Effective communication skills are the key to good cancer care

An investigation into the current perceptions of Irish Radiographers regarding patient-practitioner communication

INTRODUCTION

Many of the tasks performed by radiographers rely on effective communication with patients. This study aims to evaluate radiographers' experiences communicating with patients to determine what communication skills they believe they have, challenges they encounter and any familiarity with communication tools. It also assesses their willingness to accept further training and utilise recognised scripted communication tools, such as AIDET (Acknowledge, Introduce, Duration, Explanation and Thank you).

METHODS

Data were collected using an online survey deployed using the MS Forms platform. The survey consisted of 42 questions: 12 qualitative 'open-ended' questions and 30 'close-ended' quantitative questions. The survey remained open between March and May 2022. Quantitative data were analysed using descriptive statistics and qualitative responses using thematic content analysis. Cross distribution analysis, basic percentages, and graphic bar charts were used for quantitative data analysis.

RESULTS

One hundred and nine radiographers completed the questionnaire. Quantitative analysis found that 84 % (n = 87) of radiographers had not received additional post-qualification training in patient communication. Five communication themes emerged from the thematic analysis; (1) Expectations, (2) Education, (3) Improvements, (4) Errors, and (5) Communication Tools. The scripted communication tool AIDET, according to 86 % (n = 89) of respondents, was perceived to be potential helpful in improving radiographer-patient interactions.

CONCLUSION

Radiographers do not believe they have received adequate training for communicating with patients and would like to receive additional training and education. AIDET could be a useful communication tool as a starting guide for less experienced radiographers. There is a need for further studies that explore the use and effectiveness of scripted communication tools in radiographers' communications skills. In addition, additional post-registration training opportunities need to be available for radiographers in patient communication.

Study protocol OKRA: orientation compass for the preparing, delivering and following up on breaking bad news conversations in paediatric oncology

INTRODUCTION

In paediatric oncology, 'breaking bad news'-BBN-like cancer diagnosis is perceived as particularly challenging. Enabling a trialogue between children with their relatives and health professionals requires profound communication skills. Lacking the skills, experience or adequate support tools might result in negative consequences for both paediatric oncologists as BBN transmitters and BBN receivers as children with cancer and their relatives.In contrast to oncology for adults, multiperspective studies that explore BBN experience and specific support needs are rare, especially in Germany. Systematically developed and practically piloted support instruments, which address the specific needs of paediatric oncology, are missing.

OBJECTIVE

To systematically design and mature in practice an orientation compass for preparing, delivering and following up on BBN conversations in paediatric oncology-so-called Orientierungskompass zur Übermittlung schwerwiegender Nachrichten in der Kinderonkologie (OKRA).

METHODS AND ANALYSIS

OKRA is based on a QUAL-quant mixed study design, comprising two phases. Four groups will contribute (1) experts through personal experience (representatives for children receiving BBN and their parents), (2) medical care providers and representatives of national medical societies, (3) ambulant psychosocial/psychological support providers and (4) researchers. In phase 1, multiperspective knowledge is generated through a participatory group Delphi that involves in-depth interviews, focus group discussions and questionnaires. This process culminates in formulating theses for a high-quality BBN process (output phase 1). In phase 2, based on the theses, a pilot orientation compass is designed. Through iterative cycles with the participatory action research method, this instrument will be piloted in three paediatric oncological settings and consequently optimised.

ETHICS AND DISSEMINATION

OKRA was approved on 19 September 2023 by the ethics committee of the Medical Faculty of the University of Cologne (No. 23-1187). After project completion, the OKRA compass will be distributed to multidisciplinary paediatric oncology teams throughout Germany.

TRIAL REGISTRATION NUMBER

DRKS00031691.

Effects of on-site Supportive Communication Training (On-site SCT) on doctor-patient communication in oncology: Study protocol of a randomized, controlled mixed-methods trial

BACKGROUND

The quality of communication in oncology significantly impacts patients' health outcomes, as poor communication increases the risk of unnecessary treatment, inadequate pain relief, higher anxiety levels, and acute hospitalizations. Additionally, ineffective communication skills training (CST) is associated with stress, low job satisfaction, and burnout among doctors working in oncology. While acknowledging the importance of effective communication, the specific features of successful CST remain uncertain. Role-play and recorded consultations with direct feedback appear promising for CST but may be time-consuming and face challenges in transferring acquired skills to clinical contexts. Our aim is to bridge this gap by proposing a novel approach: On-site Supportive Communication Training (On-site SCT). The concept integrates knowledge from previous studies but represents the first randomized controlled trial employing actual doctor-patient interactions during CST.

METHODS

This randomized multicenter trial is conducted at three departments of oncology in Denmark. Doctors are randomized 1:1 to the intervention and control groups. The intervention group involves participation in three full days of On-site SCT facilitated by a trained psychologist. On-site SCT focuses on imparting communication techniques, establishing a reflective learning environment, and offering emotional support with a compassionate mindset. The primary endpoint is the change in percentage of items rated "excellent" by the patients in the validated 15-item questionnaire Communication Assessment Tool. The secondary endpoints are changes in doctors' ratings of self-efficacy in health communication, burnout, and job satisfaction measured by validated questionnaires. Qualitative interviews will be conducted with the doctors after the intervention to evaluate its relevance, feasibility, and working mechanisms. Doctors have been actively recruited during summer/autumn 2023. Baseline questionnaires from patients have been collected. Recruitment of new patients for evaluation questionnaires is scheduled for Q1-Q2 2024.

DISCUSSION

This trial aims to quantify On-site SCT efficacy. If it significantly impacts patients/doctors, it can be a scalable CST concept for clinical practice. Additionally, qualitative interviews will reveal doctors' insight into the most comprehensible curriculum parts.

TRIAL REGISTRATION

April 2023 - ClinicalTrials.gov (NCT05842083). April 2023 - The Research Ethics Committee at the University of Southern Denmark (23/19397).

The psychosocial needs of head and neck cancer patients: a multicenter study

INTRODUCTION

Cancer is among the most frequent pathologies and a major cause of death and disability. Scientific research and surgeons focus mainly on aspects relating to etiopathogenesis, diagnosis, and treatment, but often neglect the psychological needs of patients and related social factors. The aim of this study is to investigate the psychological and social needs of patients affected by head and neck cancer to improve patient management and achieve more empathetic care.

MATERIALS AND METHODS

The Need Evaluation Questionnaire (NEQ) was administered to adult patients who had to undergo surgery in 4 Italian tertiary head and neck cancer centers the day before the operation.

RESULTS

188 patients affected by stage I-IV head and neck tumors were enrolled. The main needs expressed by patients fall under the categories of either "information and dialogue", (64.3% more information about future conditions, 50% more information about treatments, 45% more information about the diagnosis, 44% more reassurance) or "spiritual support" (50% need to talk to someone who had the same experience as them).

