Cancer care communication: the power to harm and the power to heal?

Experiences and Comfort of Young Cancer Patients Discussing Cannabis with Their Providers: Insights from a Survey at an NCI-Designated Cancer Center

Cannabis use among cancer patients for managing treatment-related symptoms is increasing, yet little is known about patterns in patient-provider communication. This study examines demographic differences in cannabis use communication at a National Cancer Institute-designated cancer center. The analysis included cancer patients aged ≥ 18 years who self-reported current cannabis use (past 30 days) and had visited Sylvester Comprehensive Cancer Center within the past 5 years (N = 226). Data were collected via an anonymous electronic survey on REDCap. Responses on patients' disclosure of cannabis use to cancer doctor/care team and their comfort in discussing cannabis were analyzed. Chi-squared/Fisher's exact tests and t-tests were applied. Logistic regression estimated the associations between age and stage of cancer treatment with patients' comfort in discussing cannabis use with cancer doctor (oncologist). The sample was 51.8% male and 39.4% Hispanic (mean age, 45.9 years (SD = 15.1)); 41.1% were aged 20-39 years, 43.8% were undergoing treatment, and 35.4% were in follow-up/had finished treatment. Over half (50.4%) did not disclose cannabis use to their cancer doctor/care team. Non-disclosers were more often younger (20-39 years) than disclosers (52.6% vs. 29.5%, p < 0.01). Most patients (72.5%) felt comfortable discussing cannabis use with their oncologist; however, younger patients (20-39 years) were more often uncomfortable (40.8%). Logistic regression showed newly diagnosed patients had lower odds (aOR, 0.41; 95% CI, 0.12-0.98) of comfort discussing cannabis compared to those in follow-up/finished treatment. Younger patients (20-39 years) also had lower odds (aOR, 0.11; 95% CI, 0.03-0.40) of feeling comfortable discussing cannabis compared to older patients (≥ 60 years). Age and treatment stage significantly impact the cannabis use disclosure and comfort in discussing it with cancer doctor/care team. These findings underscore the importance of considering age-related factors and treatment status when addressing cannabis use discussions within oncology setting.

Cancer Care Terminology in African Languages

Importance

Effective communication between patients and health care teams is essential in the health care setting for delivering optimal cancer care and increasing cancer awareness. While the significance of communication in health care is widely acknowledged, the topic is largely understudied within African settings.

Objective

To assess how the medical language of cancer and oncology translates into African languages and what these translations mean within their cultural context.

Design, Setting, and Participants

In this multinational survey study in Africa, health professionals, community health workers, researchers, and scientists involved in cancer care and research and traditional healers were invited to participate in an online survey on a voluntary basis through online platforms. The survey provided 16 cancer and oncologic terms used in cancer diagnosis and treatment (eg, cancer, radiotherapy) to participants, mostly health care workers, who were asked to provide these terms in their local languages (if the terms existed) followed by a direct or close translation of the meaning in English. The survey was open from February to April 2023.

Main Outcomes and Measures

Patterns of meaning that recurred across languages were identified using thematic analysis of 16 English-translated terms categorized into 5 themes (neutral, negative, positive, phonetic or borrowed, and unknown).

Results

A total of 107 responses (response rate was unavailable given the open and widespread distribution strategy) were collected from 32 countries spanning 44 African languages, with most participants (63 [59%]) aged 18 to 40 years; 54 (50%) were female. Translations for cancer were classified as phonetic or borrowed (34 [32%]), unknown (30 [28%]), neutral (24 [22%]), and negative (19 [18%]), with the latter category including universal connotations of fear, tragedy, incurability, and fatality. Similar elements connoting fear or tragedy were found in translations of terms such as malignant, chronic, and radiotherapy. The term radiotherapy yielded a high percentage of negative connotations (24 [22%]), with a prevailing theme of describing the treatment as being burned or burning with fire, heat, or electricity, which may potentially hinder treatment.

Conclusions and Relevance

In this survey study of cancer communication and the translation of oncology terminology in African languages, the findings suggest that the terminology may contribute to fear, health disparities, and barriers to care and pose communication difficulties for health professionals. The results reinforce the need for culturally sensitive cancer terminology for improving cancer awareness and communication.

Rapport between nurses and adult patients with cancer in ambulatory oncology care settings: A scoping review

BACKGROUND

Although the importance of the nurse-patient relationship in oncology is established, a consolidated body of research describing nurse-patient rapport, especially in ambulatory care, is lacking.

OBJECTIVES

This scoping review aimed to explore knowledge about rapport between adult patients with cancer and their nurses in ambulatory oncology care, including nurse, patient, nurse-patient dyad, and system-level factors that influence rapport.

METHODS

A scoping review was conducted to explore sources of evidence and gaps in knowledge pertinent to future research. The Joanna Briggs Institute methodology for Systematic Reviews was used with searches in MEDLINE, CINAHL, and ProQuest Dissertations and Theses Global databases. Experimental, descriptive observational, and qualitative study designs that focused on patients with cancer and their nurses within an ambulatory care setting were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

The search strategy collected 4538 studies of which 10 met study criteria after screening. Forward and backward citation tracking of included articles resulted in 4 additional studies. In total, 14 studies were extracted and analyzed. Synthesis of results from the individual sources resulted in three key observations: (a) there is an absence of studies that focus directly on nurse-patient rapport; (b) the majority of extracted data on rapport-related factors described aspects of nurses' attitudes; and (c) there was minimal information on patient, nurse-patient dyad, and system-level factors reported in these studies.

CONCLUSIONS

The lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care indicates a notable gap in our empirical understanding of relationship-based care, a hallmark of cancer care provision.

TWEETABLE ABSTRACT

Nurse-patient rapport in oncology ambulatory care requires additional research @paula_koppel.

Harmful communication behaviors in cancer care: A systematic review of patients and family caregivers perspectives

OBJECTIVE

Issues regarding clinician communication remain an important source of complaints within healthcare. This systematic review aims to determine cancer patients' and their family caregivers' views on which clinicians' communication behaviors can harm (i.e. eliciting negative feelings/consequences for patients/family caregivers).

