Supportive Care in Cancer

, Volume 22, Issue 4, pp 1009–1015 | Cite as

Changing communication needs and preferences across the cancer care trajectory: insights from the patient perspective

  • Sally ThorneEmail author
  • T. Gregory Hislop
  • Charmaine Kim-Sing
  • Valerie Oglov
  • John L. Oliffe
  • Kelli I. Stajduhar
Original Article



In this program of research, we sought to expand our understanding of how cancer patients' communication needs and preferences change across the course of their illness trajectory. To address known limitations in the empirical knowledge base, we designed a study capitalizing on representative patient reports as they occurred within time and across experience obtaining care for this disease.


We used a longitudinal cohort design informed by interpretive description methodology to follow 125 patients over a multi-year period as they reflected on their ongoing experiences with cancer care communication.


In relation to each phase of their cancer care trajectory, patients identified tension points and contextual challenges impinging on what they felt constituted helpful and unhelpful patient–provider communication.


Findings from this study create a dynamic portrait of how we can better inform communication approaches and interventions through interpretations of population knowledge and individual experience.


Communication Cancer experience Physician–patient relationship Psychosocial oncology Patient-reported outcomes 



This study was supported by grants from the Canadian Institutes of Health Research (#134487) and the Canadian Cancer Society Research Institute (#020376).

Conflict of interest

The authors confirm that they have no financial relationship with the organization that sponsored the research. They also confirm that they have full control of all primary data and agree to allow the journal to review their data if requested.


