Oncology nurse communication barriers to patient-centered care

Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management

RATIONALE

Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions.

AIMS AND OBJECTIVES

This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management.

METHODS

This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field.

RESULTS

In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations".

CONCLUSION

This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.

Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals: A Systematic Review

BACKGROUND

Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients' communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical.

OBJECTIVE

To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals.

METHODS

A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results.

RESULTS

Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients' lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals' knowledge, communication skills, and patient relationships.

CONCLUSIONS

Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication.

IMPLICATION FOR PRACTICE

The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture's impact on communication effectiveness and decision-making participation.

The Perceptions of Children and Adolescents with Cancer Regarding Nurses' Communication Behaviors during Needle Procedures

Background: Communicating with children and adolescents with cancer during a needle procedure can prove challenging for healthcare professionals. Objective: Our aim was to explore the perceptions of children and adolescents with cancer regarding communication with nurses during needle procedures. Method: Thus was a qualitative phenomenological study. Data were gathered through seven in-depth interviews with a convenience sample of children and adolescents with cancer. Data were analyzed using a grounded theory approach to identify themes in the participants' narratives. Results: The analysis revealed three themes describing participants' experience: (1) nurses need to explain clearly what they are going to do while also allowing children to express their emotions without feeling coerced; (2) nurses need to be honest and approachable and relate to children as active participants in the treatment process; and (3) it is distressing to hear other children who are undergoing a needle procedure cry out in pain. Further application of the constant comparison method yielded a core theme: (4) the pressures faced by oncology nurses lead them to focus on the technical side of procedures at the expense of their young patients' communication needs. Conclusions: We suggest that hospital managers need to ensure that oncology nurses have sufficient training in communication skills and are confident in their ability to respect and respond to the communication preferences and needs of patients.

Validation of the Palliative Care Nursing Self-Competence Scale for Oncology Nurses in the United States

Oncology nurses care for persons with cancer and thus play an important role in providing palliative care to this population. However, a valid instrument to measure United States oncology nurses' confidence in providing palliative care service to persons with cancer is not available. This study examined the psychometric properties of the Palliative Care Nursing Self-Competence (PCNSC) scale in measuring oncology nurses' confidence in providing all aspects of palliative care to persons with cancer. An online survey with demographic questions and the PCNSC scale was sent to registered nurse (RN) members of the Oncology Nursing Society (ONS). The PCNSC scale consists of 50 items and 10 domains. A confirmatory factor analysis (CFA) was conducted to test the psychometric properties of the PCNSC scale in examining oncology nurses' confidence in providing palliative care. The CFA showed that the model fit reached adequate levels with the 10-factor structure of the PCNSC scale (χ2 = 2104.1, df = 1130, CFI = 0.88, RMSEA = 0.06) thus validating the scale in measuring oncology nurses' confidence in providing palliative care to persons with cancer in the United States. PCNSC retained the same 10-factor structure with 5 items in each factor, thus validating the scale. This scale can be used to assess oncology nurses' overall confidence and confidence in each domain of palliative care provision. These results can inform the development of targeted educational programs geared to enhancing oncology nurses' confidence in the United States.

Effects of the teach-back method among cancer patients: a systematic review of the literature

PURPOSE

This study aimed to systematically review published research on the use of the teach-back method among cancer patients and provide basic data for developing effective nursing interventions.

METHODS

Using a PICOS (Population, Intervention, Comparisons, Outcomes, Study Designs) framework, we reviewed 246 studies from selected electronic databases-CINAHL, EMBASE, PubMed, PsycInfo, RISS, KISS, DBpia, NDSL, and KCI-and selected five studies for further analysis. We evaluated the reference quality using Cochrane's risk of bias and risk of bias assessment tool for non-randomized studies, following which we performed reviews and analyses.