METHODS

We searched for all types of peer-reviewed studies that determined adult (≥18 years) cancer patients' and/or family caregivers' perspectives on which clinicians' communication behaviors can harm in several databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search Premier), supplemented by expert-consultation. Studies were screened using the Artificial intelligence screening tool of ASReview and data was analyzed using Thematic Analysis. To assess the quality of the studies the Qualsyst critical appraisal tool was used.

RESULTS

A total of 47 studies were included. Four main themes of harmful communication behaviors were identified: (1) Lack of tailored information provision (e.g. giving too little or too much/specific information) (2) Lack of tailored decision making (ranging from; patient exclusion, to the patients' responsibility, and/or haste) (3) Lack of feeling seen and heard (seen as a disease, not as a human being; not listened to concerns and emotions) (4) Lack of feeling held and remembered (forgotten agreements; lack of care continuity).

CONCLUSIONS

Our results reveal an overview of patients' and family caregivers' perspectives on which clinicians' communication behaviors can harm. Harm could be prevented when information and decision involvement are tailored and patients' and family caregivers' needs to feel seen, heard, held and remembered are met.

Patient communication and experiences in cancer clinical drug trials: a mixed-method study at a specialist clinical trials unit

BACKGROUND

As cancer therapies increase in their complexity, effective communication among patients, physicians, and research staff is critical for optimal clinical trial management. Currently, we understand little about on-trial communication practices and patient trial experiences over time. This mixed-method study explored patient experiences of participating in a clinical drug trial at different time points, focussing on patient communication with trial staff.

METHODS

Patients enrolled in clinical drug trials conducted at the Parkville Cancer Clinical Trials Unit were invited to complete a tailored online survey and/or a qualitative interview. Patients were recruited to three cohorts based on time since the first trial treatment: new (≥ 1 to ≤ 13 weeks), mid- (≥ 14 to ≤ 26 weeks), and long-term (≥ 52 weeks) trial patients. Descriptive statistics were calculated for survey responses. Interview data were analysed thematically with a team-based approach. Survey and interview data were integrated at the intepretation stage.

RESULTS

From May to June 2021, 210 patients completed a survey (response rate 64%, 60% male), 20 completed interviews (60% male), and 18 completed both. More long-term trial patients (46%) participated than new (29%) and mid-trial patients (26%). Survey data showed high (> 90%) patient satisfaction with the provision of trial information and communication with trial staff across trial stages, and many reported trial experiences as above and beyond standard care. Interview data indicated that written trial information could be overwhelming, and verbal communication with the staff and physicians was highly valued, especially for enrolment and side effect management among long-term patients. Patients described the key points along the clinical trial trajectory that merit close attention: clear and well-communicated randomisation practices, reliable pathways for side effect reporting and prompt response from the trial staff, and end-of-trial transition management to avoid a sense of abandonment.

CONCLUSION

Patients reported high overall satisfaction with trial management but outlined key pinch points requiring improved communication practices. Establishing a range of effective communication practices among trial staff and physicians with patients in cancer clinical trials may have a wide range of positive effects on patient accrual, retention, and satisfaction.

Feasibility and acceptability testing of CommSense: A novel communication technology to enhance health equity in clinician-patient interactions

Background

Quality patient-clinician communication is paramount to achieving safe and compassionate healthcare, but evaluating communication performance during real clinical encounters is challenging. Technology offers novel opportunities to provide clinicians with actionable feedback to enhance their communication skills.

Methods

This pilot study evaluated the acceptability and feasibility of CommSense, a novel natural language processing (NLP) application designed to record and extract key metrics of communication performance and provide real-time feedback to clinicians. Metrics of communication performance were established from a review of the literature and technical feasibility verified. CommSense was deployed on a wearable (smartwatch), and participants were recruited from an academic medical center to test the technology. Participants completed a survey about their experience; results were exported to SPSS (v.28.0) for descriptive analysis.

Results

Forty (n = 40) healthcare participants (nursing students, medical students, nurses, and physicians) pilot tested CommSense. Over 90% of participants "strongly agreed" or "agreed" that CommSense could improve compassionate communication (n = 38, 95%) and help healthcare organizations deliver high-quality care (n = 39, 97.5%). Most participants (n = 37, 92.5%) "strongly agreed" or "agreed" they would be willing to use CommSense in the future; 100% (n = 40) "strongly agreed" or "agreed" they were interested in seeing information analyzed by CommSense about their communication performance. Metrics of most interest were medical jargon, interruptions, and speech dominance.

Conclusion

Participants perceived significant benefits of CommSense to track and improve communication skills. Future work will deploy CommSense in the clinical setting with a more diverse group of participants, validate data fidelity, and explore optimal ways to share data analyzed by CommSense with end-users.

Mind your words: Oncologists' communication that potentially harms patients with advanced cancer: A survey on patient perspectives

BACKGROUND

Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives.

METHODS

An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered "yes," they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis).

RESULTS

Communication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication.

CONCLUSIONS

This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.

When Cancer Is the Self: An Interpretive Description of the Experience of Identity by Hematology Cancer Patients

BACKGROUND

The term "cancer" is imbued with identity signals that trigger certain assumed sociocultural responses. Clinical practice with hematological cancer patients suggests the experience of these patients may be different than that of solid tumor cancer patients.

OBJECTIVE

We sought to explore the research question: How are identity experiences described and elucidated by adult hematological cancer patients?

METHODS

This qualitative study was guided by interpretive description as the methodological framework.

RESULTS

Preexisting identity labels and assumptions assigned to the overarching "cancer" diagnosis were viewed by patients as entirely inadequate to fully describe and inform their experience. Instead, findings revealed the propensity of adult hematology oncology patients to co-create and enact new identities increasingly reflective of the nonlocalized nature of their cancer subtype. Three themes that arose from the data included the unique cancer-self, the invasion of cancer opposed to self, and the personification of the cancer within self.

CONCLUSIONS

Hematology oncology patients experience and claim a postdiagnosis identity that is self-described as distinct and highly specialized, and are distinct to solid tumor patients in aspects of systemic and total consumption of the self. This uniqueness is extended to the specific hematological cancer subtype down to genetics, indicating a strong "new" sense of self.