CONCLUSIONS

Common methods of explaining diagnosis, treatment, and prognosis have proven unsatisfactory to patients and most also require more psychosocial support. This highlights the need to implement interventions and activities that are increasingly geared toward supporting the psychological and relational aspects of the care journey.

Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards

Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.

Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework

The integration of shared decision-making (SDM) into undergraduate oncology education represents a critical evolution in medical pedagogy, reflecting the growing complexity and patient-centric focus of contemporary healthcare. This paper introduces a comprehensive pedagogical framework designed to embed SDM within the undergraduate medical curriculum, particularly in oncology, where the multiplicity of treatment options and their profound impact on patient life underscore the necessity of this approach. Grounded in a systematic literature review and aligned with established educational theories, this framework proposes twelve strategic approaches to cultivate future physicians proficient in both clinical acumen and patient-collaborative decision-making. The framework emphasizes real-world clinical experience, role-playing, case studies, and decision aids to deepen students' understanding of SDM. It advocates for the development of communication skills, ethical deliberation, and cultural competence, recognizing the multifaceted nature of patient care. The inclusion of patient narratives and evidence-based decision-making further enriches the curriculum, offering a holistic view of patient care. Additionally, the integration of digital tools within the SDM process acknowledges the evolving technological landscape in healthcare. The paper also addresses challenges in implementing this framework, such as curricular constraints and the need for educator training. It underscores the importance of continual evaluation and adaptation of these strategies to the dynamic field of medical education and practice. Overall, this comprehensive approach aims not only to enhance the quality of oncological care but also to prepare medical students for the complexities of modern medicine, where patient involvement in decision-making is both a necessity and an expectation.

Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students

BACKGROUND

It is a crucial task for physicians to deliver life threatening information to patients (breaking bad news; BBN). Many aspects influence these conversations on both sides, patients, and doctors. BBN affects the patient-physician relationship, patients' outcome, and physicians' health. Many physicians are still untrained for this multi-facetted task and feel unprepared and overburdened when facing situations of BBN. Therefore, any faculties should aim to integrate communication skills into their medical curricula as early as possible. The SPIKES protocol is an effective framework to deliver BBN. Aim of this study is to evaluate the feasibility and obstacles of a BBN seminar and its acceptance and learning curve among undergraduate medical students.

METHODS

158 2nd year undergraduate medical students attended a compulsory BBN seminar. The task was to deliver a cancer diagnosis to the patient within a patient - physician role-play in a gyneco-oncological setting before and after a presentation of the SPIKES protocol by the lecturer. The students evaluated important communication skills during these role-plays respectively. Self-assessment questionnaires were obtained at the beginning and end of the seminar.

RESULTS

Most students indicated that their confidence in BBN improved after the seminar (p < 0.001). They like the topic BBN to be part of lectures (76%) and electives (90%). Communication skills improved. Lecturer and seminar were positively evaluated (4.57/5).

CONCLUSION

The seminar significantly increased confidence and self-awareness in delivering life-threatening news to patients among undergraduate medical students. Important learning aspects of BBN and communication skills could be delivered successfully to the participants within a short time at low costs. The integration of communication skills should be implemented longitudinally into medical curricula starting before clinical education to increase the awareness of the importance of communication skills, to decrease anxiety, stress, and workload for future doctors and- most importantly- to the benefit of our patients.

A systematic review on the qualitative experiences of people living with lung cancer in rural areas

PURPOSE

To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas.

METHODS

Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden's framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists.

RESULTS

Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities.

CONCLUSIONS

This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

Talking about Familial Breast and Ovarian Cancer Risk-Evaluation of a Psychosocial Training Module for Gynecologists in Germany

Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an increased HBOC risk and deal with emotional, stressful situations in this context. Our project aimed at developing a training module, 'iKNOWgynetics', addressing psychosocial challenges in the context of HBOC care for primary care gynecologists. We developed the psychosocial training module in three phases: first, we conducted an online survey with n = 35 women with a family history of breast or ovarian cancer to assess patients' experiences and needs. Second, based on the results of the needs assessment, we developed the training module. Third, we evaluated the training by assessing physicians' (n = 109) self-efficacy with regard to communication skills in the context of HBOC before and after the training. In the needs assessment, seven psychosocial themes emerged. These themes, complementing a review of the literature, informed the training curriculum. The training was divided into two parts: (1) communicating with women before genetic testing and (2) care co-management for women with HBOC after genetic testing. After the training, participants reported a significant increase in self-efficacy in three domains: communicating empathetically, educating patients in a comprehensible way and dealing with emotionally challenging situations. Our results highlight the relevance of psychosocial issues for patients with HBOC. A genetic literacy training module that integrates aspects of psychosocial care increases physicians' confidence in dealing with emotionally challenging situations before and after their patients' genetic testing. Thus, such trainings may improve the care of women with hereditary cancer risks.

Telehealth serious illness care program for older adults with hematologic malignancies: a single-arm pilot study

ABSTRACT

Older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) feel shocked and bewildered when diagnosed. Serious illness conversations (SICs) may increase disease understanding and preparations for the future. However, SICs often happen late, in part because of clinician-perceived patient discomfort. Telehealth may promote patient comfort by allowing SICs to take place at home. This study assesses the feasibility and usability of a telehealth-delivered Serious Illness Care Program (SICP) for older adults with AML and MDS. We conducted a single-arm pilot study including 20 older adults with AML and MDS. Feasibility was measured using retention rate, with >80% considered feasible. Usability was measured using telehealth usability questionnaire (TUQ; range, 1-7): >5 considered usable. We collected other outcomes including acceptability and disease understanding and conducted post-visit qualitative interviews to elicit feedback. Hypothesis testing was performed at α = 0.10 owing to the pilot nature and small sample size. Retention rate was 95% (19/20); mean TUQ scores were 5.9 (standard deviation [SD], 0.9) and 5.9 (SD, 1.1) for patients and caregivers, respectively. We found the SICP to be acceptable. The majority of patients found the SICP to be very or extremely worthwhile (88.2%; 15/17), and reported it increased closeness with their clinician (75.0%; 12/16). After their visit, patient estimates of curability, and overall life expectancy aligned more closely with those of their clinicians. In qualitative interviews, most patients said that they would recommend this program to others (89.5%, 17/19). This study demonstrated that delivery of the telehealth SICP to older patients with AML and MDS is feasible, usable, and acceptable. This trial is registered at www.clinicaltrials.gov as #NCT04745676.

Navigating Intercultural Medical Encounters: An Examination of Patient-Centered Communication Practices with Italian and Foreign Cancer Patients Living in Italy

Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor-patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor's communicative behavior, patient's initiatives, misalignments, interruptions, accountability, and expressions of trust in participants' talk, Markers of uncertainty in doctor's talk, markers of emotions in doctor's talk). Forty-two video-recorded patient-oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.

