Patient real-time and 12-month retrospective perceptions of difficult communications in the cancer diagnostic period.

Communication is a notoriously complex challenge in the cancer care context. Our program of research involves exploration of patient-provider communications across the cancer trajectory from the patient perspective.Toward this end, we have been following a cohort of 60 cancer patients, representing a range of tumor sites, from immediately after diagnosis through to recovery, chronic, or advanced disease. Drawing on interpretive description analytic techniques, we documented patterns and themes related to various components of the cancer journey. In this article, we report on findings pertaining to poor communication during the initial diagnostic period, as described by patients at the time of diagnosis and 1 year later.These findings illuminate the dynamics of communication problems during that complex period, and depict the mechanisms by which patients sought to confront these challenges to optimize their cancer care experience. On the basis of these findings, considered in the context of the body of available evidence, suggestions are proposed as to appropriate directions for system-level solutions to the complex communication challenges within cancer care.

Cancer care communication: the power to harm and the power to heal?

OBJECTIVE: This study was designed to examine the belief held by many cancer patients that communication with their care providers has a meaningful part to play in shaping their disease outcomes. METHODS: From a large qualitative interview data set in which cancer patients described their perceptions of helpful and unhelpful heath care communication; we extracted the accounts of 69 patients and 13 focus group participants who specifically articulated a perceived relationship between communication and cancer outcomes. Through secondary analysis of that subset, we generated an interpretive description of patterns and themes within their accounts of a relationship between communication and cancer survivorship. RESULTS: Our findings document patient perceptions of the mechanisms involved in indirect and, some instances, direct relationships between communication encounters and cancer outcomes. CONCLUSION: Some cancer patients believe that, by virtue of its influence upon comfort, inclusion, clarity and hope, communication can influence cancer outcomes. PRACTICE IMPLICATIONS: While competing discourses exist within the patient population with regard to such associations, the perception that communication may influence clinical outcomes seems sufficiently pervasive and persistent that it warrants serious attention within care systems and by the psychosocial cancer research community.

Prognosticating futures and the human experience of hope.

OBJECTIVES: Communication between health care providers and patients with cancer and other chronic diseases typically references probabilities that certain future events will or will not occur. Beyond the context of diagnostic encounters and the transmission of "bad news," such "prognostic" communications take place in various forms throughout the illness trajectory. It is well known that such information transmitted badly can have devastating psychosocial consequences for patients and their families and, conversely, that difficult information exchanged with sensitivity can lend tremendous support. This study aimed to extend our understanding of how such communications are received and interpreted by patients, so that we might optimally apply what we know about general principles of effective communication within the particularly challenging context of predicting futures. METHODS: We conducted a combined secondary analysis of two prior qualitative studies into patient perceptions of helpful and unhelpful health care communication with 200 cancer patients and 30 persons with chronic illness. These data sets offered a rich resource for comparing perceptions across a range of contextual variables, and secondary analysis focused on future-oriented interactions, including both prognostication and prediction. RESULTS: The accounts of patients with cancer and chronic illness reveal various ways in which health care communications involving future projections interact with their human experience of hope, powerfully shaping their capacity to make sense of and live with serious illness. They include a synthesis of what patients recommend health care professionals know and understand about this challenging dynamic. SIGNIFICANCE OF RESULTS: The findings of this study offer a distinct angle of vision onto the various communications that involve future predictions, illuminating a patient perspective with the potential to inform health care communication approaches that are both informative and therapeutic. As such, the study supports a dynamic understanding of the tenuous balance between hope and honesty in the clinical encounter.

"Truth telling" and cultural assumptions in an era of informed consent.

Patient and healthcare provider communication is vital in cancer care and aspects of the patients' experiences provide valuable insight to what constitutes effective cancer communication. In this article we describe the communication experiences of patients from nondominant cultures who accessed Canadian-based cancer services. The findings enabled us to thoughtfully reflect on Western ideals about autonomy and responsibility and their relationship to informed consent in the context of cancer communication.

Hope and probability: patient perspectives of the meaning of numerical information in cancer communication.

Although the complexities inherent in human communication make it a difficult target for empirical investigation and systematic interpretation, it is well recognized that patient-provider communication can have either a powerfully negative or positive influence on the experience of cancer. Drawing on an extensive data set derived from interviews with 200 cancer patients, the authors examine the impact of information provided in numerical form within cancer care communications from the patient perspective. In this context, they present findings related to various uses and abuses of numbers within cancer care communication, and illustrate how numerical information constitutes a specialized communication form with considerable potency for shaping the cancer experience. In particular, accounts of the thematic relationship between numbers and hope, from the perspective of those on the receiving end of cancer care, provide a unique perspective from which to interpret issues of compassion, caring, and informed consent.

'Being known': patients' perspectives of the dynamics of human connection in cancer care.

In the context of a large study of effective and ineffective cancer care communications from the perspective of patients with cancer, the authors documented the pervasiveness of the desire for human connection. Analyzing accounts from 200 patients with diverse cancer experiences, they concluded that, while anonymity is generally antithetical to a comfortable cancer care encounter, there are wide variations in what it means to 'be known' in a meaningful way. In this discussion, a description of the dynamics of being known and not being known within the cancer care encounter is presented, and a range of variations considered. By illuminating the manner in which communication influences human connection within the cancer care context, the findings of this study challenge some current research directions and propose alternative conceptualizations that might better orient future inquiry to enhance practice.