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Primeau C, Chau M, Turner MR, Paterson C. Patient Experiences of Patient-Clinician Communication Among Cancer Multidisciplinary Healthcare Professionals During "Breaking Bad News": A Qualitative Systematic Review. Semin Oncol Nurs 2024:151680. [PMID: 38918149 DOI: 10.1016/j.soncn.2024.151680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care. METHODS A qualitative systematic review followed the Joanna Briggs Institute methodology and has been reported according to PRISMA guidelines. Databases, including APA PsycINFO, CINAHL, MEDLINE, and Scopus, were searched from the beginning of their date range coverage to April 2023. Data extraction and quality assessment were performed, and a meta-aggregation approach was used for data synthesis. RESULTS Twenty-eight studies were included and represented 976 patients. Key themes included (1) sensing something is wrong (prior to diagnosis), (2) reaction to the diagnosis, (3) information (during breaking bad news), (4) communication with health care professionals, (5) specialist versus nonspecialist centers, (6) decision-making, and (7) feeling supported. The review underscores the need for health care professionals to adeptly navigate and respond to individual patient needs during confronting and distressing times. CONCLUSIONS The complexity and individuality of patient-clinician communication suggest that further education is needed among the cancer multidisciplinary team to develop personalized, empathetic communication strategies in clinical practice, catering to diverse patient preferences. The findings call for more inclusive research across different cultures and languages, and a need to understand evolving communication needs, especially in the context of increasing digital communication modalities in health care. IMPLICATIONS FOR CANCER SURVIVORSHIP This review provides valuable new insights into developing effective communication strategies that are responsive to the diverse needs of patients undergoing cancer treatment. Its findings emphasize the importance of empathy, flexibility, and a personalized approach in delivering bad news and supporting patients throughout survivorship.
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Affiliation(s)
- Charlotte Primeau
- Warwick Manufacturing Group, University of Warwick Coventry, Coventry, UK
| | - Minh Chau
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Murray R Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; Flinders University, Caring Futures Institute, Adelaide, Australia; Central Adelaide Local Health Network, Adelaide, Australia.
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Kanagasabai P, Ormandy J, Filoche S, Henry C, Te Whaiti S, Willink R, Gladman T, Grainger R. Can storytelling of women's lived experience enhance empathy in medical students? A pilot intervention study. MEDICAL TEACHER 2024; 46:219-224. [PMID: 37542361 DOI: 10.1080/0142159x.2023.2243023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
PURPOSE This pilot study aimed to investigate the acceptability and efficacy of a patient storytelling intervention (live and recorded) on empathy levels of medical students. MATERIALS AND METHODS Medical students participated in a storytelling intervention that had three components: listening to live or recorded stories from women with abnormal uterine bleeding, reflective writing, and a debriefing session. Empathy scores of students pre- and post-intervention were measured using the Jefferson Scale of Empathy-student version (JSE-S). Students also completed a feedback survey. Descriptive and inferential statistics were used to analyse quantitative data and content analysis was used for text comments. RESULTS Both live and recorded storytelling interventions had positive effects on student's empathy scores post intervention. Overall, students were satisfied with the intervention and reported that it improved their understanding of life experiences of women. Suggestions were made for an in-person storytelling session and interactive discussion after listening to each story. CONCLUSION A storytelling intervention has the potential to improve medical students' empathy and understanding of lived experience of women with health conditions. This could be valuable when student-patient interactions are limited in healthcare settings, or to enable stories of small numbers of patient volunteers to reach students.
