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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Factors Affecting Communication

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The indirect forms of communication that are particularly difficult for many doctors to detect and respond to include the following:[24]

  • Allusions.
  • Paraverbal expressions (e.g., auditory pitch and tone).
  • Nonverbal behaviors (e.g., facial expression and posture).

Patients may assume that their doctors will tell them whatever is relevant; others worry about appearing foolish if they reveal their ignorance by asking questions; and some feel guilty about taking too much of the busy doctor's time.[25,26] In the absence of explicit discussion, physicians may make incorrect assumptions and unilateral decisions about patients' information needs and preferences, incorrectly assessing their own information-giving behavior.[27] Other barriers to communication may include the multiple specialists that patients see; the multiple clinicians and others that the patient may see within the treatment team (e.g., physician, mid-level practitioner, nurse, billing office clerk, patient advocate); the challenges posed by variations in education level, cultural differences, and ethnicity; and the anxiety that often accompanies an initial or high-stakes interview (e.g., disclosure of restaging results), which may affect patient comprehension and understanding.

Nurses as Advocates for Patients and Their Families

Nurses play an important role in supporting patients through the crisis of cancer and play an important role in today's multidisciplinary cancer team. They perform key functions at almost every stage of the cancer trajectory. Clinic and inpatient nurses are frequently the first clinical contacts for patients and family members and, through their initial interactions, set the tone for the support the patient will receive throughout his or her care. Nurses are important sources of information about procedures, treatments, and other aspects of patient care. Spending more time with the patient than do physician members of the treatment team, nurses are frequently the most trusted member of the cancer team when it comes to obtaining information, and they serve as advocates for the patient when important and sensitive questions such as "How bad is it?" or "How long do I have to live?" arise. Nurses must also attend to patient and family emotional needs after bad news is given and deal first with other emotionally draining situations, such as angry patients or family members or patients who are withdrawn and depressed. Advanced practice nurses provide direct patient care, often acting as physician extenders and managing much of the day-to-day care of the patient.

References:

  1. Liang W, Burnett CB, Rowland JH, et al.: Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20 (4): 1008-16, 2002.
  2. Maly RC, Leake B, Silliman RA: Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer 97 (6): 1517-27, 2003.
  3. Silliman RA, Dukes KA, Sullivan LM, et al.: Breast cancer care in older women: sources of information, social support, and emotional health outcomes. Cancer 83 (4): 706-11, 1998.
  4. Zuckerman DM: The need to improve informed consent for breast cancer patients. J Am Med Womens Assoc 55 (5): 285-9, 2000.
  5. Nattinger AB, Gottlieb MS, Veum J, et al.: Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 326 (17): 1102-7, 1992.
  6. Siminoff LA, Graham GC, Gordon NH: Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns 62 (3): 355-60, 2006.
  7. Gordon HS, Street RL Jr, Sharf BF, et al.: Racial differences in doctors' information-giving and patients' participation. Cancer 107 (6): 1313-20, 2006.
  8. Gordon HS, Street RL Jr, Sharf BF, et al.: Racial differences in trust and lung cancer patients' perceptions of physician communication. J Clin Oncol 24 (6): 904-9, 2006.
  9. Degner LF, Kristjanson LJ, Bowman D, et al.: Information needs and decisional preferences in women with breast cancer. JAMA 277 (18): 1485-92, 1997.
  10. Hietanen P, Aro AR, Holli K, et al.: Information and communication in the context of a clinical trial. Eur J Cancer 36 (16): 2096-104, 2000.
  11. McVea KL, Minier WC, Johnson Palensky JE: Low-income women with early-stage breast cancer: physician and patient decision-making styles. Psychooncology 10 (2): 137-46, 2001 Mar-Apr.
  12. Hern HE Jr, Koenig BA, Moore LJ, et al.: The difference that culture can make in end-of-life decisionmaking. Camb Q Healthc Ethics 7 (1): 27-40, 1998.
  13. Mishel MH: Reconceptualization of the uncertainty in illness theory. Image J Nurs Sch 22 (4): 256-62, 1990.
  14. Gordon EJ, Daugherty CK: 'Hitting you over the head': oncologists' disclosure of prognosis to advanced cancer patients. Bioethics 17 (2): 142-68, 2003.
  15. Baile WF, Lenzi R, Parker PA, et al.: Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20 (8): 2189-96, 2002.
  16. Mitchell JL: Cross-cultural issues in the disclosure of cancer. Cancer Pract 6 (3): 153-60, 1998 May-Jun.
  17. Harris SR, Templeton E: Who's listening? Experiences of women with breast cancer in communicating with physicians. Breast J 7 (6): 444-9, 2001 Nov-Dec.
  18. Butow PN, Tattersall MH, Goldstein D: Communication with cancer patients in culturally diverse societies. Ann N Y Acad Sci 809: 317-29, 1997.
  19. Hu WY, Chiu TY, Chuang RB, et al.: Solving family-related barriers to truthfulness in cases of terminal cancer in Taiwan. A professional perspective. Cancer Nurs 25 (6): 486-92, 2002.
  20. Tam Ashing K, Padilla G, Tejero J, et al.: Understanding the breast cancer experience of Asian American women. Psychooncology 12 (1): 38-58, 2003 Jan-Feb.
  21. Ballard-Reisch DS, Letner JA: Centering families in cancer communication research: acknowledging the impact of support, culture and process on client/provider communication in cancer management. Patient Educ Couns 50 (1): 61-6, 2003.
  22. Given BA, Given CW, Kozachik S: Family support in advanced cancer. CA Cancer J Clin 51 (4): 213-31, 2001 Jul-Aug.
  23. Morris SM, Thomas C: The carer's place in the cancer situation: where does the carer stand in the medical setting? Eur J Cancer Care (Engl) 10 (2): 87-95, 2001.
  24. Butow PN, Brown RF, Cogar S, et al.: Oncologists' reactions to cancer patients' verbal cues. Psychooncology 11 (1): 47-58, 2002 Jan-Feb.
  25. Fallowfield L, Jenkins V: Effective communication skills are the key to good cancer care. Eur J Cancer 35 (11): 1592-7, 1999.
  26. Maguire P: Improving communication with cancer patients. Eur J Cancer 35 (10): 1415-22, 1999.
  27. Towle A, Godolphin W: Framework for teaching and learning informed shared decision making. BMJ 319 (7212): 766-71, 1999.

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

WebMD Public Information from the National Cancer Institute

Last Updated: May 28, 2015
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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