Facilitators and Barriers to a Hospital-Based Communication Skills Training Programme: An Interview Study

This study aimed to investigate the facilitators and barriers experienced by the department management (DMs) and communication skills trainers (trainers) during the implementation of a 3-day communication skills training (CST) programme for healthcare professionals (HCPs). Thus, we conducted semi-structured interviews with 23 DMs and 10 trainers from 11 departments concurrently implementing the CST programme. Thematic analysis was undertaken to elucidate the themes across the interviews. Five themes were developed: resource consumption; obstacles; management support; efforts and outcomes; and a lack of systematic follow-up. Although the DMs and trainers were largely in agreement, the theme of a lack of systematic follow-up was derived exclusively from the trainers, as were two of the subthemes within obstacles: (b) seniority, profession, and cultural differences, and (c) the trainers' competencies. The greatest perceived barrier was resource consumption. In addition, DMs found planning and staff resistance to be a challenge. However, the HCPs' resistance diminished or even changed to satisfaction after participating. The mandatory approach served as both a facilitator and a barrier; DMs' support was an essential facilitator. Explicit communication related to resource demands, planning, and participation is crucial, as is management support and the allocation of resources.

Media coverage of cancer therapeutics: A review of literature

BACKGROUND

Information and stories about cancer treatment are increasingly available to patients and the general public through lay media, websites, blogs and social media. While these resources may be helpful to supplement information provided during physician-patient discussions, there is growing concern about the extent to which media reports accurately reflect advances in cancer care. This review aimed to understand the landscape of published research which has described media coverage of cancer treatments.

METHODS

This literature review included peer-reviewed primary research articles that reported how cancer treatments are portrayed in the lay media. A structured literature search of Medline, EMBASE and Google Scholar was performed. Potentially eligible articles were reviewed by three authors for inclusion. Three reviewers, each independently reviewed eligible studies; discrepancies were resolved by consensus.

RESULTS

Fourteen studies were included. The content of the eligible studies reflected two thematic categories: articles that reviewed specific drugs/cancer treatment (n = 7) and articles that described media coverage of cancer treatment in general terms (n = 7). Key findings include the media's frequent and unfounded use of superlatives and hype for new cancer treatments. Parallel to this, media reports over-emphasize potential treatment benefits and do not present a balanced view of risks of side effects, cost, and death. At a broad level, there is emerging evidence that media reporting of cancer treatments may directly impact patient care and policy-making.

CONCLUSIONS

This review identifies problems in current media reports of new cancer advances - especially with undue use of superlatives and hype. Given the frequency with which patients access this information and the potential for it to influence policy, there is a need for additional research in this space in addition to educational interventions with health journalists. The oncology community - scientists and clinicians - must ensure that we are not contributing to these problems.

The Nursing-Home Care Quality Perceived Levels from Patients and Caregivers: An Explanatory Study

Background

The nursing essential mission was to satisfy patients' and caregivers' essential health-relating demand, thanks to communicational, interventional, assistance and helping skills through an appropriate approach which best satisfied both patients and their caregivers. To assess any differences in nursing-home care quality perceived levels both by patients and caregivers.

Methods

A cohort observational study was conducted from November 2022 to January 2023 using an online anonymous questionnaire for both patients and caregivers who received nursing-home care service.

Results

A total of 677 patients (43.4%) and caregivers (56.6%) were enrolled. Most interviewees benefited from the nursing-home care service less than 12 months (p = 0.014). Quality perceptions did not significantly vary from patients and caregivers (p > 0.05) for all the items proposed, with the exception of the nursing listening skills which was better assessed by caregivers than patients (p = 0.034).

Conclusion

Patients and caregivers perceived an average quality of nursing-home care, giving particular importance to some nursing skills, such as listening skills. The general quality of nursing care was however satisfying. Findings suggested more incisive action from health-care nurses to improve quality of nursing-home care and both patient and caregiver satisfaction.

Patient prompts in surgical consultations: A systematic review

BACKGROUND

Quality communication has been found to improve patient outcomes. Despite good communication, information may still be forgotten or misunderstood by patients. A question prompt list is a document to help patients ask questions. Question prompt lists are well perceived by various stakeholders and have been found of benefit to patients. This systematic review evaluated the effectiveness of patient question prompting documents in surgical outpatient consultations.

METHODS

MEDLINE, EMBASE, and PsychINFO were searched on September 13, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of question prompt lists and their influence on patient outcomes. We excluded studies that did not have a comparator group. Because of heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (identification number: CRD42021279058).

RESULTS

Searches identified 107 suitable studies; however, only 7 studies met eligibility criteria. All included studies were randomized controlled trials, but the designs of studies were heterogenous. Three out of 7 included studies were at a high risk of bias. The included studies investigated different outcomes that could be broadly categorized into 5 themes: consultation characteristics, patient engagement, patient well-being, information exchange, and patient satisfaction. None of the studies looked at patient recall of information. Aside from length of consultation, the overall results for each category were mixed.

CONCLUSION

Current literature has suggested that question prompt lists are a low-risk intervention that could improve patient engagement and patient-doctor communication; however, there is limited evidence at present to conclusively promote their usage in perioperative surgical consultations.

Exploring metaphor's communicative effects in reasoning on vaccination

INTRODUCTION

The paper investigates the impact of the use of metaphors in reasoning tasks concerning vaccination, especially for defeasible reasoning cases. We assumed that both metaphor and defeasible reasoning can be relevant to let people understand vaccination as an important collective health phenomenon, by anticipating possible defeating conditions.

METHODS

We hypothesized that extended metaphor could improve both the argumentative and the communicative effects of the message. We designed an empirical study to test our main hypotheses: participants (N = 196, 78% females; Meanage = 27.97 years, SDage = 10.40) were presented with a text about vaccination, described in either literal or metaphorical terms, based on uncertain vs. safe reasoning scenarios.

RESULTS

The results of the study confirmed that defeasible reasoning is relevant for the communicative impact of a text and that an extended metaphor enhances the overall communicative effects of the message, in terms of understandability, persuasion, perceived safety, and feeling of control over the health situation, collective trust in expertise and uptake of experts' advice. However, the results show that this effect is significantly nuanced by the type of defeasible reasoning, especially in the case of participants' trust in expertise and commitment to experts' advice.

CONCLUSION

Both communicative and defeasible reasoning competences are needed to enhance trust in immunization, with possible different outcomes at an individual and collective level.

Child- and family-specific communication skills trainings for healthcare professionals caring for families with parental cancer: A systematic review

Introduction

As part of high-quality cancer care, healthcare professionals (HCPs) play a significant role in identifying and addressing specific needs of cancer patients parenting minor children. However, HCPs experience various barriers to adequately support parents with cancer. This systematic review explores current CSTs incorporating child- and family- specific modules for HCPs in oncology. Moreover, outcome measures and effectiveness of trainings are systematically investigated.

