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OBJECTIVES: Communicating a cancer diagnosis to a child is a complex challenge for parents. This study aims to explore (1) the communication strategies and beliefs of parents with cancer when communicating with their children and (2) the needs of these parents. METHODS: Semi-structured interviews were conducted with parents with cancer being treated at an Italian comprehensive cancer center and their healthy partners, when present. The interviews were analyzed through a constructivist approach using reflexive thematic analysis. The number of parents to be interviewed was not predetermined, but the meaning saturation procedure was followed. RESULTS: Ten parents were interviewed, meaning saturation was reached at the seventh interview. Five themes were created: (1) the challenges parents faced at this sensitive time; (2) the emotions parents experienced; (3) the beliefs that may have influenced how they communicate the illness to their children; (4) the strategies parents used to communicate the illness to their children and (5) parents' perception of their children's understanding of the illness. Fifty-seven needs, often unmet, were also identified and were grouped into three categories: (1) "existential" needs; (2) support needs; and (3) needs related to continuing to be and act as parents. SIGNIFICANCE OF RESULTS: This study provides important insights for healthcare professionals to consider in order to better support and care for these parents.
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Comunicación , Neoplasias , Relaciones Padres-Hijo , Padres , Humanos , Investigación Cualitativa , Femenino , Neoplasias/psicología , Neoplasias/complicaciones , Masculino , Adulto , Padres/psicología , Niño , Persona de Mediana Edad , Italia , Preescolar , Entrevistas como Asunto/métodos , AdolescenteRESUMEN
BACKGROUND: Neuro oncologists bear the responsibility of disclosing prognostic information to patients with glioblastoma. Despite this obligation, prognostic information is neither routinely nor effectively communicated. METHODS: A narrative review of empiric data related to prognostic disclosure in cancer and in GBM is performed, and a normative framework based on this data and our own clinical and ethical experience and consideration is presented. ANALYSIS: The authors propose a framework of staged disclosure of prognostic information, where the incurability of glioblastoma and the likelihood of neurocognitive decline are discussed at the first patient encounter, but estimations of life expectancy are deferred until a subsequent visit. This approach pragmatically balances oncologists' obligation to preserve patient autonomy and prioritize advance care planning, while also aiming to prevent information overload, allowing the news to be delivered in the context of an increasingly trustful patient-physician relationship, and allowing for more accurate estimations in light of complete pathology results, which are not often available at the first visit. CONCLUSION: Staged prognostic discussions about glioblastoma balance oncologists' ethical obligations and optimize communication of prognostic information to patients and their families. Further empirical studies implementing this approach are warranted.
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Neoplasias Encefálicas , Comunicación , Glioblastoma , Relaciones Médico-Paciente , Humanos , Glioblastoma/patología , Glioblastoma/psicología , Glioblastoma/diagnóstico , Glioblastoma/terapia , Pronóstico , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/psicología , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Planificación Anticipada de Atención , Estadificación de NeoplasiasRESUMEN
OBJECTIVES: Open communication between parents and adolescents and young adults (AYAs) with blood cancer is key to managing cancer together. However, parents avoid difficult conversations about cancer care and lack support in navigating them. To inform a communication skills intervention to help parents of AYAs navigate challenging conversations in caregiving, this mixed-method study sought to identify difficult topics and better understand psychosocial factors associated with avoidant communication. METHODS: Phase 1 involved 20 interviews with parents of AYAs with blood cancer (aged 15-29) to capture difficult conversations and factors that inform why they are challenging. Phase 2 surveyed 80 parents about openness, avoidance, and psychosocial outcomes. RESULTS: In Phase 1, parents identified 5 challenging conversation areas: (1) expressing negative feelings; (2) discussing disease/care-related information; (3) addressing sexual health; (4) navigating triadic clinical interactions; and (5) talking about mortality. Parents described 3 interrelated factors that informed why these conversations were difficult: (1) lifespan/human development; (2) emotional/psychological well-being; and (3) relational-caregiving dynamics. Quantitative results (Phase 2) confirmed the same challenging conversation areas and extended them with an additional topic parents avoid: caregiver burden. Overall avoidance of these topics was associated with lower clinical communication skills and competence, less openness between parents and AYAs, reduced willingness to communicate about cancer, and greater parental distress. Avoidance of discussing caregiver burden and sexual health with their AYA was associated with higher burden. Younger parents reported higher overall avoidance compared to older ones. Hispanic/Latino parents reported higher overall avoidance than non-Hispanic/Latino. Parents without a high school degree had higher scores for avoiding treatment discussions compared to parents with higher education levels. SIGNIFICANCE OF RESULTS: Findings highlight the need for supportive care interventions that strengthen parent caregivers' communication skills. This study also provides a roadmap of key content to include, ensuring communication skills interventions are relevant and impactful.