  1. 1.
    Arora NK (2003) Interacting with cancer patients: the significance of physicians' communication behavior. Soc Sci Med 57:791–806PubMedCrossRefGoogle Scholar
  2. 2.
    Baile WF, Aaron J (2005) Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol 17(4):331–335, 331–335PubMedCrossRefGoogle Scholar
  3. 3.
    Epstein RM, Street RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. NIH Publication No. 07–6225.
  4. 4.
    Hagerty RG, Butow PN, Ellis PM, Dimitry S, Tattersall MH (2005) Communicating prognosis in cancer care: a systematic review of the literature. Ann Oncol 16:1005–1053PubMedCrossRefGoogle Scholar
  5. 5.
    Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, Duberstein PR (2005) Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. Soc Sci Med 61:1516–1528PubMedCrossRefGoogle Scholar
  6. 6.
    Rotor DL (2003) Observations on methodological and measurement challenges in the assessment of communication during medical exchanges. Patient Educ Couns 50:17–21CrossRefGoogle Scholar
  7. 7.
    Friedrichsen MJ, Strang PM, Carlsson ME (2002) Cancer patients' interpretations of verbal expressions when given information about ending cancer treatment. Palliat Med 16:323–330PubMedCrossRefGoogle Scholar
  8. 8.
    Ong LM, Visser MR, van Zuuren FJ, Rietbroek RC, Lammes FB, de Haes JC (1999) Cancer patients' coping styles and doctor-patient communication. Psychooncology 8:155–166PubMedCrossRefGoogle Scholar
  9. 9.
    Hack TF, Degner LF, Parker PA, SCRN Communication Team (2005) The communication goals and needs of cancer patients: a review. Psychooncology 14:831–845PubMedCrossRefGoogle Scholar
  10. 10.
    Kreps GL (2003) The impact of communication on cancer risk, incidence, morbidity, mortality and quality of life. Health Commun 15:161–169PubMedCrossRefGoogle Scholar
  11. 11.
    Prinz C (2012) Disparities in cancer care: are we making progress? Cancer 118:867–868CrossRefGoogle Scholar
  12. 12.
    Carlson LE, Feldman-Stewart D, Tishelman C, Brundage M, SCRN Communication Team (2005) Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework. Psychooncology 14:812–828PubMedCrossRefGoogle Scholar
  13. 13.
    Mazor K, Roblin D, Greene S, Lemay C, Firneno C, Prouty C, Horner K, Gallagher K (2012) Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol 30:1784–1790PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ellis PM, Tattersall MH (1999) How should doctors communicate the diagnosis of cancer to patients? Ann Med 31:336–341PubMedCrossRefGoogle Scholar
  15. 15.
    Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR (1999) Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol 17:371–379PubMedGoogle Scholar
  16. 16.
    Mager WM, Andrykowski MA (2002) Communication in the cancer 'bad news' consultation: patient perceptions and psychological adjustment. Psychooncology 11:35–46PubMedCrossRefGoogle Scholar
  17. 17.
    Finset A, Smedstad M, Ogar B (1997) Physician-patient interaction and coping with cancer: the doctor as informer or supporter? J Cancer Educ 12:174–178PubMedGoogle Scholar
  18. 18.
    Sardell AN, Trierweiler SJ (1993) Disclosing the cancer diagnosis: procedures that influence patient hopefulness. Cancer 72:3355–3365PubMedCrossRefGoogle Scholar
  19. 19.
    Berry DL, Wilkie DJ, Thomas CRJ, Fortner P (2003) Clinicians communicating with patients experiencing cancer pain. Cancer Investig 21:374–381CrossRefGoogle Scholar
  20. 20.
    Ong LM, Visser MR, Lammes F, de Haes JC (2000) Doctor-patient communication and cancer patients' quality of life and satisfaction. Patient Educ Couns 41:145–156PubMedCrossRefGoogle Scholar
  21. 21.
    Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Sollner W, DeVries A, Steixner E, Lukas P, Sprinzl G, Rumpold G, Maislinger S (2001) How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? Br J Cancer 84:179–185PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Gafni A, Charles C, Whelan T (1998) The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. Soc Sci Med 47:347–354PubMedCrossRefGoogle Scholar
  24. 24.
    Hotson K (2003) Can lack of communication kill? Can Family Physician 49:492–495Google Scholar
  25. 25.
    Liang W, Burnett CB, Rowland JH, Meropol NJ, Eggert L, Hwang YT, Silliman RA, Weeks JC, Mandelblatt JS (2002) Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20:1008–1016PubMedCrossRefGoogle Scholar
  26. 26.
    Bredart A, Bouleuc C, Dolbeault S (2005) Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol 17:351–354PubMedCrossRefGoogle Scholar
  27. 27.
    Carlson LE, Bultz BD (2003) Benefits of psychosocial oncology care: improved quality of life and medical cost effect. Health Qual Life Outcome 1:8. doi: 10.1186/1477-7525-1-8 CrossRefGoogle Scholar
  28. 28.
    Salander P (2002) Bad news from the patient's perspective: an analysis of the written narratives of newly diagnosed cancer patients. Soc Sci Med 55:721–732PubMedCrossRefGoogle Scholar
  29. 29.
    Schofield PE, Butow PN, Thompson JF, Tattersall MHN, Beeney LJ, Dunn SM (2003) Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol 14:48–56PubMedCrossRefGoogle Scholar
  30. 30.
    Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K (2005) Approaching difficult communication tasks in oncology. CA Cancer J Clin 55:164–177PubMedCrossRefGoogle Scholar
  31. 31.
    Merckaert I, Libert Y, Razavi D (2005) Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol 17:319–330PubMedCrossRefGoogle Scholar
  32. 32.
    Fellowes D, Wilkinson S, Moore P (2004) Communication skills training for health care professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev Issue 2, Art No: CD003751. DOI:  10.1002/14651858.CD003751.pub2
  33. 33.
    Moore P, Rivera Mercado S, Grez Artiwques M, Lawrie T (2013) Communication skills training for healthcare professionals working with people who have cancer Cochrane Database Syst Rev DOI:  10.1002/14651858.CD003751.pub3
  34. 34.
    Feldman-Stewart D, Brundage MD, Tishelman C, SCRN Communication Team (2005) A conceptual framework for health-professional–patient communication: an application to the cancer context. Psychooncology 14:1–9CrossRefGoogle Scholar
  35. 35.
    Eggly S, Penner L, Albrecht TL, Cline RJW, Foster T, Naughton M, Peterson A, Ruckdeschel JC (2006) Discussing bad news in the outpatient oncology clinic: rethinking current communication guidelines. J Clin Oncol 24:716–719PubMedCrossRefGoogle Scholar
  36. 36.
    Salmon P, Young B (2013) The validity of education and guidance for clinical communication in cancer care: evidence-based practice will depend on practice-based evidence. Patient Educ Couns 90:193–199PubMedCrossRefGoogle Scholar
  37. 37.
    Thorne SE (2008) Interpretive description. Left Coast Press, Walnut Creek, CAGoogle Scholar
  38. 38.
    Thorne S, Armstrong E-A, Harris SR, Hislop TG, Kim-Sing C, Oglov V, Oliffe JL, Stajduhar KI (2009) Patient real-time and 12-month retrospective perceptions of difficult communications in the cancer diagnostic period. Qual Health Res 19:1383–1394PubMedCrossRefGoogle Scholar
  39. 39.
    Thorne S, Oliffe JL, Kim-Sing C, Hislop TG, Stajduhar K, Harris SR, Armstrong E-A, Oglov V (2010) Helpful communications during the diagnostic period: an interpretive description of patient preferences. Eur J Cancer Care 19:746–754CrossRefGoogle Scholar
  40. 40.
    Thorne S, Oliffe JL, Stajduhar KI (2013) Communicating shared decision making: cancer patient perspectives. Patient Educ Couns 90:291–296PubMedCrossRefGoogle Scholar
  41. 41.
    Thorne SE, Taylor K, Stephens J, Kim-Sing C, Hislop T (2013) Of guinea pigs and gratitude: the difficult discourse of clinical trials from the cancer patient perspective Eur J Cancer Care 22(5):663–672Google Scholar
  42. 42.
    Thorne SE, Stajduhar KI (2012) Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses. J Cancer Surviv 6:229–237PubMedCrossRefGoogle Scholar
  43. 43.
    Stajduhar KI, Thorne SE, McGuiness L, Kim-Sing C (2010) Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs 19:2039–2047PubMedCrossRefGoogle Scholar
  44. 44.
    Hoerger M, Epstein RM, Winters P, Fiscella K, Duberstein PR, Gramling R, Butow PN, Mohile S, Kaesberg P, Tang W, Plumb S, Walczak A, Back AL, Tandredi D, Venuti A, Cipri C, Escalera G, Ferro C, Gaudion DBH, Leatherwood B, Lewis L, Robinson M, Sullivan P, Kravitz RL (2013) Values and opinions in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer 13:188PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Thorne SE, Kuo M, Armstrong E-A, McPherson G, Harris S, Hislop G (2005) "Being known:" patient perspectives on human connection in cancer care. Psychooncology 14:887–898PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sally Thorne
    • 1
    Email author
  • T. Gregory Hislop
    • 2
  • Charmaine Kim-Sing
    • 3
  • Valerie Oglov
    • 1
  • John L. Oliffe
    • 1
  • Kelli I. Stajduhar
    • 4
  1. 1.School of NursingUniversity of British ColumbiaVancouverCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  3. 3.Department of Radiation OncologyBritish Columbia Cancer AgencyVancouverCanada
  4. 4.School of NursingUniversity of VictoriaVictoriaCanada

Personalised recommendations