IMPLICATIONS FOR PRACTICE

The manner in which hematology oncology patients in this study embraced notions of transformed self and isolating uniqueness provides practitioners with a lens through which new and innovative interventions can be constructed to improve patient care and psychosocial outcomes.

Rapport between nurses and adult patients in ambulatory oncology care settings: a scoping review protocol

OBJECTIVE

The primary objective of this scoping review is to explore what is known about cultivating rapport between nurses and adult patients in ambulatory oncology care. A bibliometric analysis will be performed to explore whether this method enhances mapping of the literature.

INTRODUCTION

Research demonstrates that patients with cancer value nurses not only for their skillful delivery of treatment but also for their support and guidance. Rapport, or nurse-patient bonding, is associated with patient satisfaction. Although the importance of the nurse-patient relationship in oncology nursing is established, less is known about the process of nurturing rapport, especially in ambulatory care where most treatment is delivered.

INCLUSION CRITERIA

This scoping review will consider studies pertaining to nurses working with adult patients undergoing treatment for any form of cancer within ambulatory oncology. It will include experimental, quasi-experimental, descriptive observational, and qualitative designs, as well as systematic reviews and dissertations.

METHODS

Researchers will search multiple databases including MEDLINE (Ovid), CINAHL (EBSCO), ProQuest Dissertations and Theses Global database, PapersFirst, and EThOS. Two independent researchers will screen the title/abstract of all retrieved citations, after which the study researchers will review the full text of selected studies for inclusion. Eligible studies will be extracted using the data extraction instrument. No time limit will be placed on the search. While studies of all languages will be included in the search, only those in English will be reviewed. Non-English studies with abstracts in English will be listed in an appendix at the end of the manuscript.

Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers

With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.

Novel multifunctional nano-hybrid polyhedral oligomeric silsesquioxane-based molecules with high cell permeability: molecular design and application for diagnosis and treatment of tumors

Chemotherapy mostly functions as a carrier for direct drug delivery to the tumor, which may induce secondary damage to healthy tissue cells around the tumor. To avoid this side effect, using multifunctional drugs with high cell permeability during chemotherapy is crucial to achieve significant antitumor efficacy. In this study, polyhedral oligomeric silsesquioxane-based multifunctional organic-inorganic hybrid molecules with potential for recognition, imaging, and treatment were designed and successfully synthesized through a facile and efficient one-pot reaction process. The structure and properties of the synthesized multifunctional molecules were characterized by Fourier transform infrared spectroscopy, nuclear magnetic resonance spectroscopy, mass spectrometry, fluorescence spectroscopy, cytotoxicity assay, surface tension testing, cell compatibility testing, hematoxylin and eosin staining, as well as in vivo and in vitro studies. The results demonstrated that these multifunctional molecules can be effectively used for delivering precisely-targeted imaging and therapeutic agents and exhibited considerable cell permeability. The excellent synergy between high permeability and precise targeting results in multifunctional molecules with superior diagnostic performance.

Improving patient-clinician communication following nephrectomy in renal cell carcinoma: Development, content validation and pilot testing of a conversation aid tool

OBJECTIVES

This study developed, and established the content validity, of a conversation aid tool (CAT) for use in clinical practice with renal cell carcinoma (RCC) patients who receive a curative nephrectomy and are at high-risk of recurrence. The CAT was pilot tested in a sample of RCC patients to establish whether the CAT increases knowledge of RCC, treatment options (such as adjuvant therapy), and care options.

METHODS

A cross-sectional, mixed methods design was used involving initial, exploratory interviews with RCC patients, RCC specialists and a steering group. Further content validation interviews were conducted with RCC patients and specialists. A web-based survey was conducted with RCC patients (N = 60), to compare the CAT versus a standard of care (SOC) consultation comparator tool on patient knowledge.

RESULTS

Findings from exploratory interviews were used to develop the CAT. Content validation interviews demonstrated that the CAT was well understood and relevant to RCC patients. The web-based survey demonstrated that viewing the CAT significantly improved participants knowledge of RCC, and care options, when compared to the SOC.

CONCLUSION

The findings highlight that the CAT is a relevant, comprehensive and well-understood tool for use in the post-nephrectomy consultation.

PRACTICE IMPLICATIONS

Use of the CAT may increase patient knowledge of RCC and care options.

The Usefulness of Patient-Reported Outcomes and the Influence on Palliative Oncology Patients and Health Services: A Qualitative Study of the Prospective Outcomes and Support Initiative

BACKGROUND

Through the British Columbia, Prospective Outcomes and Support Initiative (POSI), registered nurses collect patient-reported outcome (PRO) data during telephone follow-up with palliative oncology patients.

OBJECTIVE

The research objective was to describe the usefulness and influence of the nursing care provided through POSI follow-up on palliative patients and health services.

METHODS

We used a qualitative interpretive description approach involving the collection and analysis of semistructured interview data with 20 palliative patients and 12 oncology nurses. All participant data were subjected to an inductively derived coding framework. Analytic categories were identified and iteratively revised through constant comparative techniques to develop representative themes.

RESULTS

The accounts of patients and nurses suggest that telephone follow-up with PROs enabled the nurses to (1) focus on the priorities of patients experiencing complex health challenges, (2) manage complex symptoms, (3) ease the patient's transition home, and (4) improve access to and use of health services. Suggestions for improving POSI nurse follow-up centered on flexibility in the timing of the follow-up, creating dedicated POSI work assignments, and having additional time to personalize assessments and nursing care beyond the PRO questionnaires.

CONCLUSIONS

Nursing care employing PROs via telephone follow-up can improve palliative cancer patients' quality of life and health service use.

IMPLICATIONS FOR PRACTICE

Nurses are optimally positioned to use PROs following cancer treatment completion but require organizational resources and support to optimize patient and system outcomes.

Cancer caregivers' experiences of prognosis in Australia: a qualitative interview study

OBJECTIVES

Forecasting survival in cancer is a particularly challenging facet of oncological work and can involve complex interactions with patients and their families. While there is considerable research on patient experiences of being provided with, or becoming aware of, their prognosis, there has been much less emphasis placed on the experiences of caregivers. The aim of this paper was to examine caregivers' experiences of prognosis.