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Cuidadores , Comunicación , Padres , Humanos , Masculino , Femenino , Adulto , Adolescente , Adulto Joven , Padres/psicología , Investigación Cualitativa , Cuidadores/psicología , Encuestas y Cuestionarios , Entrevistas como Asunto/métodosRESUMEN
BACKGROUND: For many individuals, living with cancer means having a chronic and complex health condition that requires well-coordinated care between primary and specialist settings. Continuity of care is often compromised by lack of shared information between providers about a person's circumstances, communication support needs, health information or cultural requirements. This project aimed to use co-design with people from culturally and linguistically diverse backgrounds who have lived experience of cancer and their care providers to create a resource to enhance continuity of care when accessing multiple health providers. METHODS: A co-design group (n = 9) was formed comprising of people from different cultural and linguistic backgrounds with lived experience of cancer (n = 4) as survivors or carers, alongside healthcare providers (n = 5) working in primary care or as specialists. Co-design group members were recruited from cancer support organisations, consumer organisations, primary health networks, hospital oncology services and professional networks nationally in Australia to provide diverse lived experience of cancer and professional expertise in the provision of cancer care. A series of four co-design workshops were held, supported by asynchronous communication facilitated by an external agency to create and refine the final prototype resource. RESULTS: The co-design group created a person-held tool called Care My Way for individuals with cancer to share socio-cultural information with health providers. This resource was developed in response to an identified gap in person-held resources that for people with cancer to communicate their socio-cultural information beyond interpreter requirements, language spoken and country of birth so that health providers can understand how this may influence care. Care My Way comprises of four components through which people living with cancer can share information about (1) themselves, (2) their communication approach and support needs, (3) their cancer journey and care, and (4) their care requirements based on cultural and faith backgrounds. Using Care My Way seeks to promote relational and informational continuity of care between multiple health professionals for people with cancer whose care spans primary and specialist settings. CONCLUSIONS: Person-held tools such as Care My Way provide an opportunity for people affected by cancer to identify critical information about themselves and their care, including the socio-cultural information relevant to their care. Using Care My Way puts the individual at the heart of decision-making about the information they wish to share and may provide a low-cost, accessible and flexible method for individuals to share information about themselves, their culture and their health between primary and specialist settings in a bid to improve quality of care. Evaluative studies are now required to determine the effectiveness of this tool for improving continuity of care. PATIENT OR PUBLIC CONTRIBUTION: This study is part of a 4-year project that was designed with consumers who have lived experiences of cancer as a patient or carer from diverse cultural and linguistic backgrounds in Australia. The project included consumer investigators and a Consumer Advisory Group throughout the lifecycle. The co-authors of this manuscript include consumers (C.P., J.E.) who were members of the co-design group who wished to contribute as authors.
