1
|
Haverfield MC, Carrillo Y, Itliong JN, Ahmed A, Nash A, Singer A, Lorenz KA. Cultivating Relationship-Centered Care: Patient, Caregiver, and Provider Communication Preferences for and Experiences with Prognostic Conversations. HEALTH COMMUNICATION 2024; 39:1256-1267. [PMID: 37165555 DOI: 10.1080/10410236.2023.2210383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationship-centered care in identifying communication practices that enhance the prognostic conversation experience.
Collapse
Affiliation(s)
| | | | | | - Anum Ahmed
- Communication Studies, San José State University
| | - Amia Nash
- School of Public Health, University of California
| | - Adam Singer
- School of Medicine, University of California Los Angeles
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Department of Primary Care and Population Health, Stanford University School of Medicine
| |
Collapse
|
2
|
Nahm SH, Subramaniam S, Stockler MR, Kiely BE. Timing of prognostic discussions in people with advanced cancer: a systematic review. Support Care Cancer 2024; 32:127. [PMID: 38261070 DOI: 10.1007/s00520-023-08230-3] [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] [Received: 08/07/2023] [Accepted: 12/03/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Many people with cancer (patients) want to know their prognosis (a quantitative estimate of their life expectancy) but this is often not discussed or poorly communicated. The optimal timing of prognostic discussions with people with advanced cancer is highly personalised and complex. We aimed to find, organise, and summarise research regarding the timing of discussions of prognosis with people with advanced cancer. METHODS We conducted a systematic review of publications from databases, clinical practice guidelines, and grey literature from inception to 2023. We also searched the reference lists of systematic reviews, editorials, and clinical trial registries. Eligibility criteria included publications regarding adults with advanced cancer that reported a timepoint when a discussion of prognosis occurred or should occur. RESULTS We included 63 of 798 identified references; most of which were cross-sectional cohort studies with a range of 4-9105 participants. Doctors and patients agreed on several timepoints including at diagnosis of advanced cancer, when the patient asked, upon disease progression, when there were no further anti-cancer treatments, and when recommending palliative care. Most of these timepoints aligned with published guidelines and expert recommendations. Other recommended timepoints depended on the doctor's clinical judgement, such as when the patient 'needed to know' or when the patient 'seemed ready'. CONCLUSIONS Prognostic discussions with people with advanced cancer need to be individualised, and there are several key timepoints when doctors should attempt to initiate these conversations. These recommended timepoints can inform clinical trial design and communication training for doctors to help improve prognostic understanding.
Collapse
Affiliation(s)
- Sharon H Nahm
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shalini Subramaniam
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Bankstown Cancer Centre, Sydney, Australia
| | - Martin R Stockler
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Concord Cancer Centre, Sydney, Australia
| | - Belinda E Kiely
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia.
- Concord Cancer Centre, Sydney, Australia.
- Macarthur Cancer Therapy Centre, Sydney, Australia.
| |
Collapse
|
3
|
Font Jiménez I, Ortega Sanz L, González Pascual JL, González Sanz P, Aguarón García MJ, Jiménez-Herrera MF. Reflective based learning for nursing ethical competency during clinical practices. Nurs Ethics 2023; 30:598-613. [PMID: 36919260 DOI: 10.1177/09697330221140513] [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: 03/16/2023]
Abstract
BACKGROUND A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students. AIM To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies. RESEARCH DESIGN Qualitative study with a content analysis according to Elo and Kinglas framework. PARTICIPANTS AND RESEARCH CONTEXT Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women. METHODOLOGY The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method. ETHICAL CONSIDERATIONS Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form. FINDINGS Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity. CONCLUSION All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.