RESULTS

Five studies were selected for the final analysis, including four quasi-experimental studies and one randomized controlled experimental study. The intervention programs were provided mostly by outpatient clinics. The cancer types of the subjects were breast cancer and gastrointestinal cancer in four and one study, respectively. The number and duration of the interventions varied depending on the content. The number of outcome variables ranged from 1 to 5, depending on the study; among these, self-efficacy, symptom experience, and distress were used. Teach-back intervention programs significantly affected happiness, health literacy, anxiety about death, symptom experience, distress, and self-efficacy.

CONCLUSION

This study found that teach-back interventions have positive health outcomes including happiness, uncertainty, self-efficacy, self-management behavior, symptom experience, distress, anxiety, and health literacy among cancer patients. However, it found no effects with regard to drug administration, functional measurements, or satisfaction. Future research should continuously examine the teach-back approach and assess its positive health outcomes for cancer patients.

Experiences of surviving life-threatening illness: The meaning of recovery

BACKGROUND

Recovery from life-threatening illness may be experienced as more demanding and lasts longer than patients first expect. Many patients experience recovery after life-threatening illness, as filled with complex problems. These problems are primarily physical and psychological, although also social, and adversely affect daily life as well as perceived quality of life. Patients experience uncertainty about living with the legacy of a life-threatening illness and how it negatively limits their daily lives and experienced health.

AIM

The purpose is to illuminate experiences of the meaning of recovery from life-threatening disease.

ETHICAL APPROVAL

Approval for the study was obtained through a Regional Research Ethics Committee.

METHODS

This study was conducted as a qualitative narrative study. This means that written stories of human recovery beyond suffering from life-threatening disease were collected and analysed with a phenomenological hermeneutic method.

RESULTS

The findings reveal two major areas - intrapersonal meanings and relational meanings. Four themes were found in these areas, each of which was divided into subthemes as follows: obstacles, for example disappointment of life, alienation of self and opportunities/resources: for example balance, own knowledge, hope and gratitude; relational obstacles, for example a lack of care, stigmatisation and economic stress; and relational resources such as informal care and professional care.

STUDY LIMITATIONS

The informants were predominantly women that may be explained by the fact that females seem to be more often engaged in social media and willing to participate in these kinds of studies. Another limitation is that we only reached out to Swedish speaking Facebook groups when recruiting our informants.

CONCLUSIONS

In the narratives of their recovery process, surprisingly few focused on professional health care as a resource. Experiences from the study may be used to further develop care, especially to support patient self-care regarding intrapersonal and relational resources that promote patient recovery beyond suffering from life-threatening disease.

Communication skills in nursing: A phenomenologically-based communication training approach

The aim of this article is to present a communication skills training curriculum for nursing students, based upon phenomenology. Research shows that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational and cultural factors. Like other health care professionals, nurses may also have difficulties communicating with patients due to personal fears and shortcomings. The communication training curriculum based upon phenomenology aims at systematically training students to stay focused upon patients' and relatives' narratives, allowing them to reflect upon and better understand their current situation. This approach to communication is applicable in any clinical situation where it important to provide space for the patients' experiences. The philosophical principles guiding the training are presented here as well as the practical steps in the program. Finally, the approach is compared to other common communication methods used in nursing (motivational interviewing, caring conversations, empathy training). The authors hope that the article will highlight the nurses' role as dialogue partner as well as emphasize the importance of communication skills training in nursing education. This approach can be refined, tested and modified in future research and may serve as an inspirational model for creating a generic communicative competence for nurses. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Exploring associations between older adults' demographic characteristics and their perceptions of self-care actions for communicating with healthcare professionals in southern United States

AIMS

This study examined associations between older adults' demographic factors and their perceived importance of, desire to and ability to perform seven self-care behaviours for communicating with healthcare professionals.

DESIGN

This cross-sectional survey study analysed subset data of 123 older adults 65 years and older, living in southern United States.

METHODS

The Patient Action Inventory for Self-Care (57 items, grouped into 11 categories) was used to collect self-reported self-care data. Demographic characteristics were also collected. Descriptive statistics and logistic regression analyses were used to tests for relationships between the variables relevant to the research objective.