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Continuidad de la Atención al Paciente , Difusión de la Información , Neoplasias , Atención Primaria de Salud , Humanos , Neoplasias/terapia , Atención Primaria de Salud/organización & administración , Difusión de la Información/métodos , Continuidad de la Atención al Paciente/organización & administración , Australia , Comunicación , Femenino , MasculinoRESUMEN
OBJECTIVE: Deprescribing is not well integrated into clinical practice and improving patient education is recommended to foster deprescribing communication. Based on our experience developing, adapting, and implementing the Optimize deprescribing educational intervention for persons living with dementia, we discuss lessons learned in providing deprescribing education to patients and family members or other care partners. METHODS: The Optimize study was a cluster randomized, pragmatic trial in primary care that provided deprescribing education to individuals with cognitive impairment, polypharmacy and multiple chronic conditions, and their care partners. The initial intervention provided materials by mail ahead of visits. The delayed control intervention provided materials at the point of care. In 28 semi-structured interviews with 16 patients alone, 10 patient-caregiver dyads, and 2 caregivers alone, conducted across both intervention arms and analyzed using the framework method for implementation assessment, participants reflected on approaches to providing educational materials to support deprescribing in primary care. RESULTS: Patients and care partners welcomed receiving educational materials about deprescribing. Patients and care partners had varying suggestions for modes of materials delivery (e.g., online, mail, with prescriptions). Competing demands at the point of care interfered with clinic staff distributing materials at that time, although some patients were theoretically agreeable to this approach. Providers requested timing materials delivery to align with clinical encounters that foster discussing medications and goals of care. CONCLUSIONS: These pragmatic learnings suggest that operational approaches to deprescribing education for polypharmacy include multiple team members and multiple modes of delivering information about deprescribing and polypharmacy to patients and care partners. Detailed approaches deserve further investigation.
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Cuidadores , Atención a la Salud , Demencia , Deprescripciones , Educación del Paciente como Asunto , Humanos , Femenino , Masculino , Anciano , Polifarmacia , Educación del Paciente como Asunto/métodos , Cuidadores/educación , Cuidadores/psicología , Atención Primaria de Salud , Anciano de 80 o más Años , Demencia/tratamiento farmacológico , Persona de Mediana Edad , Comunicación , Entrevistas como Asunto , Investigación CualitativaRESUMEN
BACKGROUND: Addressing patient emotions is a key aspect of patient-centered care and can strengthen trust and the physician-patient relationship. However, research suggests that physicians often miss opportunities to respond empathically to patients' emotional cues and concerns. OBJECTIVE: We conducted a systematic review and meta-analysis to evaluate the proportion of empathic opportunities physicians took in response to patients' emotional cues and concerns, and how this is associated with outcomes such as the physician-patient relationship, satisfaction, anxiety, and consultation duration. METHODS: We systematically searched PubMed, EMBASE, and PsycINFO from the inception of each database to February 28, 2025. Eligible studies included randomized clinical trials and observational studies assessing physicians' responses to adult patients' emotional cues and concerns. Three independent reviewers extracted data on outcomes and study characteristics. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The study is registered in PROSPERO and was conducted according to the PRISMA guidelines. The primary outcome was the proportion of empathic opportunities taken by physicians. Secondary outcomes included the frequency and type of physicians' responses to patients' emotional expressions, and their associations with the physician-patient relationship, patient anxiety, satisfaction, and consultation duration. RESULTS: We included 61 studies (10,013 patients) in this review and 43 studies (6662 patients) with a total of 19,227 emotional cues and concerns in the quantitative synthesis. The overall pooled proportion of empathic opportunities taken by physicians was 0.47 (95â¯% CI, 0.39-0.54). Rates were lower in oncology (0.35; 95â¯% CI, 0.27-0.44) compared to general practice (0.61; 95â¯% CI, 0.49-0.72) and other disciplines (0.50; 95â¯% CI, 0.36-0.63). CONCLUSION: Physicians respond to fewer than half of patients' emotional cues-especially in oncology, where response rates are lowest-highlighting the need for better support in developing empathic skills. TRIAL REGISTRATION: PROSPERO (CRD42023405646).