DESIGN

This study used semistructured interviews; transcripts were analysed thematically using the framework approach. These data are part of a larger research project focused on experiences of cancer survivorship.

SETTING

Recruitment was from two metropolitan hospitals in Queensland, Australia.

PARTICIPANTS

50 caregivers of patients living with cancer and receiving treatment at two metropolitan hospitals (32% male, 68% female) participated in this study.

RESULTS

Four main themes were identified: (1) caregivers' uncertainty around the meaning and implications of prognosis, (2) caregivers' sense of exclusion in prognostic conversations, (3) the practice of situating prognosis within a context of hope and (4) the precarious balance between realism, optimism and strategic 'ignorance'.

CONCLUSIONS

Caregivers are in many respects the unseen third party of prognostic communication. Developing a better understanding of caregivers' perceptions of prognosis, including how this may be challenged, accepted or otherwise, is important in engaging caregivers in the process of communicating prognostic information. Facilitating greater participation by caregivers in prognostic conversations could potentially address evident complexities and even improve the experiences of all stakeholders in cancer care settings.

The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication

BACKGROUND

The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients.

METHODS

Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis.

RESULTS

The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery.

CONCLUSIONS

The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.

Patient perspectives on adapting meaning-centered psychotherapy in advanced cancer for the Chinese immigrant population

The Chinese immigrant community faces multiple obstacles to effective cancer support and psychosocial care post diagnosis. Meaning-centered psychotherapy (MCP) is an empirically based treatment (EBT) that has been found to significantly reduce psychological distress while increasing spiritual well-being and a sense of meaning and purpose in life in patients with advanced cancer. However, it has not yet been adapted for Chinese immigrants who have unique linguistic and cultural needs. This study presents a community needs assessment to inform the cultural adaptation of MCP for Chinese patients with advanced cancer using Bernal et al.'s ecological validity model and the cultural adaptation process model of Domenech-Rodriquez and Weiling. Interviews were conducted until saturation with 12 Chinese immigrants with advanced cancer to determine the community's needs and preferences regarding the MCP intervention. Transcripts were translated and analyzed using Atlas.ti and six frequently occurring themes were identified: Coping; End of Life; Family; Culture, Religion, and Language; Immigration; and Specific Adaptations to MCP. Sociocultural values, beliefs, and practices such as filial piety and the use of Traditional Chinese Medicine (TCM) should be considered when adapting EBTs for Chinese immigrant cancer patients.

COMSKIL Communication Training in Oncology-Adaptation to German Cancer Care Settings

Medical communication is a skill which can be learned and taught and which can substantially improve treatment outcomes, especially if patients' communication preferences are taken into account. Here, we give an overview of communication training research and outline the COMSKIL program as a state-of-the-art communication skills training in oncology. COMSKIL has a solid theoretical foundation and teaches core elements of medical communication in up to ten fully operationalized modules. These address typical situations ranging from breaking bad news to responding to difficult emotions, shared decision-making, and communicating via interpreters.

Positive cancer care in Peru: Patient and provider perspectives

Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.

Adapting Meaning-Centered Psychotherapy in Advanced Cancer for the Chinese Immigrant Population

The Chinese immigrant community faces multiple barriers to quality cancer care and cancer survivorship. Meaning-centered psychotherapy (MCP) is an empirically-based treatment shown to significantly reduce psychological distress while increasing spiritual well-being and a sense of meaning and purpose in life in advanced cancer patients. However, it has not yet been adapted for racial and ethnic minority populations for whom the concept of "meaning" may likely differ from that of westernized White populations. In this study, we conducted a community needs assessment to inform the cultural adaptation of MCP for Chinese patients with advanced cancer, in accordance with Bernal et al. ecological validity model and the cultural adaptation process model of Domenech-Rodriquez and Weiling. We conducted interviews until saturation with 11 key Chinese-serving community leaders and health professionals with a range of areas of expertise (i.e. oncology, psychology, palliative care, cancer support services), to examine community needs, priorities, and preferences within the context of the MCP intervention. Sessions were audio recorded and transcribed. The research team analyzed the transcripts using Atlas.ti. Six frequently occurring themes were identified. Interviewees described the role of the family, traditional Chinese values, cancer stigma, and social norms (e.g. saving face) in adapting MCP. Researchers and clinicians should consider the role of the family in treatment, as well as specific social and cultural values and beliefs in adapting and delivering MCP for Chinese patients with advanced cancer.

Observations of the communication practices between nurses and patients in an oncology outpatient clinic

PURPOSE

Effective communication in cancer care and treatment is linked to better health outcomes, improved treatment adherence, and improved quality of life for cancer patients. While the characteristics of effective communication have been identified, there is sparse knowledge about the current conditions for providing effective communication especially within the outpatient clinical context, where the majority of cancer patients are currently being treated. This study aimed to explore communication practices between nurses and patients undergoing chemotherapy in an outpatient clinic to gain insight into how patients are supported in this setting.

METHODS

Data were collected through 70 h of participant observations of nurse-patient interactions supplemented with ad hoc interviews with nurses in an oncology outpatient clinic. The methodology and data analysis are guided by interpretive description, thematic analysis and symbolic interactionism.

RESULTS

Three themes were generated that characterised communication in the outpatient clinic: Treatment-centred communication, efficient communication and spatially-bound communication. While there was good opportunity for patients to learn about treatment and side effects during cancer treatment, psychosocial concerns were rarely addressed.

CONCLUSIONS

The outpatient setting influences the type and quality of communication between nurses and patients. Improvement of communication should include not only verbal and written information, but focus on the importance of nonverbal communication in the oncology outpatient clinic. Furthermore, there is a need to make environmental adjustments that can facilitate the opportunity for patients to express their needs and for nurses to respond to them.

Experiences and health care preferences of women with ovarian cancer during the diagnosis phase

OBJECTIVE

An ovarian cancer diagnosis presents physical and psychological challenges. Usually identified at an advanced stage, the disease involves invasive treatment and has a high mortality rate. The diagnosis phase is generally a time of heightened distress. Accordingly, the aim of this qualitative study was to explore the health care experiences and preferences of women with ovarian cancer during this phase, and identify opportunities to enhance women's experiences and outcomes.