RESULTS

Regression findings showed that separated older adults felt less able to share ideas about their healthcare experiences compared to married older adults. Male older adults reported less desire to list issues to discuss and less desire to share ideas about their care experience with their healthcare professionals compared to their female counterparts.

Experiences of adult cancer patients receiving counseling from nurses: a qualitative systematic review

INTRODUCTION

Counseling is a brief psycho-educational intervention that is useful in facilitating personal growth and adaptive resolution of life stresses. With increased recognition on the psycho-emotional needs of patients with cancer, it is prudent to consider the possibility of expanding the role of nurses in the provision of counseling.

OBJECTIVE

This qualitative systematic review aimed to establish the best available evidence on the experiences of adult cancer patients receiving counseling provided by nurses.

INCLUSION CRITERIA

This review included studies on adult cancer patients of at least 18 years of age who were diagnosed with oncological malignancies of any type and staging. The phenomena of interest were the experiences of adult cancer patients who received nurse counseling (patient education, psycho-education and/or supportive counseling) that was conducted face-to-face or via other communication modes. The review included studies done in institutional and community settings. Qualitative data including, but not limited to, designs of phenomenology, grounded theory, ethnography, action research, feminist research and mixed methods research were considered.

SEARCH STRATEGY

A three-step search strategy was utilized to find both published and unpublished studies in the English language. Databases searched included CINAHL, MEDLINE, Embase, JSTOR, PsycINFO, Scopus, ScienceDirect, Wiley Online Library and ProQuest Dissertations and Theses Global. Two reviewers independently appraised the 14 included studies using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. The studies were of moderate to high quality, mostly, falling short in quality due to lack of statements locating the researchers and their influence on the research. Data were extracted from included papers using the standardized JBI data extraction tool.

DATA SYNTHESIS

Two reviewers independently reviewed and pooled similar findings into categories. All three reviewers then collaborated in finalizing these derived categories to generate a meta-synthesis.

RESULTS

Five synthesized findings were generated during the meta-synthesis: (1) Nurses provide tailored information and teaching to enhance patients' coping; (2) Nurses attend to patients' emotional needs; (3) Nurses assume the role of a significant person in the patients' journey; (4) Patients feel valued as a whole person and the ready availability of nursing interactions; and (5) Nursing role ambiguity and time constraints limit nurse counseling.

CONCLUSION

Overall, cancer patients' experiences with nurse counseling are positive and beneficial to them. Despite some nursing role ambiguity and time constraints impeding nurse counseling, this review has established the diverse instrumental roles nurses have played in enhancing adaptive coping in patients across their illness trajectory. In particular, the nurses' presence and availability, a trusting nurse-patient relationship, use of psychotherapy techniques, a holistic approach, human touch and continuity of care were highlighted as key factors in enhancing healing. The role of the nurse navigator and the use of expressive writing warrant more attention when tending to patients' psycho-emotional distress.

The implementation and evaluation of a communication skills training program for oncology nurses

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

"I Just Felt Like I Was Stuck in the Middle": Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

CONTEXT

Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance practice providers such as physician assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs' current experiences in their daily practices.

OBJECTIVES

This study aimed to explore roles PAs serve in communicating with terminally ill patients/families; PAs' attitudes and opinions about communication roles; and perceived barriers and facilitators of communication with patients/families in the hospital setting.

METHODS

Five focus groups were conducted with PAs practicing on adult medical services at three acute care hospitals of an academic medical center in Bronx, New York. An open-ended question guide was used. An inductive thematic analysis strategy was used to examine the data from transcribed audiotapes of focus group sessions to identify emergent concepts and themes.

RESULTS

The overarching theme that emerged was being stuck in the middle. PAs experienced ambiguity around their roles and responsibilities in communications between the medical team as well as patients and families; gaps in knowledge and skills; and organizational or structural deficits in the patient care systems that placed them in uncomfortable situations.