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Señales (Psicología) , Emociones , Empatía , Relaciones Médico-Paciente , Médicos , Humanos , Médicos/psicología , Satisfacción del Paciente , Atención Dirigida al Paciente , Comunicación , AnsiedadRESUMEN
Teaching the 'art' of surgical communication, which encompasses nuanced skills such as empathy and navigating uncertainty, presents a significant challenge in medical education. While structured frameworks are well-taught, a persistent gap exists between knowing communication theory and applying it effectively in practice. This perspective argues that the critical barrier is not a deficit in communication models, but a 'knowing-doing gap' within surgical faculty, perpetuated by clinical pressures and the hidden curriculum. Closing this gap requires a fundamental reimagining of faculty development, moving beyond didactic instruction toward transformative, experiential learning. We propose 3 evidence-based directions: 1) deliberate practice using simulated scenarios combined with facilitated, reflective feedback to enhance self-awareness; 2) structured reflective practice through narrative medicine to cultivate empathy and perspective-taking; and 3) in situ peer observation and coaching to transfer skills directly into the clinical environment. By investing in these deep-seated developmental strategies, we can equip faculty to become masterful models of communication, thereby fostering a new generation of surgeons who are not only skilled technicians but also compassionate healers.
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Comunicación , Docentes Médicos , Cirugía General , Desarrollo de Personal , Humanos , Cirugía General/educación , Curriculum , Empatía , Desarrollo de Personal/métodos , Competencia ClínicaRESUMEN
OBJECTIVES: Effective critical care communication is vital for patient safety, yet the risks of ambiguous abbreviations and acronyms or initialisms in clinical communication remain understudied. This narrative review aims to identify potentially ambiguous abbreviations and acronyms in critical care and evaluate their potential implications for clinical safety and communication quality. From this, educational interventions and standardized protocols could be devised to optimize communication. METHODS: PubMed and Embase databases were used to identify studies and reports on the use of abbreviations and acronyms in medical care and references of identified publications were screened. Additionally, the large language model "Chat Generative Pre-Trained Transformer-4omni" was used to generate a list of ambiguous terms used in critical care. RESULTS: We identified 52 ambiguous acronyms and initialisms, and 24 abbreviations used in critical care with multiple meanings, risking critical errors during communication and ward transfers. These ambiguities stem from specialty, context, or institutional differences. The literature discusses optimization of communication in critical care during hand-offs or more complex solutions including auto-expansion software or protocols. Only few studies discussed the dangers of medication errors or misunderstandings due to abbreviation use. Abbreviations contribute to as much as 13 % of medication errors. Strategies are proposed to reduce abbreviation-related errors including spelling out terms initially, using closed-loop communication, standardized unit-approved lists, regular education, and avoiding jargon. CONCLUSIONS: Ambiguous abbreviations and acronyms pose a significant threat to safe and effective communication in critical care. Standardized terminology, education, and clear documentation practices are urgently needed to mitigate these risks and improve patient safety.
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Abreviaturas como Asunto , Comunicación , Cuidados Críticos , Seguridad del Paciente , Humanos , Cuidados Críticos/normas , Errores Médicos/prevención & controlRESUMEN
Our study used the PRISMA-ScR checklist to conduct a scoping review about the concepts of human factors (HF) and systems engineering (SE) in the intensive care unit (ICU). Using specific key words, we performed a literature search to collect relevant studies. We then used inclusion and exclusion criteria to narrow our pool of studies prior to data extraction. We performed data extraction on 64 studies. The main categories of interventions included workflow processes, communication/information transfer, technology implementation, palliative care and a combination of multiple components. We found that most interventions resulted in a positive impact. When the duration of the outcomes of the intervention was divided into categorial time frames, the most common reported duration was more than 6 months to 1 year though a significant portion of studies did not report such a duration. Most studies had interventions that focused on tasks and the care team. The least common type of area addressed by interventions was organizational conflicts.