Methods

The systematic review was registered within PROSPERO (registration code: CRD42020139783). Systematic searches were performed in four databases (PubMed, Cinahl, PsycInfo, Web of Science) in 12/2020, including an update in 12/2021 and 08/2022. Quantitative, primary studies fulfilling the pre-defined inclusion criteria were included. Due to the expected heterogeneity a meta-analysis was not conducted. Study selection and quality assessment were conducted by two independent researchers, data extraction by one. Study quality was assessed using an adapted version of the National Institutes of Health quality assessment tool for pre-post studies without control group.

Results

Nine studies were included in this review following an experimental pre-post design only. Two CSTs were specifically designed to improve communication with cancer patients parenting minor children, the remaining seven incorporated a brief family module only. Seven programs were face-to-face trainings, one an e-learning and one a webinar. Eight studies found at least one statistically significant improvement in communication after training. However, quality of most studies was fair.

Conclusion

This is the first review exploring specific CSTs for HCPs caring for cancer patients parenting minor children. As only two CSTs focused on parental cancer, evidence on the effectiveness of such CSTs is limited. Existing CSTs should be evaluated properly and include details on content of family modules. Further studies including and evaluating specific CSTs focusing on parental cancer are needed in order to strengthen HCPs’ competencies to meet specific needs of patients parenting minor children.

Translating knowledge into practice for communication skills training for health care professionals

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits. Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as 'core business', otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.

Gynecologic oncology patient perspectives and knowledge on advance care planning: A quality improvement intervention

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Gynecologic oncology patients prefer advance care planning (ACP) communication outpatient with their gynecologic oncologist.

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A quality improvement intervention offering advance care planning resources increased ACP discussions.

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A quality improvement intervention offering advance care planning resources improved ACP document creation proficiency.

Objectives

Assess and improve advance care planning (ACP) awareness and uptake among gynecologic oncology patients.

Methods

Using a quality improvement Plan-Do-Check-Act framework, we completed a single institution needs assessment and intervention. The needs assessment was a 26-question survey assessing baseline ACP knowledge and preferences of gynecologic oncology patients. We used this survey to implement an outpatient intervention in which patients were offered ACP resources (pamphlet, discussion with their gynecologic oncologist, and/or social work referral). We conducted a post-intervention survey among patients who had and had not received ACP resource(s) to assess whether our intervention increased ACP knowledge, discussions, or uptake.

Results

Among 106 patients surveyed in the needs assessment, 33 % had ACP documents, 26 % had discussed ACP with a physician, and 82 % thought discussing ACP was important. The majority preferred these conversations in the outpatient setting (52 %) with their gynecologic oncologist (80 %) instead of nurses or trainees. In the intervention, 526 patients were offered ACP resources. Compared to women who did not receive resources (n = 324), patients who received ACP resource(s) (n = 202) were more likely to have ACP discussions with their gynecologic oncologist (38 % vs 68 %, P = 0.001) and had greater proficiency regarding how to create ACP documents (median score 5/10 vs 8/10, P = 0.048), although they were no more likely to have ACP documented in their electronic medical record (27 % vs 9 %, p = 0.08).

Conclusions

ACP uptake among gynecologic oncology patients is low, but ACP discussions with an oncologist during outpatient visits are important to patients and improve their knowledge regarding completing ACP documents.

Cancer patients' experiences and preferences when receiving bad news: a qualitative study

PURPOSE

Receiving a cancer diagnosis significantly impacts patients' lives, and how the bad news is delivered influences patients' trajectory, psychosocial adjustment and openness to psycho-oncological support. We explored how patients' experiences, reactions and preferences were when receiving the news and which optimization recommendations can be made.

METHODS

We conducted an exploratory qualitative study with patients who enrolled in the new integrated cross-sectoral psycho-oncological care programme 'isPO', being enrolled 12 months post-diagnosis. Data on the main issue (i.e. perception of the moment when the diagnosis is received) were collected via telephone interviews that were fully audiotaped and transcribed. Two independent coders conducted inductive content analyses using MAXQDA.

RESULTS

Out of 38 approached patients, 23 cancer patients with 13 different tumour entities participated. They had a mean age of 54.2 (SD 16.2); n = 17 (74%) were female. Three major themes with 14 corresponding subthemes emerged: (1) patients' experiences with the bad news delivery, including setting, mode, preparation and perceived needs; (2) patients' reactions to the bad news, such as shock, fear and helplessness, disbelief and denial, anger and feeling of injustice, thankfulness and depression; and (3) patients' receiving preferences, including psycho-oncological support, addressing informational needs, needs-driven comprehensive support and a competent multidisciplinary support team.

CONCLUSIONS

The quality of bad news delivery and addressing patients' needs should be strongly considered by physicians. We recommend integrating patients' perspective on the quality management processes of breaking bad news. For providing needs-centred high-quality care, applying existing guidelines and acquiring patient-centred communication skills are central.

A prospective cross-sectional survey comparing patient and provider expectations regarding ovarian cancer prognosis

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Providers believe prognostic discussions are important for ovarian cancer patients.

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Providers report having prognostic conversations more often than patients.

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Ovarian cancer patients and providers have different expectations surrounding treatment, remission, and survival.

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Age, marital status, religion, and cancer stage may affect patient perceptions of ovarian cancer prognosis.

Introduction

There is limited data comparing patient and physician expectations regarding ovarian cancer prognosis. Our primary objective was to compare physician and patient estimates of survival to 6 months, 1 year, and 5 years; secondary objectives included comparing provider and patient responses on the likelihood of requiring future treatments and categorizing patient and provider preferences regarding communication about prognosis.

Methods

A prospective cross-sectional survey was delivered to 10 gynecologic oncology providers and 50 adult ovarian cancer patients from November 2015-April 2016 at one institution. Descriptive statistics were used to categorize survey answers and compare survey answers between patients and providers; multivariable logistic regression evaluated patient survey responses.

Results

All providers (100%) believed treating providers should discuss prognosis and 90% reported having prognostic conversations with patients, compared to 63%, 37%, and 4% of patients who reported discussing prognosis, living wills/advance directives, and palliative care/hospice services, respectively, with their provider. Compared to their provider, patients gave significantly lower estimations of requiring any future therapy (mean score 84.6 vs 74, p <.001) and future chemotherapy (mean score 84.1 vs 69.8, p <.001) and significantly higher estimations of requiring future surgery (mean score 23.3 vs 40, p <.001), achieving remission (mean score 33.5 vs 47.5, p =.009), survival to 1 year (mean score 77.1 vs 86.4, p =.002), and survival to 5 years (mean score 40.5 vs 61.3, p <.001).

Conclusions

Although gynecologic oncology providers believe it is important to discuss prognosis and end-of-life care, there are gaps in communication, knowledge, and expectations between providers and ovarian cancer patients.