CONCLUSION

Interventions aimed at improving PA communication with terminally ill patients and their families should target institutional structures, systems, and culture around roles and responsibilities in addition to skill and knowledge gaps to be most effective.

Nurses' Perceptions of Diagnosis and Prognosis-Related Communication: An Integrative Review

BACKGROUND

Disclosure of diagnostic and prognostic information has become the standard in the United States and increasingly around the world. Disclosure is generally identified as the responsibility of the physician. However, nurses are active participants in the process both intentionally and inadvertently. If not included in initial discussions regarding diagnosis and prognosis, the nurse may find it challenging to openly support the patient and family.

OBJECTIVE

The aim of this study is to synthesize published literature regarding nurses' perceptions and experiences with diagnosis and prognosis-related communication.

METHODS

The Whittemore and Knafl method guided the integrative review process. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Health Sciences in ProQuest, PubMed, and Web of Science were used to review the literature from 2000 to 2015. Constant comparison methods were used to analyze the data and develop themes.

RESULTS

Thirty articles met all of the inclusion criteria and were included in this review. Several themes emerged from the data, including the nurse's role in the process of diagnosis and prognosis-related communication, barriers and difficulties related to communication, and positive and negative outcomes.

CONCLUSIONS

Nurses play an integral role in the process of diagnostic and prognostic disclosure. Further exploration of both physician and patient perceptions of the nurse's role are needed. Interprofessional training regarding diagnosis and prognosis-related communication is essential to promote collaboration and better empower nurses in this process.

IMPLICATIONS FOR PRACTICE

Nurses should aim to purposefully partner with physician colleagues to plan and participate in diagnostic and prognostic discussions. Nurses should identify opportunities to improve their knowledge, understanding, and comfort with challenging conversations.

The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news

AIMS

The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news.

BACKGROUND

The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice.

DESIGN

The study used a descriptive survey design involving self-reported written accounts and framework analysis.

METHODS

Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014.

FINDINGS

Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news.

CONCLUSION

The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice.

Unmet Needs for Clinical Ethics Support Services in Nurse: Based on focus group interviews

BACKGROUND

As nurses' ethical competence in their own fields is essential, clinical ethics support services help nurses improve ethical competence.

OBJECTIVES

The purpose of this study was to identify the unmet needs of ethical support for nurses in clinical settings and explore the differences by nursing units.

RESEARCH DESIGN

Focus group interview design was applied. Participants and research context: Data were collected via four rounds of focus group interviews with 37 nurses at intensive care units, medical-surgical units, emergency departments and oncology units. Major questions were as follows: 'What is nurses' experience of ethical difficulties while working as a clinical nurse?' and 'What kinds of clinical ethics support services do nurses require in different clinical settings?' Inductive content analysis was performed to analyse the data. Ethical considerations: Ethical approval was obtained from the institutional review of board at the College of Nursing.

FINDINGS

Five categories (with 14 subcategories) were identified: difficulty providing evidence-based care, lack of support in maintaining patients' and family members' dignity, insufficient education regarding clinical ethics, loss of professional self-esteem and expectations concerning organizational support. Nurses' desire for ethical support varied according to department.

CONCLUSION

Nurses face both practical and existential ethical issues that require rapid solution each day. There is a need for ethical counselling to prevent compassion fatigue and identify means via which nurses reflect on their daily lives in their own fields. In-house training should be provided for each unit, to improve ethical competence and facilitate the development of pragmatic, sensible solutions.

Oncology nurses' communication challenges with patients and families: A qualitative study

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions.

Nurses' perspectives: hospitalized older patients and end-of-life decision-making

AIMS

To explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues.

BACKGROUND

Critical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life.

DESIGN

It is a mixed method study.

METHODS

A secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics.

RESULTS

Comments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals (x‾ age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations.

CONCLUSIONS

Nurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services.

RELEVANCE TO PRACTICE

Palliative care and EOL decision-making will remain a nursing priority as people age and require increased care.

Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses' perspectives

The integration of complementary and alternative medicine (CAM) and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs) to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP) education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.