Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Factors Affecting Communication
The indirect forms of communication that are particularly difficult for many doctors to detect and respond to include the following:
- 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. 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.
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