Questions and emotional expressions from patients and companions while participating in multidisciplinary tumor conferences in breast and gynecological cancer centers

OBJECTIVE

To investigate (a) how many questions and negative emotions (cues/concerns) breast and/or gynecologic cancer patients and companions express during their case discussion in multidisciplinary tumor conferences (MTCs), (b) with which topics the emotions are linked, and (c) which patient- and context-related characteristics determine patients' communicative behavior.

METHODS

This observational study included audio/video recordings of MTCs with patient participation in three breast and gynecological cancer centers. Using the Verona Coding Definitions of Emotional Sequences, patients' and companions' questions and negative emotions expressed were analyzed. Multiple regression analyses were used to determine associations between communicative behavior and patient- and context-related characteristics.

RESULTS

We identified 607 questions and 230 cues/concerns expressed by patients/companions in 82 case discussions in MTCs. The number of questions was significantly associated with the hospital. In case discussions with patients who had need for psychological support and who were accompanied, more questions were asked by patients/companions.

CONCLUSION

The results show that active patient participation does not depend only on patient characteristics, but also on the hospital setting.

PRACTICE IMPLICATIONS

If cancer centers want to enable patient participation in MTCs, they must define the role of the patient before. Subsequently, conditions must be created to enable this role expectation.

Patients' perceptions of the quality of nursing services

Introduction

The quality of nursing services is one of the main factors accelerating patients' recovery. The present study aimed to examine patients' perceptions of the quality of nursing services in the teaching hospitals of Iran.

Methods

This cross-sectional research was a descriptive-analytical study conducted in 2021, in which 1067 patients were selected as the research sample. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient using SPSS software version 23.

Results

From the patients' perspective, the mean and standard deviation of the quality of nursing services was 191.47 ± 19.51. Among the quality dimensions, all services quality: psychosocial (91.34 ± 9.34), physical (65.72 ± 10.18), and communication (34.41 ± 6.21) were placed at the moderate level. A significant association was found between patients’ age and nursing service quality. The perceived nursing service quality was subject to sex (P = 0.01, t = 1.921) and place of residence (P = 0.02, t = 1.873).

Conclusion

According to the findings, the quality of nurses 'care was "moderate" from the patients' perspectives. Planning is recommended to reinforce and promote the quality of nursing services.

Evaluating the association of frailty with communication about aging-related concerns between older patients with advanced cancer and their oncologists

BACKGROUND

A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown.

METHODS

This was a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and impairment on 1 or more GA domains (ClinicalTrials.gov Identifier NCT02107443; principal investigator Supriya G. Mohile). Practice sites were randomized to either the GA-intervention or usual care. Frailty was assessed with a deficit accumulation index (range, 0-1), and patients were stratified as robust (0 to <0.2), prefrail (0.2 to <0.35), or frail (≥0.35). The clinic visit after the GA-intervention was audio-recorded, transcribed, and coded to evaluate the number and quality of conversations about aging-related concerns. Linear mixed models examined differences in the number and quality of conversations within and between arms. All P values were 2-sided.

RESULTS

Patients (n = 541) were classified as robust (27%), prefrail (42%), or frail (31%). In the usual care arm, frail patients (vs robust ones) engaged in more aging-related conversations (adjusted mean difference, 1.73; 95% confidence interval [CI], 0.59-2.87), conversations of higher quality (difference, 1.12; 95% CI, 0.24-2.0), and more discussions about evidence-based recommendations (difference, 0.71; 95% CI, 0.04-1.38; all P values ≤ .01). Similarly, in the GA intervention arm, frail patients (vs robust ones) engaged in more aging-related conversations (difference, 2.49; 95% CI, 1.51-3.47), conversations of higher quality (difference, 1.31; 95% CI, 0.56-2.06), and more discussions about evidence-based recommendations (difference, 0.87; 95% CI, 0.32-1.42; all P values ≤ .01). Furthermore, the GA-intervention significantly improved the number and quality of conversations in all patients: robust, prefrail, and frail (all P values ≤ .01).

CONCLUSIONS

Patients with higher degrees of frailty and those exposed to the GA-intervention had more and higher quality conversations about aging-related concerns with oncologists.

LAY SUMMARY

A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown. This study conducted a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and 1 or more GA domain impairments. Patients were stratified as robust, prefrail, or frail. The number and quality of conversations about aging-related concerns that occurred during the clinic visit after the GA-intervention were determined. Patients with higher degrees of frailty and those in the GA intervention arm had more and higher quality conversations about aging-related concerns with oncologists.

Development, acceptability and uptake of an on-line communication skills education program targeting challenging conversations for oncology health professionals related to identifying and responding to anxiety and depression

Background

Anxiety and depression screening and management in cancer settings occurs inconsistently in Australia. We developed a clinical pathway (ADAPT CP) to promote standardized assessment and response to affected patients and enhance uptake of psychosocial interventions. Health professional education is a common strategy utilised to support implementation of practice change interventions. We developed an interactive on-line education program to support staff communication and confidence with anxiety/depression screening and referral prior to the ADAPT CP being implemented in 12 oncology services participating in the ADAPT CP cluster randomised controlled trial (CRCT). The aim of this research was to assess acceptability and uptake of the education program.

Patient Involvement: Although the wider ADAPT Program included patient consumers on the Steering Committee, in the context of this research consumer engagement included health professionals working in oncology. These consumers contributed to resource development.

Methods

Development was informed by oncology and communication literature. The five online modules were pilot tested with 12 oncology nurses who participated in standardised medical simulations. Acceptability and uptake were assessed across the 12 Oncology services participating in the ADAPT CRCT.

Results

During pilot testing the online training was reported to be acceptable and overall communication and confidence improved for all participants post training. However, during the ADAPT CRCT uptake was low (7%; n = 20). Although those who accessed the training reported it to be valuable, competing demands and the online format reportedly limited HPs’ capacity and willingness to undertake training.

Conclusions

This interactive on-line training provides strategies and communication skills for front-line staff to guide important conversations about psychosocial screening and referral. Building workforce skills, knowledge and confidence is crucial for the successful implementation of practice change interventions. However, despite being acceptable during pilot testing, low uptake in real world settings highlights that organisational support and incentivisation for frontline staff to undertake training are critical for wider engagement. A multimodal approach to delivery of training to cater for staff preferences for face to face and/or online training may maximise uptake and increase effectiveness of training interventions.

Trial registration

Pilot study ACTRN12616001490460 (27/10/2016). ADAPT RCT ACTRN12617000411347(22/03/2017).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07521-5.

Communication and collaboration skills training in Radiation Oncology in Australia and New Zealand: A qualitative study

PURPOSE

Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods.

MATERIALS AND METHODS

Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent.

RESULTS

After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub-themes.

CONCLUSIONS

There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work-based assessments. CCST templates are recommended.

