosed at an advanced stage require considerably more emotional, informative, and instrumental support from nurses, doctors, family, other patients, and priests than was anticipated by the authors. IMPLICATIONS FOR NURSING Extending routine history taking via the addition of questions to the proposed questionnaire may help to better recognize a particular patient's situation and unique needs. An increasingly patient-focused approach could improve the individual nursing care in this region of Europe. Ultimately, a multidisciplinary team would be required to meet the needs of patients with CRC undergoing chemotherapy.
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Affiliation(s)
- Ewa Sierko
- Department of Oncology, Medical University and the Comprehensive Cancer Center, Bialystok, Poland.
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Wissow L, Gadomski A, Roter D, Larson S, Lewis B, Brown J. Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care. PATIENT EDUCATION AND COUNSELING 2011; 82:226-32. [PMID: 20444568 PMCID: PMC2947561 DOI: 10.1016/j.pec.2010.03.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 03/09/2010] [Accepted: 03/31/2010] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Training in communication can change clinician behaviors, but brief training may function by altering attitudes rather than teaching new skills. We used data from a trial of mental health training for office-based primary care to determine indicators of uptake that predicted parent and child outcomes. METHODS Clinicians (n=50) were randomized to be controls or receive training. Uptake was determined comparing pre- and post-training visits with standardized patients (SPs) coded for skills and patient centeredness. Clinical outcomes were assessed by recruiting and following 403 children/youth ages 5-16 making visits to participants. At 6 months, change in mental health was assessed by parent and youth reports using the Strengths and Difficulties Questionnaire. RESULTS Trained clinicians used more agenda setting, time, and anger management skills than controls and showed increased patient centeredness toward SP parents, but not adolescents. Increased patient-centeredness toward parents predicted improvement in child/youth symptoms and functioning (rated by parents), and improvement in youth-rated symptoms. Increased skills alone were not associated with improvement, but patients of clinicians above the mean for both skill and patient-centeredness change improved most.
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Affiliation(s)
- Lawrence Wissow
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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Brundage MD, Feldman-Stewart D, Tishelman C. How do interventions designed to improve provider-patient communication work? Illustrative applications of a framework for communication. Acta Oncol 2010; 49:136-43. [PMID: 20100151 DOI: 10.3109/02841860903483684] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this broad overview for the Conference: "State of the Science in Cancer Care", we review a conceptual framework of physician-patient communication and use the framework to inform the application of theory regarding communication and patient preferences in clinical practice. Using a selection of research, we illustrate how problematic issues in communication can be represented by the framework. We further illustrate how interventions designed to improve communication or to elicit patients' preferences in a medical encounter may have their desired effect, or may be optimally evaluated.
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Marks R, Ok H, Joung H, Allegrante JP. Perceptions about collaborative decisions: perceived provider effectiveness among 2003 and 2007 Health Information National Trends Survey (HINTS) respondents. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 3:135-146. [PMID: 21154089 DOI: 10.1080/10810730.2010.522701] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patient-provider communication is an important element in cancer treatment and prevention. We examined the degree of concordance perceived to exist between the patient's preferences for inclusion in decision-making processes and their actual experiences among two population-based cohorts of U.S. adults with and without cancer histories who were surveyed in 2003 and 2007. Associations were examined between selected sociodemographic characteristics of respondents and the extent to which respondents perceived their health providers "always" involved them in decisions about their health to the extent desired. Data came from the Health Information National Trends Survey (HINTS), and SPSS and SAS-Callable SUDAAN statistical packages were used to analyze the data. Results showed a decrement in the proportion of favorable responses between 2003 and 2007. While there was no gender effect on the reported perceptions in either year, there was a significant effect of ethnicity (p = .001) in both years. Age, income, and employment were also independently associated (p = .001) in 2007. In contrast to 2003, higher education was significantly associated with communication satisfaction, as was having a cancer diagnosis, in 2007. There was a significant relationship between several sociodemographic variables and respondent perceptions about the consistency with which providers included patients as desired in decision-making. We conclude that communication between patient and provider remains suboptimal in cancer prevention and treatment.
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Affiliation(s)
- Ray Marks
- City University of New York and Columbia University, Department of Health and Behavior Studies, Teachers College, 525W 120 St., New York, NY 10027, USA.
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