Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients

BackgroundDoctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum.MethodsIn-depth interviews with seven breast cancer patients were carried out.ResultsThemes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as ‘a disease of the mind’, which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important.ConclusionCurrent findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions.

[1]  O. Merdy,et al.  Identifying trajectory clusters in breast cancer survivors’ supportive care needs, psychosocial difficulties, and resources from the completion of primary treatment to 8 months later , 2015, Supportive Care in Cancer.

[2]  W. Lam,et al.  The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study , 2013, Psycho-oncology.

[3]  C. Hill,et al.  A Guide to Conducting Consensual Qualitative Research , 1997 .

[4]  P. Butow,et al.  Communication styles in the cancer consultation: preferences for a patient‐centred approach , 2000, Psycho-oncology.

[5]  G. Maskarinec,et al.  Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives , 2002, Psycho-oncology.

[6]  J. Dalen.  Communication skills in context: trends and perspectives. , 2013 .

[7]  P. Schulz,et al.  Information seeking and avoidance throughout the cancer patient journey: two sides of the same coin? A synthesis of qualitative studies , 2014, Psycho-oncology.

[8]  Jane M. Young,et al.  What are the unmet supportive care needs of people with cancer? A systematic review , 2009, Supportive Care in Cancer.

[9]  E. Smets,et al.  All eyes on the patient: the influence of oncologists’ nonverbal communication on breast cancer patients’ trust , 2015, Breast Cancer Research and Treatment.

[10]  S. Thorne,et al.  Helpful communications during the diagnostic period: an interpretive description of patient preferences. , 2010, European journal of cancer care.

[11]  J. Bengel,et al.  Information and decision making: patients' needs and experiences in the course of breast cancer treatment. , 2008, Patient education and counseling.

[12]  P. Pugliese,et al.  Information and Awareness of Diagnosis and Progression of Cancer in Adult and Elderly Cancer Patients , 2000, Tumori.

[13]  Doris Howell,et al.  Clinician-patient communication: a systematic review , 2009, Supportive Care in Cancer.

[14]  T. Falcone,et al.  The Human Side of Cancer: Living with Hope, Coping with Uncertainty , 2000 .

[15]  J. Tulsky,et al.  How oncologists and their patients with advanced cancer communicate about health‐related quality of life , 2010, Psycho-oncology.

[16]  S. van Dulmen,et al.  Patient Education About Treatment in Cancer Care: An Overview of the Literature on Older Patients' Needs , 2007, Cancer nursing.

[17]  Sarah M. Greene,et al.  Patients' and family members' views on patient‐centered communication during cancer care , 2013, Psycho-oncology.

[18]  Sylvie Dolbeault,et al.  Doctor-patient communication and satisfaction with care in oncology , 2005, Current opinion in oncology.

[19]  J. Huebner,et al.  Discontinuation and non-adherence to endocrine therapy in breast cancer patients: is lack of communication the decisive factor? , 2014, Journal of Cancer Research and Clinical Oncology.

[20]  J. Aaron,et al.  Breast Cancer: Unique Communication Challenges and Strategies to Address them , 2009, The breast journal.

[21]  S. Thorne,et al.  Changing communication needs and preferences across the cancer care trajectory: insights from the patient perspective , 2014, Supportive Care in Cancer.

[22]  Judith A. Hall,et al.  Inaccuracies in physicians' perceptions of their patients. , 1999, Medical care.

[23]  R. Leonhart,et al.  Communication matters: the impact of communication and participation in decision making on breast cancer patients' depression and quality of life. , 2009, Patient education and counseling.

[24]  T. Wise.  The Human Side of Cancer: Living With Hope, Coping With Uncertainty , 2002 .

[25]  J. Tulsky,et al.  Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers , 2015, Supportive Care in Cancer.

[26]  Peter Salmon,et al.  Doctors' communication of trust, care, and respect in breast cancer: qualitative study , 2004, BMJ : British Medical Journal.

[27]  S. Thorne,et al.  Time‐related communication skills from the cancer patient perspective , 2009, Psycho-oncology.

[28]  P. Butow,et al.  Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours , 2012, Supportive Care in Cancer.

[29]  R. Street,et al.  The initial clinical interview—can it reduce cancer patients’ fear? , 2015, Supportive Care in Cancer.