METHODS

Thirty-four women diagnosed with ovarian cancer were recruited from across Australia (median age = 60.5 years, range = 31-74 years). Semistructured interviews explored participants' experience of health care services and preferences during the diagnosis phase. Thematic analysis of interview transcripts followed.

RESULTS

Five themes were identified including "navigating uncertainty" which summarized women's general experiences throughout the diagnosis phase and provided a context for concomitant health care preferences. Four other themes highlighted significant areas where health care may be better aligned with women's preferences. These included "responsiveness in health care," "relational communication," "person-centered information," and "preparation for living beyond cancer treatment."

CONCLUSIONS

Responsive and prompt health care services that employ relational communication, provide patient-centered information, and prepare women for survivorship could improve the health care experiences of women diagnosed with ovarian cancer.

Cancer Survivors' Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans

Prior studies reveal gaps in cancer survivors' discussions with health care providers about follow-up care and receipt of care plans; however, whether survivorship care planning may vary by cancer type is not known. We surveyed 615 survivors of breast, colorectal, prostate, lung cancer, and melanoma enrolled in three health plans to examine cancer survivors' self-reported discussions of follow-up care, including the need for surveillance, late and long-term effects, emotional needs, and health behaviors. We assessed whether cancer survivors received a written treatment summary and post-treatment care instructions. Most (92%) survivors reported having a discussion about the need for surveillance; 75%, late and long-term effects; 69%, lifestyle and health behaviors; and 53%, emotional and social needs. Most (88%) reported receiving post-treatment care instructions and 47%, a treatment summary. While there was little difference among survivors' receipt of surveillance or health behavior recommendations by cancer type (p = 0.85 and p = 0.66, respectively), discussions of late and long-term effects occurred among 82% of prostate, 78% of breast, 73% of melanoma, 72% of colorectal, and 67% of lung survivors (p = 0.06). Approximately half of survivors reported discussions of emotional needs, with modest differences by cancer type (p = 0.08). Our findings indicate that most patient-provider discussions cover information on surveillance, with less emphasis on late and long-term effects, lifestyle and health behaviors, and substantially less focusing on emotional and social needs. No or modest differences in discussions occurred by cancer type. Whether tailoring information to individual cancer survivor needs is beneficial should be examined.

Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication

Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.

Exceptional patients and communication in cancer care-are we missing another survival factor?

OBJECTIVE

There is increased awareness of the issue of exceptional survival beyond expectations among cancer patients with poor prognosis, and researchers are starting to look closely at this phenomenon. In this study, we explored the perceptions of these "exceptional patients" as to their understanding and insight into their unusual experience.

METHODS

We used a qualitative approach consisting of in-depth, open-ended interviews with exceptional patients in two locations, Texas and Israel, from 2007 to 2014. The interviews were audio-recorded and qualitatively analyzed, and gave rise to illness narratives entailing detailed descriptions of patients experience over the course of their disease and treatment. A qualitative content analysis focusing on contextual meaning was utilized.

RESULTS

Twenty-nine patients participated in our study. The mean years since diagnosis was 9.55 years (range, 4-23 years). All patients had received conventional treatment, including surgery, chemotherapy, and radiation therapy. One of the prevailing themes in these interviews was related to the patient-doctor relationship. Most participants mentioned that the support they received from one or more physicians was a crucial factor for their exceptional survival.

CONCLUSION

The significance of patient-doctor relationship in cancer survival requires further research. This research is especially important as it adds to the current trend of patient centered care and points to the added value of relationship between health providers and patients. This relationship, as perceived by these exceptional patients, can be a factor that adds to improved survival in cancer care.

Comfort and hope in the preanesthesia stage in patients undergoing surgery

PURPOSE

Comfort and hope have been identified as important components in the care of perianesthesia patients. The purpose of this study was to explore the relationship between comfort and hope in the preanesthesia stage in patients undergoing surgery.

DESIGN

A descriptive cross-sectional survey was conducted with 191 surgical patients.

METHODS

Data were collected using the Perianesthesia Comfort Questionnaire and Herth Hope Index.

FINDINGS

Direct and significant relationships were observed between comfort and hope (P≤.001, r=0.65). Also, significant relationships were observed between educational level and marital status with comfort (P≤.01). The relationship between educational level and hope was significant (P≤.001). Significant relationships were also observed between gender and marital status with hope (P≤.01).

CONCLUSIONS

Overall, this study showed that a significant relationship exists between comfort and hope. Additionally, some demographic characteristics influenced comfort and hope in these patients. Health care providers should arrange the environment in a way that allows the surgical patients to experience comfort and hope and recognize the impact of personal characteristics when caring for surgical patients, particularly in the preanesthesia stage.

Exploring hope and healing in patients living with advanced non-small cell lung cancer

PURPOSE/OBJECTIVES

To explore the experience and meaning of hope in relation to the healing process of patients living with stage IIIb or IV non-small cell lung cancer.

RESEARCH APPROACH

Interpretative qualitative study design.

SETTING

Peter Brojde Lung Cancer Centre in the Jewish General Hospital in Montreal, Quebec, Canada.

PARTICIPANTS

12 English- and French-speaking patients, aged 36-78 years.

METHODOLOGIC APPROACH

One 60-90-minute semistructured interview per participant was conducted. An inductive approach to data analysis was taken, involving immersion in the data, coding, classifying, and creating linkages.

FINDINGS

Four main themes emerged: (a) the morass of shattered hope, (b) tentative steps toward a new hope paradigm, (c) reframing hope within the context of a life-threatening illness, and (d) strengthening the link between hope and wellness.

CONCLUSIONS

Patients described a process where hope was diminished or lost entirely, regained, and reshaped as they learned to live and grow following their diagnosis.

INTERPRETATION

This study adds to the literature by describing the dynamic nature of hope as well as factors facilitating or hindering the hope process. It demonstrates how finding meaning, a structural component of healing, can be used to envision a new hopeful future. This study suggests hope and healing cannot exist in isolation, and highlights the importance of understanding the fluctuating nature of hope in patients with advanced lung cancer to foster it, therefore promoting healing.