Collapse
Affiliation(s)
- Isabel Font Jiménez
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Laura Ortega Sanz
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain; Grup de Recerca GAP, CIBERSAM, Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Juan Luis González Pascual
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Pilar González Sanz
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, Madrid, Spain
| | - Maria Jesús Aguarón García
- Departament d'Infermeria, Gup de Recerca Avançada en Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - María F Jiménez-Herrera
- Departament d'Infermeria, Gup de Recerca Avançada en Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| |
Collapse
|
4
|
Brotons P, Virumbrales M, Elorduy M, Díaz de Castellví S, Mezquita P, Gené E, Balaguer A. Improvement of medical students' performance in simulated patient interviews by pre-clinical communication training. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:148-153. [PMID: 35716402 PMCID: PMC9902174 DOI: 10.5116/ijme.6299.c15f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the communication skills shown by medical students during simulated patient interviews between those who received training in communication during the preclinical years and those who did not. METHODS A retrospective study was conducted to analyze the communication skills of several cohorts of fourth-year medical students from Universitat Internacional de Catalunya during simulated patient interviews. Out of a total of 477 students included in the study, 229 (48%) had received training in communication skills through a 60-hour elective course during the preclinical second year, while the remaining 248 (52%) had received none. Communication skills were assessed by an evaluation team using a numerical scale (0 to 10) that included eight categories: "verbal", "non-verbal", "empathy", "concreteness", "warmth", "message content", "assertiveness", and "respect". Scores obtained by trained and non-trained students were compared using the t-test. RESULTS A trend towards obtaining better results was observed among students who had received communication training (mean score: 6.98/10) versus none (6.83/10, t(1,869)=-1.95, p=0.05). Non-trained male students obtained significantly lower mean scores than non-trained females in the categories of "respect" (7.48/10 vs. 7.83/10, t(968)=-2.89, p<0.01), "verbal communication" (6.87/10 vs. 7.15/10, t(968)=-2.61, p=0.01), "warmth" (6.53/10 vs. 6.95/10, t(968)=-3.40, p<0.01), and "non-verbal communication" (6.49/10 vs. 6.79/10, t(968)=-2.48, p=0.01). Trained female and male students had similar scores. CONCLUSIONS Training in communication skills during the preclinical years may improve fourth-year students' performance in simulated interviews with patients, particularly among males. These results demonstrate the importance of introducing specific training in communication skills early in the undergraduate medical curriculum.
Collapse
Affiliation(s)
- Pedro Brotons
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Montserrat Virumbrales
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Elorduy
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sandra Díaz de Castellví
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pau Mezquita
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Emili Gené
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Albert Balaguer
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
5
|
Yu L, Zheng F, Xiong J, Wu X. Relationship of patient-centered communication and cancer risk information avoidance: A social cognitive perspective. PATIENT EDUCATION AND COUNSELING 2021; 104:2371-2377. [PMID: 33583647 DOI: 10.1016/j.pec.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We examined the relationship between patient-centered communication and cancer risk information avoidance and estimated the mediating role of self-efficacy in this relationship. METHODS Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2033), this study aims to provide a comprehensive understanding of the relationship between patient-centered communication and cancer risk information avoidance via correlation analysis, stepwise regression models, and mediation analysis. RESULTS Patient-centered communication was significantly negatively associated with cancer risk information avoidance (β= -0.09, p < 0.01) after controlling for gender, income, education, and cancer risk perception. Self-efficacy fully mediated the relationship of patient-centered communication with cancer risk information avoidance. CONCLUSION Patient-centered communication can improve patients' self-efficacy, thereby preventing them from avoiding cancer risk information. PRACTICE IMPLICATIONS The negative relationship between patient-centered communication and cancer risk information avoidance substantiates that improving patient-centered communication is a promising approach to support caregivers in their activities, reduce patients' subjective cancer burden, and even improve their health. To address cancer-related issues, policymakers can consider interventions from the external environment and internal personal cognition perspectives.
Collapse
Affiliation(s)
- Lei Yu
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
| | - Feiyang Zheng
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
| | - Jie Xiong
- Department of Strategy, Entrepreneurship & International Business, ESSCA School of Management, 49003 Angers, France.
| | - Xiang Wu
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy. RECENT FINDINGS First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
Collapse
Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France.
| |
Collapse
|