Language Proficiency and Survival in Pancreatic Cancer: a Propensity Score-Matched Analysis

BACKGROUND

Limited English proficiency has been shown to negatively affect health outcomes. However, as of now, little is known about survival rates of patients with limited English proficiency (LEP) and pancreatic ductal adenocarcinoma (PDAC) when compared to patients with English proficiency (EP) in an urban, non-safety net setting. We aimed to compare survival rates between patients with LEP and those with EP who had a diagnosis of PDAC.

METHODS

A single-institution retrospective propensity-matched cohort study of patients with biopsy-proven PDAC was undertaken. Demographics, clinical characteristics, and language information were collected for all participants. Patients were classified as having LEP or EP based on their preferred speaking language at the time of admission and matched on baseline characteristics using propensity scores. Survival analysis methods were used to study survival rates in patients with PDAC based on their EP status.

RESULTS

Of 739 included patients, 71 (9.48%) had LEP, mean age was 68.4 ± 10.9, and 51.8% were female. Both groups of patients were comparable for age, gender, marital status, and time to treatment. LEP status was associated with higher odds of death in both unmatched (HR 1.65, 95% CI 1.22-2.22) and matched (HR 1.60, 95% CI 1.03-2.47) analyses. Additionally, patients with LEP had significantly decreased odds of receiving cancer-directed treatment and increased odds of advanced stage cancer at presentation.

CONCLUSIONS

In this cohort of patients with PDAC, LEP predicted worse survival. The results of this study suggest that, after accounting for interpreter use, other factors contribute to this disparity. Such factors, as yet unmeasured, may include health literacy and cultural expectations, for which further investigation is warranted to better understand and limit this survival disparity.

Healthcare avoidance: a qualitative study of dental care avoidance in Germany in terms of emergent behaviours and characteristics

Background

The treatment of acute pain is part of everyday dental practice. Often, these symptoms result from years of patients' inadequate or missing dental routines and lead to a reduction in the quality of life or health of the patients and to high costs for the health care system. Despite the enormous advantages of modern dentistry, many patients avoid going to the dentist. Therefore, the study aimed to determine the reasons and behaviours that cause patients to avoid visits to the dentist.

Methods

We conducted semi-structured interviews with patients who had an above-average DMFT index and had been going to the dentist only irregularly for years. The sample participants were recruited from the northern German region of Mecklenburg-Western Pomerania. 20 individual interviews were recorded, transcribed verbatim and coded. We used a qualitative framework approach to code the transcripts in order to establish a consensus among the researchers. Ultimately, through discussions and reviews of the attributes and meaning of the topics, a typology could be established.

Results

A typology of patients who avoid the dentist was developed. Four independent characteristic patterns of dentist avoidance could be developed: avoiding the dentist due to "distance" (type A; includes subtype A1 "avoiding the dentist due to negligence" and subtype A2 "dental avoidance due to neutralization"), "disappointment" (type B), "shame" (type C), and "fear" (type D). Using the typology as a generalised tool to determine the minimum and maximum contrasts, it was possible to capture the diversity and multidimensionality of the reasons and behaviours for avoidance. All patients had negative dental experiences, which had led to different avoidance patterns and strategies.

Conclusions

The identified avoidance characteristics represent a spectrum of patients from Northern Germany who avoid going to the dentist. This is the first comprehensive study in Germany representing avoidance behaviour of dentist patients in the form of a typology. The results suggest that dentistry also needs qualitative research to better understand patient characteristics and provide direct access to patients who avoid regular dental visits. Thus, the results make a potentially fundamental contribution to the improvement of dental care and enrich its understanding.

Do you want to receive bad news through your patient accessible electronic health record? A national survey on receiving bad news in an era of digital health

Despite the fact that patient accessible electronic health records (PAEHRs) have been around for many years in several countries, there is a lack of research investigating patient's preferences for receiving bad news, including through PAEHRs. Little is also known about the characteristics of the patients who prefer to receive bad news through the PAEHR in terms of, for example medical diagnosis, age and educational level. This study, based on a national patient survey in Sweden (N = 2587), investigated this. Results show that, generally, receiving bad news by reading in the PAEHR is still among the least preferred options. Additionally, a higher proportion of men want to receive bad news in the PAEHR compared to women (p = 0.001), and the same goes for those who are not working/have worked in healthcare (p = 0.007). An effect of disease groups was also found, showing that diabetes patients in particular, want to receive bad news through the PAEHR.

Evaluation of a Tool that Enables Cancer Patients to Participate in the Decision-Making Process during Treatment Selection

BACKGROUND

Patient participation in decisions related to their treatment is strongly recommended. This study was conducted to develop and evaluate a support tool that can help patients make decisions related to their own treatment.

METHODS

Twenty cancer patients who were hospitalized for first-line treatment were enrolled. Before hospitalization, a 'Check sheet on treatment selection', which contained 14 questions, was distributed to patients and/or their families. After hospitalization, the attending physician explained the treatment while referring to the written check sheet. At discharge, patients' responses to the 'Questionnaire on check sheet and treatment selection' were collected to evaluate the utility of the check sheet. Finally, the 'Questionnaire of the check sheet' was handed to the attending physician to evaluate.

RESULTS

Of the fourteen patients who responded to the questionnaire, all indicated that the check sheets were helpful for decision-making and that using the sheets empowered them to ask their doctors questions. Only one person felt uncomfortable with compiling the check sheet. Physicians stated that the check sheet facilitated patient decision-making and improved communication with patients. However, some felt that this activity increased the administrative burden of medical professionals.

CONCLUSION

Almost all patients stated that the present check sheet was useful as a decision support tool and facilitated communication between doctors and patients. Before incorporation into general clinical practice, this increased benefit should be weighed against the potential extra administrative workload imposed on clinicians.

Cancer patients' information seeking behavior related to online electronic healthcare records

Patients' online access to their EHR together with the rapid proliferation of medical information on the Internet has changed how patients use information to learn about their health. Patients' tendency to turn to the Internet to find information about their health and care is well-documented. However, little is known about patients' information seeking behavior when using online EHRs. By using information horizons as an analytical tool this paper aims to investigate the information behavior of cancer patients who have chosen to view their EHRs (readers) and to those who have not made that option (non-readers). Thirty interviews were conducted with patients. Based on information horizons, it seems that non-reading is associated with living in a narrower information world in comparison to readers. The findings do not suggest that the smallness would be a result of active avoidance of information, or that it would be counterproductive for the patients. The findings suggest, however, that EHRs would benefit from comprehensive linking to authoritative health information sources to help users to understand their contents. In parallel, healthcare professionals should be more aware of their personal role as a key source of health information to those who choose not to read their EHRs.

Communication and humanization of care: Effects over burnout on nurses

BACKGROUND

Healthcare professionals may have certain psychological characteristics which contribute to increasing the quality of their professional performance.

OBJECTIVE

Study the effect that humanization of care and communication have on the burnout syndrome in nursing personal.

METHODS

The sample included a total of 330 Spanish nurses. Analytical instruments used were the Health Professional's Humanization Scale (HUMAS), Communication Styles Inventory Revised (CSI-R) and Brief Burnout Questionnaire Revised (CBB-R).