Palliative care patients' perceptions of the work involved in understanding and managing the network of care provision surrounding them

OBJECTIVE

To explore the work carried out for cancer palliative care patients in understanding and dealing with the often large network of care provision surrounding them.

METHOD

Qualitative thematic analysis of interviews with 24 patients (aged 48-85 years) with 15 different types/sites of cancer and palliative care needs.

RESULTS

The main theme of 'patient work-their strategies and project management' is presented. Subthemes included: being organised and keeping records; planning ahead and coordinating care; information gathering; understanding the hierarchy and knowing who the key people are; strategies to remember names and roles; understanding and 'working the system'. Insights are given into the work carried out on patients' behalf by family, although it was unclear who would do this work if no family was available. Some of the challenges faced by patients and families are identified. These included limited information; uncertainty when care is transferred between different teams or locations; deciding who to contact and how; and negotiating through gatekeepers.

CONCLUSIONS

The number and variety of people contributing to the care of a cancer palliative care patient can be difficult for patients and family to comprehend. Work is required by patients or family on their behalf to achieve the level of understanding required to become accomplished at navigating the system and project managing their care organisation, and is probably influenced by role expectations and previous experience. Much of this additional, often hidden, workload for patients and family could probably be reduced with clear, timely information provision by health professionals.

Illustrating the (in)visible: understanding the impact of loss in adults living with secondary lymphedema after cancer

Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC). SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women with SLC were recruited from two research sites (Fredericton, NB, and Ottawa, ON, Canada) to participate in semi-structured interviews about the physical and psychosocial aspects of SLC. Using a methodology of interpretive description, our analysis of participant interviews reveals the complex ways in which men and women felt both visible and invisible within various contexts. We discuss three majors themes: (in)visibility and appearance related to material losses; (in)visibility and action connected to visible losses in function, as well as invisible struggles to care for oneself; and the loss of present and future well-being, as SLC renders some limitations visible while potentially obscuring a hopeful future indefinitely. Our research indicates that timely diagnosis of SLC would be an immediate first step in recognizing the physical and emotional dimensions of the condition. To accomplish this, increased awareness is needed. To enhance quality of life for those living with SLC, the development of new resources and psychosocial supports is also required.

Patients' perceptions of how healthcare providers communicate with them and their families following a diagnosis of colorectal cancer and undergoing chemotherapy treatment

PURPOSE

Chemotherapy can result in many unpredictable and often debilitating side-effects hence patients undergoing chemotherapy treatment may have to rely on their loved ones to support them through this most challenging period. In view of this possibility then good communication skills between patients, healthcare providers and family members is of paramount importance for effective patient outcomes. The aim of this study therefore, was to explore patients' perceptions of how healthcare providers communicate with them and their family members whilst undergoing chemotherapy treatment for cancer.

METHODS

Using a qualitative methodology and a descriptive design, data were collected using unstructured interviews with patients undergoing chemotherapy (n = 14) and analysed by content analysis.

RESULTS

Participants expressed that both they and their family members were treated with compassion, kindness, empathy and understanding. They appreciated the time given to them and their family members to listen and answer their questions before, during and/or after treatment. In addition they commented positively on the warm and cheerful environment and the selective use of appropriate humour by oncology healthcare providers in the chemotherapy units.

CONCLUSION

The data highlights in particular the positive communication encounters between patients with cancer and their healthcare providers and family members. Oncology nurses were identified as being particularly supportive to both patients and their family members. Despite chemotherapy units being a difficult place to be a part of, this study highlights that healthcare providers can help make this a less daunting place for patients and their family members through their appropriate use of professional communication.

An envisioning about the caring in listening

The purpose of this article is to make visible further dimensions and uncover an envisioning about the caring in listening in the field of caring science, which may improve the care for the suffering human being, the patient. Eriksson's caritative theory of caring constitutes the starting point for this search for knowledge, while the research method is realised by a hermeneutic reading based on the philosopher of hermeneutics, Gadamer's thought. The research is realised by a reading of Fyodor Dostoyevsky's literary works. The literary characters Sonia in Crime and Punishment and Alyosha in The Brothers Karamazov, uncovers patterns of meaning-bearing units towards the caring and the interpretation of a more profound envisioning about the caring in listening. The uncovering and interpretation show that patients in their suffering long to meet a caregiver who listens without the least condemnation in their eyes and demeanour. Patients need a listening caregiver who shows compassion and who has the courage to remain in the struggle of suffering and to carry the patients through insupportable pain, guilt and shame. Through listening, it is possible to reawaken a numb heart, to take individuals who have gone through a good deal of suffering, from darkness, degradation, unendurable pain to the light and to awaken their zest for life and joy to live. Listening renews, delivers and transforms human beings so that they can begin to find a new direction in life and start living a life in accordance with their own fundamental order, purpose, essential decision and individuality. Listening takes patients out of their loneliness and unbearable suffering into communion and a life worth living.

Breaking bad news of cancer diagnosis - Perception of the cancer patients in a rural community in Malaysia

Context:

Breaking of bad news is an important component in the management of cancer patients.

Aims:

This study aimed to assess the perceptions of breaking bad news of cancer diagnosis.

Settings and Design:

It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district.

Materials and Methods:

Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents.

Statistical Analysis Used:

Data was entered and analyzed using SPSS version 19.0.

Results:

Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients’ key area of concerns. There were significant difference between sex and “information giving” (P = 0.028) and “general consideration” (P = 0.016) and also between “the age and setting the scene” (P = 0.042). Significant difference was also found between the types of cancer and “the setting of scene” (P = 0.018), “breaking bad news technique” (P = 0.010), “eliciting concerns” (P = 0.003) and “information giving” (P = 0.004).

Conclusion:

Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals’ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors.

Communicating good care: a qualitative study of what people with urological cancer value in interactions with health care providers

PURPOSE

Communication with health care providers is important to help meet cancer patients' information and support needs. It can significantly affect the extent to which patients feel cared for, respected and involved, and it can influence a range of cancer care processes and outcomes. This paper presents findings from a study which explored urological cancer patients' experiences of care, focussing on insights into what they appeared to value in their interactions with health care providers and why.

METHOD

In-depth interviews were undertaken with 20 men and 6 women with different types of urological cancer at a range of times since diagnosis. Interviews were audio-recorded, transcribed and thematically analysed using an established interpretive approach.

RESULTS

Patients valued being treated as someone who mattered and was worthy of care; being recognised and responded to as an individual; and experiencing support for autonomy/agency. Reasons for their valuations related to the implications of communicative interactions for the ways patients thought health professionals related to them 'as persons'. Our findings highlight the value of relational aspects of communication for: indicating to patients what clinicians think of their worth; facilitating individualised care; and enabling patients to contribute to their own care.

CONCLUSIONS

Efforts to improve health care provider-patient communication should attend not only to the transfer of information about the condition and its management but to the range of features of interactions that can signal to people how health care providers relate to them as persons.

'It stays with me': the experiences of second- and third-year student nurses when caring for patients with cancer

Little is known about student nurses experiences of nursing patients with cancer in the UK. With the increasing survival of people with cancer and with cancer no longer seen as a terminal illness it is useful to understand student nurses clinical experience when nursing those with cancer. This study takes a phenomenological approach involving three focus group interviews with 20 student nurses from the second and third year of their course in one centre in the UK. All the students had experience of caring for patients with cancer. The key themes emerging from the study were: Communication, Impact on Self, Lack of Support and End-of-Life-Care. Students emphasised the need to have more knowledge and support in relation to cancer care. They describe how they lack communication skills and found it difficult to handle their emotions. A number of students found the whole experience of caring for patients with cancer emotionally distressing and draining and they describe avoiding contact with these patients by using distancing and avoidance strategies. Student nurses need additional support through demystifying cancer, using reflective practice and good mentoring in the clinical area to enable students to feel supported, and develop confidence in their capacity for care for people with cancer.

The importance of symptom surveillance during follow-up care of leukemia, bladder, and colorectal cancer survivors

PURPOSE

We examined cancer survivors' experience of bothersome symptoms, association of symptom bother with health-related quality of life (HRQOL), survivors' perception of symptom care, and their symptom-related information needs.

METHODS

Using self-report survey measures, survivors of leukemia, bladder, or colorectal cancer who were 2-5 years post-diagnosis and received follow-up care in the past year (N = 623) provided information about the presence of bothersome symptoms, symptom-related information needs, adequacy of symptom-related care, and their physical and mental HRQOL. Multivariable statistical analyses were conducted to identify correlates of symptom bother, inadequate care, and symptom information needs and to examine the association between symptom bother and HRQOL.

RESULTS

Twenty-eight percent of the 606 respondents experienced symptom bother in the past year (46 % of leukemia, 24 % of bladder, and 26 % of colorectal cancer survivors). Younger survivors, those of Hispanic ethnicity, with low income, those with recurrent cancer, and chemotherapy recipients were more likely to report symptom bother (all p < 0.05). Symptom bother was associated with lower physical and mental HRQOL (p < 0.001). While 92 % of survivors with symptoms discussed them with their follow-up care physician, 52 % of these reported receiving inadequate symptom care. Survivors reporting inadequate symptom care were 2.5 times as likely to identify symptom information needs compared to those who received adequate care (p < 0.05).

CONCLUSIONS

One in four cancer survivors report symptoms 2-5 years post-diagnosis, and only half of these survivors receive adequate care to address those symptoms. Research that refines and tests symptom care interventions for this population is warranted.

Communication challenges for chronic metastatic cancer in an era of novel therapeutics

Advances in the production of novel therapies for cancer management are creating new challenges for the support of increasing numbers of persons surviving for extended periods with advanced disease. Despite incurable and life-limiting metastatic conditions, these patients are living longer with serious disease, pushing the boundaries of what science explains and clinicians can confidently interpret using available evidence. Here we report findings from an early subset of such individuals within a longitudinal qualitative cancer cohort study on clinician-patient communication across the cancer trajectory. In these findings, we contextualize experiential accounts of communication in a changing environment of the costs and uncertainties of personalized medicine, and examine the complex psychosocial circumstances of this rapidly growing patient population. Interpretation of these findings illustrates how emerging issues in cancer treatment influence the experience of these patients, their social and support networks, their cancer care specialists, and the multidisciplinary teams charged with coordinating their care.

"Doctor, what do i have?" Knowledge of cancer diagnosis among immigrant/migrant minorities

This study explores patient knowledge of cancer diagnosis among underserved immigrant/migrant minorities. Patients were recruited at a hospital-based cancer clinic in New York City. Demographic and self-reported diagnosis and treatment information were collected; charts were reviewed to ascertain cancer diagnosis. Four hundred thirty-four patients were included. Eighty-seven percent preferred to speak a language other than English in the health care setting. Sixteen percent had incorrect knowledge of their cancer diagnosis. Multivariate analysis indicated that both preference for a non-English language and diagnosis of a "below the belt" cancer were jointly predictive of incorrect knowledge (LR = 17.01; p = 0.0002). "Below the belt" cancers included bladder, colorectal, gynecological, penile, prostate, and testicular cancers. Among this cohort of immigrant/migrant cancer patients, a considerable proportion was unaware of their correct cancer diagnoses. This may have a significant impact on subsequent cancer education, treatment, and care. Limited-English-proficiency patients may be at particular risk.

The validity of education and guidance for clinical communication in cancer care: evidence-based practice will depend on practice-based evidence

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.

A Qualitative Review of Occupational Therapists' Listening Behaviors and Experiences When Caring for Patients in Palliative or Hospice Care

Listening behaviors and experiences of occupational therapists working with patients in palliative or hospice care were investigated. Because the U.S. Government's Healthy People 2020 mandates better listening in health care, this research is timely. A qualitative design using semi-structured interviews and member checks provided researchers with rich text that revealed patterns and themes associated with listening behaviors, listening experiences, and listening training of occupational therapists working in palliative and hospice care. Participants were selected using typical case and snowball sampling. Six participants from two distinct geographic regions of the United States agreed to be interviewed. Interviews revealed four themes: working within the OT Practice Framework, key listening behaviors used in this context, listening barriers and challenges, and clinical competence and training needed prior to working with this population. This small sample size represents only a fraction of the occupational therapists working in palliative or hospice care, yet provides a foundation for further research and underscores the importance of listening behaviors.

Identifying the informational and psychosocial needs of Chinese immigrant cancer patients: a focus group study

PURPOSE

The Chinese immigrant community faces multiple barriers to quality cancer care and cancer survivorship. Psychosocial interventions can positively impact quality of life, anxiety, and distress in cancer patients. In this study, we explored the informational and psychosocial needs of Chinese cancer patients to inform the development of culturally targeted support and survivorship interventions.

METHODS

We conducted four focus groups with a total of 28 Chinese cancer patients to elucidate their cancer informational and psychosocial needs. The groups were conducted using standard methodology and guided by community-based participatory research principles. Sessions were audio recorded, transcribed, and translated into English. The research team conducted the analysis.

RESULTS

Frequently occurring themes included (1) the need for accurate information on cancer and treatment options, (2) the role of language barriers in accessing cancer care, (3) the role of food in cancer and the need for nutritional information, and (4) the role of Chinese medicine in cancer treatment. Participants expressed significant dissatisfaction with the amount, reliability, and/or comprehensibility of available information.

CONCLUSIONS

Support groups and programs should be developed to address participants' needs for more information on cancer and its treatment. Programs should educate and empower patients on how to find further Chinese language information and resources and effectively communicate their questions and needs to providers in an interpreted encounter. System-level approaches should be implemented to ensure provision of interpretation services. Additionally, programs should incorporate the unique cultural needs of this population related to food/nutrition and Chinese medicine.

Comparing decision making between cancer patients and the general population: thoughts, emotions, or social influence?

This study extends a risk information seeking and processing model to explore the relative effect of cognitive processing strategies, positive and negative emotions, and normative beliefs on individuals' decision making about potential health risks. Most previous research based on this theoretical framework has examined environmental risks. Applying this risk communication model to study health decision making presents an opportunity to explore theoretical boundaries of the model, while also bringing this research to bear on a pressing medical issue: low enrollment in clinical trials. Comparative analysis of data gathered from 2 telephone surveys of a representative national sample (n = 500) and a random sample of cancer patients (n = 411) indicated that emotions played a more substantive role in cancer patients' decisions to enroll in a potential trial, whereas cognitive processing strategies and normative beliefs had greater influences on the decisions of respondents from the national sample.

Relationships and emotional wellbeing among African American and White advanced cancer caregivers

OBJECTIVE

Advanced cancer family caregivers who have good relationships with other family members and with patient's health care providers (PHCPs) have less emotional distress than caregivers with poor relationships. Given a history of different experiences in medical settings among Whites and African Americans, we examined moderation effects by race.

METHODS

Baseline data from an ongoing study were collected via telephone interviews with 397 family caregivers of advanced cancer patients at two cancer clinics. Depressed mood and anxiety were measured with the 14-item Profile of Mood States.

RESULTS

Caregivers reporting good relationships with family (p<.001) and PHCPs (p<.001) had lower anxiety and less depressed mood (family, p<.01; PHCP, p<.001). Caregiver race moderated relationship quality: Whites with good PHCP relationships felt less depressed mood (p<.01) and anxiety (p<.01). African Americans with good family relationships showed less depressed mood (p<.05), but no association with anxiety.

CONCLUSION

Good relationships are important for caregivers, but PHCPs may have more influence on the wellbeing of White than of African American caregivers.

PRACTICE IMPLICATIONS

Developing relationships with caregivers of advanced cancer patients may improve wellbeing for caregivers. In addition, creating strategies to support family relationships may be a useful intervention, especially for African American advanced cancer caregivers.

Creativity in clinical communication: from communication skills to skilled communication

Medical Education 2011: 45: 217-226 Objectives  The view that training in communication skills produces skilled communication is sometimes criticised by those who argue that communication is individual and intuitive. We therefore examine the validity of the concept of communication as a skill and identify alternative principles to underpin future development of this field. Methods  We critically examine research evidence about the nature of clinical communication, and draw from theory and evidence concerning education and evaluation, particularly in creative disciplines. Results  Skilled communication cannot be fully described using the concept of communication skills. Attempts to do so risk constraining and distorting pedagogical development in communication. Current education practice often masks the difficulties with the concept by introducing subjectivity into the definition and assessment of skills. As all clinical situations differ to some extent, clinical communication is inherently creative. Because it is rarely possible to attribute specific effects to specific elements of communication, communication needs to be taught and evaluated holistically. Conclusions  For communication teaching to be pedagogically and clinically valid in supporting the inherent creativity of clinical communication, it will need to draw from education theory and practice that have been developed in explicitly creative disciplines.

Positive and negative interactions with health professionals: a qualitative investigation of the experiences of informal cancer carers

BACKGROUND

Empathic and informative interactions with health professionals are important for the well-being of people with cancer. However, there is a dearth of research examining the construction and experience of interactions with health professionals from the perspective of informal cancer carers.

OBJECTIVE

The aim of this study was to explore how cancer carers subjectively position their experiences of interactions with health professionals, in particular, their construction of experiences as positive or negative, and the perceived consequences of such interactions. Positioning theory is used to examine how the sociomedical construction of health professionals shapes carers' experiences of interactions with them.

METHOD

Semistructured interviews were carried out with 53 informal cancer carers across a range of cancer types and stages, analyzed using thematic decomposition.

RESULTS

Carers positioned positive interactions as those involving health professionals who were warm and genuine, accessible and approachable, and who made carers feel accepted and comfortable. In the case of allied health professionals, the provision of a space for carers' cathartic release was also constructed positively. Negative interactions were positioned as those involving poor communication and a lack of empathy, poor or absent information provision, and absence of guidance about additional support.

CONCLUSIONS

Positive experiences with health professionals were positioned by carers as leading to feelings of empowerment, value, and recognition, and negative interactions as leading to distress, anger, frustration, and feelings of isolation.

IMPLICATIONS FOR PRACTICE

It is important for health professionals to be supportive of carers' needs, to communicate in an empathic manner, to be approachable and accessible, and to recognize carers needs and concerns.