ABSTRACT
BACKGROUND
Communication breakdowns in cancer care are common and represent a failure in patient-centered care. While multiple studies have elicited patients’ perspectives on these breakdowns, little is known about cancer care providers’ attitudes regarding the causes and potential solutions.
OBJECTIVE
To examine providers’ (1) perceptions of the nature and causes of communication breakdowns with patients in cancer care and (2) suggestions for managing and preventing breakdowns.
DESIGN
Qualitative study of nine focus groups held at three sites (Massachusetts, Georgia and Washington).
PARTICIPANTS
Fifty-nine providers: 33 % primary care physicians, 14 % oncologists, 36 % nurses, and 17 % nurse practitioners, physician assistants, and others.
APPROACH
Directed content analysis of focus group transcripts.
KEY RESULTS
Providers’ perceptions of the causes of communication breakdowns fell into three categories: causes related to patients, providers, or healthcare systems. Providers perceived that patients sometimes struggle to understand cancer and health-related information, have unrealistic expectations, experience emotional and psychological distress that interferes with information exchange; and may be reticent to share their confusion or concerns. Providers described their own and colleagues’ contributions to these breakdowns as sharing inaccurate, conflicting, or uncoordinated information. Providers also described the difficulty in balancing hope with reality in discussions of prognosis. System issues named by providers included insufficient time with patients, payment systems, and changing protocols that inhibit communication and coordination of care. Potential solutions included greater patient engagement, team coordination, and systems that promote patient feedback.
CONCLUSIONS
Providers described multiple causes for communication breakdowns at the patient, provider, and system level. Multi-level interventions that coordinate care and encourage feedback may help to address or prevent communication breakdowns.
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REFERENCES
Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer. 2003;88(5):658–65.
Thorne SE, Bultz BD, Baile WF. Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology. 2005;14(10):875–84. discussion 885–876.
Wagner EH, Aiello Bowles EJ, Greene SM, et al. The quality of cancer patient experience: perspectives of patients, family members, providers and experts. Qual Saf Health Care. 2010;19(6):484–9.
Mazor KM, Roblin DW, Greene SM, et al. Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol. 2012;30(15):1784–90.
Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: National Academies Press; 2007.
Aiello Bowles EJ, Tuzzio L, Wiese CJ, et al. Understanding high-quality cancer care: a summary of expert perspectives. Cancer. 2008;112(4):934–42.
Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295–301.
Arora NK. Interacting with cancer patients: the significance of physicians' communication behavior. Soc Sci Med. 2003;57(5):791–806.
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.
Thorne S, Armstrong EA, Harris SR, et al. Patient real-time and 12-month retrospective perceptions of difficult communications in the cancer diagnostic period. Qual Health Res. 2009;19(10):1383–94.
Duclos CW, Eichler M, Taylor L, et al. Patient perspectives of patient–provider communication after adverse events. Int J Qual Health Care. 2005;17(6):479–86.
Teno JM, Lima JC, Lyons KD. Cancer patient assessment and reports of excellence: reliability and validity of advanced cancer patient perceptions of the quality of care. J Clin Oncol. 2009;27(10):1621–6.
Thorne SE, Stajduhar KI. Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses. J Cancer Surviv. 2012;6(2):229–37.
Stajduhar KI, Thorne SE, McGuinness L, Kim-Sing C. Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs. 2010;19(13–14):2039–47.
Thorne SE, Kuo M, Armstrong EA, McPherson G, Harris SR, Hislop TG. ‘Being known’: patients’ perspectives of the dynamics of human connection in cancer care. Psychooncology. 2005;14(10):887–98. discussion 899–900.
Parker PA, Davison BJ, Tishelman C, Brundage MD. What do we know about facilitating patient communication in the cancer care setting? Psychooncology. 2005;14(10):848–58. discussion 859–860.
Bakker DA, Fitch MI, Gray R, Reed E, Bennett J. Patient-health care provider communication during chemotherapy treatment: the perspectives of women with breast cancer. Patient Educ Couns. 2001;43(1):61–71.
Ishikawa H, Takayama T, Yamazaki Y, Seki Y, Katsumata N. Physician–patient communication and patient satisfaction in Japanese cancer consultations. Soc Sci Med. 2002;55(2):301–11.
Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood). 2012;31(5):1030–8.
McGuire AL, McCullough LB, Weller SC, Whitney SN. Missed expectations? Physicians’ views of patients’ participation in medical decision-making. Med Care. 2005;43(5):466–70.
Street RL Jr, Haidet P. How well do doctors know their patients? Factors affecting physician understanding of patients’ health beliefs. J Gen Intern Med. 2010;26(1):21–7.
Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L. Breaking bad news about cancer: patients’ preferences for communication. J Clin Oncol. 2001;19(7):2049–56.
Caruso A, Di Francesco B, Pugliese P, Cinanni V, Corlito A. Information and awareness of diagnosis and progression of cancer in adult and elderly cancer patients. Tumori. 2000;86(3):199–203.
Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18(8):2116–25.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
Cleary PD, Gross CP, Zaslavsky AM, Taplin SH. Multilevel interventions: study design and analysis issues. J Natl Cancer Inst Monogr. 2012;2012(44):49–55.
Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2011;86(1):9–18.
Arora NK. Advancing research on patient-centered cancer communication. Patient Educ Couns. 2008;70(3):301–2.
Arora NK, Street RL Jr, Epstein RM, Butow PN. Facilitating patient-centered cancer communication: a road map. Patient Educ Couns. 2009;77(3):319–21.
Browne K, Roseman D, Shaller D, Edgman-Levitan S. Analysis & commentary. Measuring patient experience as a strategy for improving primary care. Health Aff (Millwood). 2010;29(5):921–5.
Mazor KM, Beard RL, Alexander GL, Arora NK, Firneno C, Gaglio B, Greene SM, Lemay CA, Roblin DW, Street RL, Gallagher TH. Patients’ and family members’ views on patient-centered communication during cancer care. Psychooncology. 2014;22(1):163–72.
Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Ann Intern Med. 2012;157:461–7.
Acknowledgements
This research was supported by Award Number CA-P20-137219 from the National Cancer Institute.
Portions of this work have been presented at the HMORN Annual Meeting in Boston MA, 2011.
Conflicts of Interest
The authors declare that they do not have a conflict of interest.
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Prouty, C.D., Mazor, K.M., Greene, S.M. et al. Providers’ Perceptions of Communication Breakdowns in Cancer Care. J GEN INTERN MED 29, 1122–1130 (2014). https://doi.org/10.1007/s11606-014-2769-1
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DOI: https://doi.org/10.1007/s11606-014-2769-1