RESULTS

Two broad nursing profiles could be differentiated by their level of humanization (those with scores over the mean and those with scores below it in optimistic disposition, openness to sociability, emotional understanding, self-efficacy, and affection), where the largest group had the high scores. A communication repertoire based on verbal aggressiveness impacted indirectly on the effect of humanization on burnout, mainly in the personal impact component. We observed the relation of humanization profiles in nursing staff with the job dissatisfaction and burnout components. Besides that, some communication styles, verbal aggressiveness and questioningness, have an indirect effect on the relationship between humanization profiles and job dissatisfaction.

CONCLUSIONS

The results on the relationship between communication styles and burnout, and the mediator effect of communication styles on the relationship between humanization of care and burnout in nursing personnel are discussed.

Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

BACKGROUND

Head and neck cancers (HNC) and their treatments cause dysfunction and distress. Ongoing psychological assessment using disease-specific patient-reported measures may optimize clinical decision-making, facilitate interventions to reduce psychosocial burden. As most such measures are developed in English, non-English speaking patients are disadvantaged. This study translated HNC-specific measures (Body Image Scale, Patient Concerns Inventory, Zung's Self-Rating Anxiety and Depression Scales and Patient Health Questionnaire-9) into three Indian languages (Hindi, Tamil and Telugu) and linguistically validated them.

METHODS

Translation followed established guidelines on translation and linguistic validation of measures. Process involved two independent forward translations, reconciliation, two independent backward translations by bilingual experts, and cognitive debriefing interviews with nine healthcare professionals (HCPs) and 29 HNC patients. Translated versions were compared with the original versions for semantic, cultural and conceptual equivalence.

RESULTS

Overall, 17 Hindi items, 19 Tamil items and 13 Telugu items were identified to have semantic, cultural and/or conceptual issues. These were resolved to achieve equivalence with the original measures. Interviews with HCPs indicated that equivalent terms for words such as anxiety, panicky, sexuality, and self-conscious might be difficult to understand. Interviews with patients indicated all items were understandable, easy, sensitive, unambiguous and relevant. Hence, no further revisions were made.

CONCLUSIONS

The translated Hindi, Tamil and Telugu versions of the Body image scale, Patient concerns inventory, Zung's self-rating anxiety and depression scales and Patient health questionnaire-9 measures are conceptually and linguistically validated and equivalent with the original English versions. Psychometric validation of these measures with relevant patient populations is needed.

Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study

Objectives

This study examined the relationship between professionals’ perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals’ experiences in improvement science were a moderator on such a relationship.

Design

From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed.

Setting

Three Swedish regions.

Participants

155 healthcare professionals who had previously participated in courses in improvement science.

Results

The covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals’ experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals’ perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals’ experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals.

Conclusion

Increased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals’ experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.

A concept analysis of remission within the domain of cancer survivorship

AIM

This concept analysis aims to formulate a unique theoretical definition of the term remission as used in cancer survivorship.

BACKGROUND

Inadequate communication between healthcare providers and cancer survivors is a shared burden affecting survivor well-being. Healthcare providers regularly use the term remission in cancer prognosis, treatment, and long-term cancer management; yet, how healthcare providers and cancer survivors define and interpret the concept of remission is less understood.

DESIGN

The Walker and Avant method of concept analysis was applied to define the term remission within the domain of cancer survivorship. DATA SOURCE: Three health sciences databases were chosen for the literature search, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline. REVIEW METHODS: Included research articles were evaluated to define the antecedents, attributes, consequences, and empirical referents of the term remission.

RESULTS

A cancer diagnosis is the most commonly cited antecedent to cancer remission. During remission, most cancer patients are free of measurable or symptomatic disease; however, the remission milestone is complemented by multiple physical and psychological symptoms. More specific cancer remission attributes include anxiety, recurrence fears, self-perseverance, and loss of social support. Both positive and negative outcomes accompany cancer remission, including acceptance of the treatment journey, appreciation for life, hope, persistent anxiety, personal relief, and triggered memories.

CONCLUSIONS

This concept analysis reviewed numerous publications to understand remission in the context of cancer survivorship. Advanced practice and registered nurses have a continued opportunity to improve the communication methods of patient-centered teaching and care planning for cancer patients in remission.

Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients

Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.

What if… I Asked Cancer Patients About Psychological Distress? Barriers in Psycho-Oncological Screening From the Perspective of Nurses-A Qualitative Analysis

INTRODUCTION

Screening questionnaires to assess psychological distress in cancer patients are well-established, but in practice there are difficulties in implementation screening up to referral to psycho-oncology. Interdisciplinary collaboration between psycho-oncology, physicians, and nursing is very important to this process. However, there are barriers and obstacles on all sides.

OBJECTIVE

The aim of this study is to capture in particular the barriers from the perspective of oncology nursing.

MATERIALS AND METHODS

Semi-structured interviews with nursing experts (n = 15; n = 10 female; 24-62 years) from different oncology departments of three university hospitals in Germanys were conducted and qualitative content analysis was carried out by two raters.

RESULTS

The Screening routine is variably well-integrated into daily clinical practice. Structural barriers such as time pressure and a lack of focus on mental distress in nursing are present. Barriers on the side of nurses are primarily a lack of knowledge and communication insecurities when dealing with patients.

CONCLUSIONS

There is a need for training and implementation of a disciplinary screening approach. The structural and organizational barriers, which are a challenge for the successful screening process due to unfavorable interdisciplinary team communication and clinical daily structure, should be addressed in further studies. Implications for Practice: In order to establish an interdisciplinary screening process and to overcome the barriers, trainings to deal with knowledge deficits and insecurities seem to be useful.

Enhancing your ‘webside’ manner: communication during COVID ‐19

Virtual communication and interacting with patients while partially hidden behind a mask are now part of everyday clinical practice as a result of COVID‐19. Healthcare professionals need to develop new strategies to ensure that non‐verbal cues and the reassurance that subtle body language can provide are not compromised.

Hospital end-of-life care: families' free-text notes

BACKGROUND

Palliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients' loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones' perspectives on need for improvements.

AIM

To identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.

DESIGN

Within the validation study of the questionnaire 'Care of the Dying Evaluation' (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.

SETTING/PARTICIPANTS

Loved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.

RESULTS

993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient's and/or loved one's will, involvement in decision-making at the end of life (patient's volition) and having the possibility to say goodbye.

CONCLUSIONS

It is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients' will and to be emotionally supported.

TRIAL REGISTRATION NUMBER

This study was registered at the German Clinical Trials Register (DRKS00013916).

The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation

INTRODUCTION

Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level.

AIMS

To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists.

METHODS/MATERIALS

Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups.

RESULTS

An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient.