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Affiliation(s)
| | - Judy Ormandy
- University of Otago, Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | | | | | - Sarah Te Whaiti
- University of Otago, Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Robin Willink
- Biostatistics group, University of Otago, Wellington, New Zealand
| | - Tehmina Gladman
- Education unit, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
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Schlumbrecht M, Wright K, George S. Unique Considerations in Early Detection, Risk, and Awareness of Endometrial Cancer in Black Women. Cancer Control 2023; 30:10732748231202952. [PMID: 37732413 PMCID: PMC10515581 DOI: 10.1177/10732748231202952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States. Over the last several decades, the incidence of aggressive tumors, and thus the rate of death from disease, has increased significantly. The population most affected by these epidemiologic shifts are Black women. Symptom awareness, lack of treatment access, and failure of providers to provide guideline-concordant care are just some of the drivers behind these changes. Race as a social construct has historically categorized women into groups that are not reflective of the nuanced personalization that is required for cancer prevention strategies and targeted cancer treatments. There is, however, an increasing understanding that disaggregation by place of birth and social context are important to understand care-seeking behaviors, genetic drivers of disease, and factors that lead to deleterious outcomes. In this review, we will focus on specific individual-level influences that impact disease diagnosis and care-seeking among Black women, recognizing that the global disparities which exist in this disease encompass multiple domains. Such considerations are crucial to understanding drivers of self-efficacy and to develop programs for knowledge awareness and empowerment within a framework that is both useful and acceptable to these diverse communities at risk.
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Affiliation(s)
- Matthew Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kallia Wright
- School of Communication, University of Miami, Coral Gables, FL, USA
| | - Sophia George
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Jellema P, Annemans M, Heylighen A. Re-grounding the concept of liminality by foregrounding spatial aspects in experiences of cancer care. Health Place 2021; 70:102582. [PMID: 34000604 DOI: 10.1016/j.healthplace.2021.102582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Liminality captures the passing stages in transitioning from one sociocultural status to another. As its spatial dimension remains under-examined, we analyse this in experiences of people affected by cancer. We review liminality in cancer-related literature and juxtapose this with empirical material. Analysing interview data (with eight patients) and participant-made photos highlights why places may be experienced differently throughout a period of illness and how places of diagnosis and care 'stretch' across locations. We conclude that exploring liminality's spatial dimension has implications for people 'living beyond' cancer, advances sociological understandings of (cancer) illness, and may inform healthcare facility design.
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Affiliation(s)
| | - Margo Annemans
- KU Leuven, Dept. of Architecture, Research[x]Design, Belgium
| | - Ann Heylighen
- KU Leuven, Dept. of Architecture, Research[x]Design, Belgium
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Henry C, Jefferies R, Ekeroma A, Filoche S. Beyond the numbers-understanding women's experiences of accessing care for abnormal uterine bleeding (AUB): a qualitative study. BMJ Open 2020; 10:e041853. [PMID: 33203638 PMCID: PMC7674079 DOI: 10.1136/bmjopen-2020-041853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To gain a deeper understanding of women's experiences of accessing care for abnormal uterine bleeding (AUB) in order to inform future strategies to improve care pathways, including the early detection of endometrial cancer. DESIGN We conducted semistructured interviews with 15 women who attended their first gynaecological specialist consultation for AUB at Wellington Regional Hospital between October and December 2019. Inductive thematic analysis was used to explore experiences and barriers to seeking care. RESULTS The median age of the participant cohort was 45 years, with women self-identifying as New Zealand European (9/15), Māori (2/15) and Pasifika (4/15). All women had sought investigation for their AUB in primary care, for some women this was over a timeframe of many years. For all women, AUB had a significant and traumatic impact on their quality of life including their relationships and their work or education. Women described how they felt they often received inadequate care for AUB, and reported negative experiences with their general practitioner. Timely access was further compounded by feelings of embarrassment and that AUB was a taboo subject, and being able to discuss it with family, friends and their general practitioners was difficult. CONCLUSION Women in our cohort experienced a multitude of compounding influences that acted as barriers to them having access to appropriate and timely care. Information campaigns that create awareness around 'abnormal periods' alongside better health provider practice guidelines for AUB investigation need to be a priority.
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Affiliation(s)
- Claire Henry
- Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand
| | - Regina Jefferies
- Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand
| | | | - Sara Filoche
- Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand
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Henry C, Ekeroma A, Filoche S. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC WOMENS HEALTH 2020; 20:123. [PMID: 32532350 PMCID: PMC7291434 DOI: 10.1186/s12905-020-00986-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
Background Although Abnormal Uterine Bleeding (AUB) can have serious medical consequences and significantly impacts daily life, the overall trend is that most women do not seek care for these symptoms. The objective of this review was to synthesise factors impeding women’s access care for AUB. Methods Systematic literature review of qualitative studies (interview and focus group) regarding the lived in experiences of women with abnormal menstrual symptoms, followed by a thematic analysis of these studies. We screened CINAHL, SCOPUS, ProQuest, OVID and Pubmed for qualitative studies. Studies were assessed using the Clinical Appraisal Skills Programme checklist and thematic synthesis was used to develop themes from the findings of the studies. Results The review yielded 12 studies that satisfied the inclusion criteria. Three themes were developed that described barriers for women seeking care for AUB: health literacy (understanding of normal periods, role of cervical Pap smears and lack of access to appropriate information), taboo/normalisation (fear and embarrassment of symptoms, prioritising others) and health care provider (lack of accessible and trusted female GPs and poor experiences with GPs). Conclusions For 20 years women have consistently reported poor experiences in accessing care for AUB. The findings from our review indicate that drivers to impeding access are multiple; therefore any approaches to improve access will need to be multi-level – from comprising local sociocultural considerations to improved GP training.
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Affiliation(s)
- Claire Henry
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand.
| | - Alec Ekeroma
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand
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Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study. BJGP Open 2020; 4:bjgpopen20X101001. [PMID: 31911419 PMCID: PMC7330188 DOI: 10.3399/bjgpopen20x101001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 01/07/2023] Open
Abstract
Background Late stage diagnosis of oesophageal and gastric cancer is common, which limits treatment options and contributes to poor survival. Aim To explore patients' understanding, experience and presentation of symptoms before a diagnosis of oesophageal or gastric cancer. Design & setting Between May 2016 and October 2017, all patients newly diagnosed with oesophageal or gastric cancer were identified at weekly multidisciplinary team meetings at two large hospitals in England. A total of 321 patients were invited to participate in a survey and secondary care medical record review; 127 (40%) participants responded (102 patients had oesophageal cancer and 25 had gastric cancer). Of these, 26 participated in an additional face-to-face interview. Method Survey and medical record data were analysed descriptively. Interviews were analysed using thematic analysis, informed by the Model of Pathways to Treatment. Results Participants experienced multiple symptoms before diagnosis. The most common symptom associated with oesophageal cancer was dysphagia (n = 66, 65%); for gastric cancer, fatigue or tiredness (n = 20, 80%) was the most common symptom. Understanding of heartburn, reflux and indigestion, and associated symptoms differed between participants and often contrasted with clinical perspectives. Bodily changes attributed to personal and/or lifestyle factors were self-managed, with presentation to primary care prompted when symptoms persisted, worsened, or impacted daily life, or were notably severe or unusual. Participants rarely presented all symptoms at the initial consultation. Conclusion The patient interval may be lengthened by misinterpretation of key terms, such as heartburn, or misattribution or non-recognition of important bodily changes. Clearly defined symptom awareness messages may encourage earlier help-seeking, while eliciting symptom experience and meanings in primary care consultations could prompt earlier referral and diagnosis.
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Sidenius A, Manderson L, Mogensen O, Rudnicki M, Møller LMA, Hansen HP. “But this is a good cancer:” Patient perceptions of endometrial cancer in Denmark. J Clin Nurs 2018; 28:245-256. [DOI: 10.1111/jocn.14615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Anne Sidenius
- Research Unit of General Practice Department of Public Health Faculty of Health Sciences University of Southern Denmark Odense C Denmark
- Department of Gynecology and Obstetrics University Hospital of Zealand Roskilde Denmark
| | - Lenore Manderson
- School of Public Health University of the Witwatersrand Johannesburg South Africa
- The Institute at Brown for Environment & Society (IBES) Brown University Providence Rhode Island
| | - Ole Mogensen
- Department of Obstetrics and Gynaecology Karolinska University Hospital Stockholm Sweden
- Research Unit of Gynaecology and Obstetrics (RUGO) Department of Clinical Research Faculty of Health Sciences University of Southern Denmark Odense CDenmark
| | - Martin Rudnicki
- Department of Gynaecology and Obstetrics University Hospital Odense Odense C Denmark
| | | | - Helle Ploug Hansen
- Research Unit of General Practice Department of Public Health Faculty of Health Sciences University of Southern Denmark Odense C Denmark
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