Doctors' communication of trust, care, and respect in breast cancer: qualitative study

Abstract Objective To determine how patients with breast cancer want their doctors to communicate with them. Design Qualitative study. Setting Breast unit and patients' homes. Participants 39 women with breast cancer. Main outcome measure Patients' reports of doctors' characteristics or behaviour that they valued or deprecated. Results Patients were not primarily concerned with doctors' communication skills. Instead they emphasised doctors' enduring characteristics. Specifically, they valued doctors whom they believed were technically expert, had formed individual relationships with them, and respected them. They therefore valued forms of communication that are currently not emphasised in training and research and did not intrinsically value others that are currently thought important, including provision of information and choice. Conclusions Women with breast cancer seek to regard their doctors as attachment figures who will care for them. They seek communication that does not compromise this view and that enhances confidence that they are cared for. Testing and elaborating our analysis will help to focus communication research and teaching on what patients need rather than on what professionals think they need.

[1]  S J Pocock,et al.  British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. , 1981, British medical journal.

[2]  Pär Salander,et al.  Bad news from the patient's perspective: an analysis of the written narratives of newly diagnosed cancer patients. , 2002, Social science & medicine.

[3]  M. Stewart,et al.  Breast cancer patients' experiences of patient-doctor communication: a working relationship. , 2000, Patient education and counseling.

[4]  H. D. de Haes,et al.  Patient centered decision making in palliative cancer treatment: a world of paradoxes. , 2003, Patient education and counseling.

[5]  G. Makoul,et al.  Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement , 2001, Academic medicine : journal of the Association of American Medical Colleges.

[6]  R. Henriksson,et al.  The creation of protection and hope in patients with malignant brain tumours. , 1996, Social science & medicine.

[7]  L. Fallowfield,et al.  Offering choice of surgical treatment to women with breast cancer. , 1997, Patient education and counseling.

[8]  V. Jenkins,et al.  Effective communication skills are the key to good cancer care. , 1999, European journal of cancer.

[9]  P. Butow,et al.  Communicating prognosis to patients with metastatic disease: what do they really want to know? , 2002, Supportive Care in Cancer.

[10]  J. Bensing,et al.  The effectiveness of a computer‐assisted instruction programme on communication skills of medical specialists in oncology , 2002, Medical education.

[11]  D. Cegala,et al.  Physician communication skills training: a review of theoretical backgrounds, objectives and skills , 2002, Medical education.

[12]  J. Bowlby.  The making & breaking of affectional bonds , 1979 .

[13]  C. Lampic,et al.  Cancer patient and staff ratings of the importance of caring behaviors and their relations to patient anxiety and depression. , 1998, Journal of Advanced Nursing.

[14]  Moyses Szklo,et al.  Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the atherosclerosis risk in communities study. , 2002, Diabetes.

[15]  M. Jefford,et al.  Informing and involving cancer patients in their own care. , 2002, The Lancet. Oncology.

[16]  Tom Carney.  Fourth Generation Evaluation , 1991 .

[17]  P. Butow,et al.  Lay constructions of decision‐making in cancer , 2002, Psycho-oncology.

[18]  P. Butow,et al.  Hearing the bad news of a cancer diagnosis: the Australian melanoma patient's perspective. , 2001, Annals of oncology : official journal of the European Society for Medical Oncology.

[19]  K. McPherson,et al.  Cancer patients' information needs and information seeking behaviour: in depth interview study , 2000, BMJ : British Medical Journal.

[20]  R. Sanson-Fisher,et al.  Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer. , 2000, European journal of cancer care.

[21]  Phyllis N Butow,et al.  Insights from cancer patient communication research. , 2002, Hematology/oncology clinics of North America.

[22]  M Baum,et al.  Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. , 1990, BMJ.

[23]  P. Maguire,et al.  Improving communication with cancer patients. , 1999, European journal of cancer.

[24]  Lesley Fallowfield,et al.  Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial , 2002, The Lancet.

[25]  D. Rutter,et al.  Doctor-patient communication and outcome in cancer patients: An intervention , 1996 .