DISCUSSION/CONCLUSION

Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

Patients' communication preferences for receiving a cancer diagnosis: Differences depending on cancer stage

OBJECTIVE

This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis.

METHODS

A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale.

RESULTS

Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support.

CONCLUSIONS

Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

Genetic Counseling, Testing, and Management of HBOC in India: An Expert Consensus Document from Indian Society of Medical and Pediatric Oncology

PURPOSE

Hereditary breast and ovarian cancer (HBOC) syndrome is primarily characterized by mutations in the BRCA1/2 genes. There are several barriers to the implementation of genetic testing and counseling in India that may affect clinical decisions. These consensus recommendations were therefore convened as a collaborative effort to improve testing and management of HBOC in India.

DESIGN

Recommendations were developed by a multidisciplinary group of experts from the Indian Society of Medical and Pediatric Oncology and some invited experts on the basis of graded evidence from the literature and using a formal Delphi process to help reach consensus. PubMed and Google Scholar databases were searched to source relevant articles.

RESULTS

This consensus statement provides practical insight into identifying patients who should undergo genetic counseling and testing on the basis of assessments of family and ancestry and personal history of HBOC. It discusses the need and significance of genetic counselors and medical professionals who have the necessary expertise in genetic counseling and testing. Recommendations elucidate requirements of pretest counseling, including discussions on genetic variants of uncertain significance and risk reduction options. The group of experts recommended single-site mutation testing in families with a known mutation and next-generation sequencing coupled with multiplex ligation probe amplification for the detection of large genomic rearrangements for unknown mutations. Recommendations for surgical and lifestyle-related risk reduction approaches and management using poly (ADP-ribose) polymerase inhibitors are also detailed.

CONCLUSION

With rapid strides being made in the field of genetic testing/counseling in India, more oncologists are expected to include genetic testing/counseling as part of their clinical practice. These consensus recommendations are anticipated to help homogenize genetic testing and management of HBOC in India for improved patient care.

Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews

BACKGROUND

Despite the significant benefits of palliative care (PC) services for cancer patients, multiple challenges hinder the provision of PC services for these patients. Low- and middle-income countries (LMICs) are witnessing a sharp growth in the burden of non-communicable diseases. There is a significant gap between demand and supply of PC in LMICs in current health services. This review aims to synthesise evidence from previous reviews and deliver a more comprehensive mapping of the existing literature about personal, system, policy, and organisational challenges and possible facilitators on the provision of PC services for cancer patients in LMICs.

METHODS

A systematic review of reviews was performed following PRISMA guidelines. PubMed, EMBASE, SCOPUS, PsycINFO, Web of Sciences, CINAHL, and Cochrane Library databases were searched to identify review papers published between 2000 and 2018 that considered challenges and possible facilitators to PC provision. A modified socioecological model was used as a framework for analysing and summarising findings.

RESULTS

Fourteen reviews were included. The reviews varied in terms of aim, settings, and detail of the challenges and possible facilitators. The main challenges of personal and health care systems included knowledge deficits and misunderstandings from patients, families, the general public, and health care providers about PC; and inadequate number of trained workforce. Besides, limited physical infrastructure, insufficient drugs for symptom relief and lack of a comprehensive national plan for implementing PC were the core organisational and policy level challenges that were recognised. Furthermore, the main possible facilitators that were identified included provision of adequate training for health care providers and health education for patients, families and the general public to enhance their knowledge, beliefs, and attitudes to PC. Finally, involvement of policymakers and making drugs available for symptom relief should also be in place to improve the health care systems.

CONCLUSIONS

Understanding challenges to the provision of PC for people with cancer could help in the development of a PC pathway in LMICs. This knowledge could be used as a guide to develop an intervention programme to improve PC. Political influence and support are also required to ensure the sustainability and the provision of high-quality PC.

The impact of an educational video about radiotherapy and its toxicities in head and neck cancer patients. Evaluation of patients' understanding, anxiety, depression, and quality of life

OBJECTIVES

Head and neck radiotherapy can cause several toxicities, and its management has important treatment implications. Proper information about treatment is crucial to assist patients by preparing them and enhancing their ability to manage their illness. Thus, this study aimed to verify the impact of an educational video on the improvement of the patient's understanding, satisfaction, quality of life, and influence on their emotional state in different moments of treatment.

METHODS

A 10 min video about head and neck radiotherapy and its toxicities was produced. A prospective randomized clinical trial was performed in two groups: a control group (n = 65), which received standard verbal and written information, and an experimental group (n = 65), which received standard information and the video. Appropriated questionnaires (HADS, UW-QOLv4, IRTU, and Post-RTU) were applied in four different moments in order to evaluate patients' understanding, anxiety, depression, and quality of life.

RESULTS

The video improved the understanding of treatment and its side effects. Also, the video group reported better awareness about oral health care during the treatment. Osteoradionecrosis and radiation-related caries were the most unknown side effects. On the other hand, the educational video did not modify the patients' anxiety, depression, and quality of life. All patients reported high satisfaction with the video.

CONCLUSIONS

Audiovisual tools may improve patients' understanding of radiotherapy and were shown to be a useful tool when used in association with verbal and written information in cancer centers. In addition, information about osteoradionecrosis and radiation-related caries must be reinforced to patients.

Correlates of Adjuvant Therapy Attitudes in African American Breast Cancer Patients

PURPOSE

Black breast cancer patients delay and underutilize adjuvant breast cancer therapies; yet, very few studies have specifically examined Black women's attitudes toward breast cancer therapy. This study observed the influence of self-reported interpersonal processes of care (e.g. self-efficacy) clinical and sociodemographic factors and sociocultural (e.g. religiosity), related to Black breast cancer patients' attitudes toward radiation and systemic therapies (chemotherapy and adjuvant endocrine therapy - "AET").

METHODS

This was a secondary analysis of data from the Narrowing Gaps in Adjuvant Therapy Study (2006-2011). The analysis included 210 Black women who were newly diagnosed with breast cancer. Bivariate and multiple regression analyses were performed between independent variables (e.g., demographics) and three outcome variables (chemotherapy, AET, and radiation therapy) to asses women's perceptions of therapy type. The lasso method was used to select variables correlated with therapy attitudes.

RESULTS

Most women reported negative attitudes toward AET (56%) and radiation (54%); fewer negative attitudes were observed toward chemotherapy (47%). Higher education and greater perceived susceptibility of a recurrence were associated with more positive attitudes toward chemotherapy. Regarding radiation therapy, women with greater patient satisfaction were more likely to have more positive attitudes.

CONCLUSIONS

Our study findings may aid in the development of behavioral interventions targeted to mitigate Black women breast cancer treatment disparities. We found modifiable factors (e.g. communication, satisfaction ratings) that support opportunities for clinicians to better address Black women's needs regarding adjuvant treatment options. The development of tailored interventions for newly diagnosed Black breast cancer patients on patient related factors in health care are warranted for Black women with lower educational levels.

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.