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Cuidados Críticos , Ergonomía , Unidades de Cuidados Intensivos , Humanos , Comunicación , Cuidados Críticos/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Cuidados Paliativos/organización & administración , Flujo de TrabajoRESUMEN
OBJECTIVE: This study aimed to explore how the narrative identities of patients with medically unexplained chronic pain change over time following repeated dismissal of their attempts to communicate their pain. METHODS: We conducted a narrative analysis using interviews from the Database of Personal Experiences of Health and Illness-Japan. Participants were 16 adults living with medically unexplained pain (MUEP), including individuals diagnosed with fibromyalgia, complex regional pain syndrome, or chronic pain disorder, and individuals without a confirmed diagnosis. A reflexive thematic analysis, informed by the concept of epistemic injustice, was applied. RESULTS: We generated three themes that illustrate the painful processes through which patients gradually withdrew from narrating their pain. Repeated disbelief and dismissal by clinicians constituted testimonial injustice, while the lack of social or linguistic resources reflected hermeneutical injustice. These forms of injustice mutually reinforced each other, leading to anticipatory silence, withdrawal from help-seeking, and profound self-doubt. Some patients internalized blame for their lack of recovery, further deepening their isolation. Many expressed feeling "unworthy of being heard" and questioning their own credibility as communicators. In contrast, rare moments of sincere acknowledgment, such as "I believe you," provided substantial emotional relief and helped restore a sense of dignity. These moments were described as transformative experiences of epistemic justice. CONCLUSION: Besides persistent pain, patients with MUEP experience structural and relational injustices that silence their voices. The invalidation and suppression of patient narratives intensify their suffering and social isolation. PRACTICE IMPLICATIONS: Clinicians should cultivate epistemic humility and validate patient narratives, regardless of diagnostic certainty. Establishing institutional and cultural conditions that protect narrative spaces is both an ethical and practical imperative for the care of patients with MUEP.
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Dolor Crónico , Comunicación , Síntomas sin Explicación Médica , Narración , Relaciones Médico-Paciente , Humanos , Dolor Crónico/psicología , Investigación Cualitativa , Femenino , Masculino , Persona de Mediana Edad , Japón , Adulto , Entrevistas como Asunto , AncianoRESUMEN
OBJECTIVES: Despite the well-documented benefits of a healthy lifestyle for many patients, discussing lifestyle is currently not a structural part of routine clinical practice in hospital care. The aim of this study was to gain insight in the attitudes of healthcare professionals (HCPs) towards discussing lifestyle in their routine clinical practice, and explore differences between various types of HCPs. METHODS: Semi-structured interviews were conducted with healthcare professionals (i.e. doctors, nurses, and allied health professionals (AHP)) from different departments (i.e. cardiology, gastrointestinal medicine, gynaecology, hepato-pancreato-biliary surgery, internal medicine, neurology, orthopaedics) in two university medical centers in the Netherlands. Interviews were audio-recorded and analyzed using a hybrid inductive-deductive analysis with Atlas.ti and MaxQDA. An existing framework by Van Aalderen et al. was utilized to explore attitudes, focusing on cognitive beliefs, affective states, and perceived control. RESULTS: The domain of cognitive beliefs had four distinguishing beliefs regarding perceived relevance (i.e. beliefs about: 1) relevance; 2) responsibility; 3) consequences; and 4) referral options), three sub-themes regarding perceived patient beliefs (i.e. patient motivation; patient capability; and patient opportunities) and one sub-theme regarding perceived difficulty. For the domain affective states the two themes were: enjoyment and anxiety. The domain of perceived control had two themes: self-efficacy and context dependency, which had three sub-themes (i.e. time, financial reimbursement and institutional policy). Overall, doctors seem more ambivalent in their attitudes than nurses and allied health professionals. CONCLUSIONS: A relatively large and diverse sample of healthcare professionals provided insight into health care professional's attitudes towards discussing lifestyle with patients during routine consultations. Research is needed to improve health promotion training for HCPs, patient-professional dynamics, and for implementation in routine clinical practice. PRACTICE IMPLICATIONS: HCPs need greater self-efficacy, support, and clear policies to integrate lifestyle discussions into routine care, requiring collaboration between educators, managers, and organizations.
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Actitud del Personal de Salud , Comunicación , Personal de Salud , Estilo de Vida , Humanos , