Skip to main content

Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses

Journal of Cancer Survivorship volume 6, pages 229–237 (2012)Cite this article

Abstract

Introduction

Although high quality professional–patient communication is recognized as fundamental to effective cancer care, less attention has been paid to developing an evidence basis for communications surrounding the stage of the cancer journey when primary cancer treatment concludes, management responsibilities shift from oncology specialist services into the generalist care domain, and the patient transitions beyond patienthood and into survivorship.

Methods

Using applied qualitative methodology, we analyzed a database of multiple interviews with 14 Canadian cancer patients from a larger study of changing communication needs and preferences across the cancer trajectory. Through constant comparative analysis, we generated a thematic summary of interpretive understandings from the patient perspective of communication patterns across the transition from active treatment to survivorship.

Results

The accounts illuminate the complexities of the communication environment in which the transition to survivorship occurs. Communication gaps and misinterpretations by clinicians contributed to the confusion, insecurity, vulnerability, loss, and abandonment associated with this transition when they failed to accurately and sensitively respond to individual conditions.

Discussion/conclusions

Despite increasing recognition of the importance of this transition, communication gaps occur in relation to attending to cues, giving prior warning, avoiding avoidance, sensitivity to context, managing relationships, surfacing anxieties, and clarifying roles and responsibilities. These findings expand upon previous reports to explain mechanisms whereby interactions between clinicians and patients may significantly shape the transitional experience and set the stage for survivorship.

Implications for cancer survivors

From the perspective of cancer survivors, the transition beyond initial treatment warrants well-informed anticipatory and supportive healthcare communications.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Ha JF, Longnecker N. Doctor–patient communication: a review. Oschner J. 2010;10:38–43.

    Google Scholar 

  2. Albrecht T, Penner L, Cline R, Eggly S, Ruckdeschel J. Studying the process of clinical communication: issues of concepts, context, and research directions. J Heal Commun. 2009;14:47–56.

    Article  Google Scholar 

  3. Baile WF, Aaron J. Patient–physician communication in oncology: past, present, and future. Curr Opin Oncol. 2005;17(4):331–5.

    PubMed  Article  Google Scholar 

  4. Cunningham AJ. The mind–cancer connection: can the patient’s mental state assist in healing? Oncol Exch. 2004;3(3):19–26.

    Google Scholar 

  5. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363(9405):312–9.

    PubMed  Article  Google Scholar 

  6. Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L. Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002;20(8):2189–96.

    PubMed  Article  Google Scholar 

  7. Schofield P, Carey M, Love A, Nehill C, Wein S. Would you like to talk about your future treatment options? Discussing the transition from curative cancer treatment to palliative care. Palliat Med. 2006;20(4):397–406.

    PubMed  Article  Google Scholar 

  8. Beach WA, Easter DW, Good JS, Pigeron E. Disclosing and responding to cancer “fears” during oncology interviews. Soc Sci Med. 2005;60(4):893–910.

    PubMed  Article  Google Scholar 

  9. Bultz BD, Thorne S, Fitch MF. Who owns emotional care of the cancer patient? Untangling the conceptual confusion. Oncol Exch. 2004;3:32–5.

    Google Scholar 

  10. Surbone A, Baider L, Weitzman TS, Brames MJ, Rittenberg CN, Johnson J. Psychosocial care for patients and their families is integral to supportive care in cancer: MASCC position statement. Support Care Cancer. 2009;18(2):255–63.

    PubMed  Article  Google Scholar 

  11. Epstein RM, Street RL. Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: NIH Publication no. 07–6225; 2007.

  12. Thorne SE, Hislop TG, Armstrong EA, Oglov V. Cancer care communication: the power to harm and the power to heal? Patient Educ Couns. 2008;71(1):34–40.

    PubMed  Article  Google Scholar 

  13. Carlson LE, Feldman-Stewart D, Tishelman C, Brundage MD, SCRN Communication Team. Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework. Psycho-Oncology. 2005;14(10):812–28.

    PubMed  Article  Google Scholar 

  14. Brundage M, Feldman-Stewart D, Tishelman C. How do interventions designed to improve provider-patient communication work? Illustrative applications of a framework for communication. Acta Oncol. 2010;29(3):136–43.

    Article  Google Scholar 

  15. Feldman-Stewart D, Brundage MD, Tishelman C, SCRN Communication Team. A conceptual framework for patient–professional communication: an application to the cancer context. Psycho-Oncology. 2005;14(10):801–9.

    PubMed  Article  CAS  Google Scholar 

  16. Butow P. The communication goals and needs of cancer patients: a review. Psycho-Oncology. 2005;14:846–7.

    Article  Google Scholar 

  17. Schofield PE, Butow PN. Towards better communication in cancer care: a framework for developing evidence-based interventions. Patient Educ Couns. 2004;55(1):32–9.

    PubMed  Article  Google Scholar 

  18. Thorne SE. Communication in cancer care: what science can and cannot teach us. Cancer Nurs. 1999;22(5):370–8.

    PubMed  Article  CAS  Google Scholar 

  19. 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. 2006;62(3):355–60.

    PubMed  Article  Google Scholar 

  20. Hesse BW. Cancer communication: status and future directions. J Heal Commun. 2009;14:109–27.

    Article  Google Scholar 

  21. Aziz N. Cancer survivorship research: state of knoweldge, challenges, and opportunities. Acta Oncol. 2007;46:417–4312.

    PubMed  Article  Google Scholar 

  22. Stanton AL. Psychosocial concerns and interventions for cancer survivors. J Clin Oncol. 2006;24(32):5132–7.

    PubMed  Article  Google Scholar 

  23. Haylock PJ. State of the science: the shifting paradigm of cancer care. Am J Nurs. 2006;106(3 suppl):16–9.

    PubMed  Article  Google Scholar 

  24. Feuerstein M. Quality health care for cancer survivors: a survivor’s perspective. J Cancer Surviv. 2009;3:1–3.

    PubMed  Article  Google Scholar 

  25. Doyle N. Cancer survivorship: evolutionary concept analysis. J Adv Nurs. 2008;62(4):499–509.

    PubMed  Article  Google Scholar 

  26. Feuerstein M. Defining cancer survivorship. J Cancer Surviv. 2007;1:5–7.

    PubMed  Article  Google Scholar 

  27. Feuerstein M. The Journal of Cancer Survivorship: retrospective and future directions. J Cancer Surviv. 2011;5:315–9.

    PubMed  Article  Google Scholar 

  28. Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011. Toronto, ON: Canadian Cancer Society, http://www.cancer.ca/; 2011.

  29. Phillips JL, Currow DC. Cancer as a chronic disease. Collegian. 2010;17(2):47–50.

    PubMed  Article  Google Scholar 

  30. Hewitt M, Greenfield S, Stovall E, eds. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press, http://www.nap.edu/catalog/11468.html. 2006.

  31. Roundtree A, Giordano S, Price A, Suarez-Almazor M. Problems in transition and quality of care: perspectives of breast cancer survivors. Support Care Cancer. 2011;19(2):1921–9.

    PubMed  Article  Google Scholar 

  32. Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing! J Clin Oncol. 2005;24:5458–60.

    Article  Google Scholar 

  33. Arora NK. Importance of patient-centered care in enhancing patient well-being: a cancer survivor’s perspective. Qual Life Res. 2009;18(1):1–4.

    PubMed  Article  Google Scholar 

  34. Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomark Prev. 2011;20(10):1996–2005.

    Article  Google Scholar 

  35. Bober SL, Recklitis CJ, Campbell EG, Park ER, Kutner JS, Najita JS, et al. Caring for cancer survivors: a survey of primary care physicians. Cancer. 2009;115(18 Suppl):4409–18.

    PubMed  Article  Google Scholar 

  36. Kantsiper M, McDonald EL, Geller G, Schockney L, Snyder C, Wolff AC. Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med. 2009;24 Suppl 2:459–66.

    Article  Google Scholar 

  37. Meyerowitz BE, Kurita K, D’Orazio LM. The psychological and emotional fallout of cancer and its treatment. Cancer J. 2008;14(6):410–3.

    PubMed  Article  Google Scholar 

  38. Jefford M, Karahalios E, Pollard A, Baravelli C, Carey M, Franklin J, et al. Survivorship issues following treatment completion: results from focus groups with Australian cancer survivors and health professionals. J Cancer Surviv. 2008;2:20–3.

    PubMed  Article  Google Scholar 

  39. Mao JJ, Bowman MA, Stricker CT, DeMichele A, Jacobs L, Chan D, et al. Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J Clin Oncol. 2009;27(6):933–8.

    PubMed  Article  Google Scholar 

  40. Miller K, Merry B, Miller J. Seasons of survivorship revisited. Cancer J. 2008;14(6):369–74.

    PubMed  Article  Google Scholar 

  41. Hawkins NA, Pollack LA, Leadbetter S, Steel WR, Carroll J, Donal JG, et al. Information needs of patients and perceived adequacy of information available before and after treatment of cancer. J Psychosoc Oncol. 2008;26(2):1–16.

    PubMed  Article  Google Scholar 

  42. Clayton MF, Dudley WM. Patient-centered communication during oncology follow-up visits with breast cancer survivors: content and temporal structure. Oncol Nurs Forum. 2009;36(2):E68–79.

    PubMed  Article  Google Scholar 

  43. Royak-Schaler R, Passmore SR, Gadalla S, Hoy K, Khan M, Tkaczuk K, et al. Exploring patient–physician communication in breast cancer for African American women following primary treatment. Oncol Nurs Forum. 2008;25(5):836–43.

    Article  Google Scholar 

  44. Rowland JH. What are cancer survivors telling us? Cancer J. 2008;14(6):361–8.

    PubMed  Article  Google Scholar 

  45. Jacobs LA, Palmer SC, Schwartz LA, DeMichele A, Mao JJ, Carver J, et al. Adult cancer survivorship: evolution, research, and planning care. CA Cancer J Clin. 2009;29(6):391–410.

    Article  Google Scholar 

  46. Ma WW, Adjei AA. Novel agents on the horizon for cancer therapy. CA Cancer J Clin. 2009;59:111–37. doi:10.3322/caac.20003.

    PubMed  Article  Google Scholar 

  47. Malin J, Sayers E-J, Jefford M. What Is quality health care for cancer survivors? In: Feuerstein M, Ganz PA, editors. Health services for cancer survivors, part 1. New York: Springer; 2011. p. 27–49.

    Chapter  Google Scholar 

  48. Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;40:25–30. doi:10.1093/jncimonographs/lgq002.

    Article  Google Scholar 

  49. Sisler J, McCormack-Speak P. Bridging the gap between primary care and the cancer system. Can Fam Physician. 2009;55:273–8.

    PubMed  Google Scholar 

  50. Health Canada. Canada’s health care system. http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php. Accessed 28 Dec 2011.

  51. Thorne S, Reimer Kirkham S, MacDonald-Emes J. Interpretive description: a non-categorical qualitative alternative for developing nursing knowledge. Res Nurs Heal. 1997;20(2):169–77.

    Article  CAS  Google Scholar 

  52. Thorne SE. Interpretive description. Walnut Creek, CA: Left Coast Press; 2008.

    Google Scholar 

  53. Lewis L. Discussion and recommendations: addressing barriers in the management of cancer survivors. Am J Nurs. 2006;106(3):S91–5.

    Article  Google Scholar 

  54. Sacks O. A leg to stand on. London: Duckworth; 1984.

    Google Scholar 

  55. Rodriguez K, Gambino F, Butow P, Hagerty R, Arnold R. Pushing up daisies: implicit and explicit language in oncologist–patient communication about death. Support Care Cancer. 2007;15(2):153–61.

    PubMed  Article  Google Scholar 

  56. Thorne SE, Kuo M, Armstrong E-A, McPherson G, Harris S, Hislop G. “Being known:” Patient perspectives on human connection in cancer care. Psycho-Oncology. 2005;14:887–98.

    PubMed  Article  Google Scholar 

  57. Rowland JH, Hewitt M, Ganz PA. Cancer survivorship: a new challenge in delivering quality cancer care. J Clin Oncol. 2006;24(3):5101–3.

    PubMed  Article  Google Scholar 

  58. Nekhlyudov L. “Doc, should I see you or my oncologist?”: a primary care perspective on opportunities and challenges in providing comprehensive care for cancer survivors. J Clin Oncol. 2009;27(15):2424–6.

    PubMed  Article  Google Scholar 

  59. Taplin S, Rodger A. Towards improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care. J Natl Cancer Inst Monogr. 2010;40:3–10.

    Article  Google Scholar 

  60. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol. 2006;24(32):5112–6.

    PubMed  Article  Google Scholar 

  61. Hewitt ME, Bamundo A, Day R, Harvey C. Perspectives on post treatment cancer care: qualitative research with survivors, nurses, and physicians. J Clin Oncol. 2007;25(16):2270–3.

    PubMed  Article  Google Scholar 

  62. Taplin SH, Rodgers AB. Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care. J Natl Cancer Inst Monogr. 2010;40:3–1.

    Article  Google Scholar 

  63. Lofti-Jam K, Schofield PE, Jefford M. What constitutes ideal survivorship care? Cancer Forum. 2009;33(3):172–5.

    Google Scholar 

  64. Rowland JH, Ganz PA. Cancer survivorship plans: a paradigm shift in the delivery of quality cancer care. In: Feuerstein M, Ganz PA, editors. Health services for cancer survivors, Part 2. New York: Springer; 2011. p. 169–85.

    Chapter  Google Scholar 

  65. Shulman L, Jacobs L, Greenfield S, Jones B, McCabe M, Syrjala K, et al. Cancer care and cancer survivorship care in the United States: will we be able to care for these patients in the future? J Oncol Pract. 2009;5(3):119–23.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Valerie Oglov and Joanne Reimer for their assistance with this project.

Grant support

The Canadian Institutes for Health Research (#74545) and the Canadian Cancer Society Research Institute (#020376) supported this research.

Financial disclosures

The authors have no financial disclosures to report.

Author information

Affiliations

  1. School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada

    Sally E. Thorne

  2. School of Nursing, University of Victoria, Victoria, BC, Canada

    Kelli I. Stajduhar

Authors
  1. Sally E. Thorne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelli I. Stajduhar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sally E. Thorne.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thorne, S.E., Stajduhar, K.I. Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses. J Cancer Surviv 6, 229–237 (2012). https://doi.org/10.1007/s11764-012-0216-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-012-0216-z

Keywords

  • Cancer
  • Quality of life
  • Communication
  • Survivors
  • Patient-centered care
  • Professional–patient relations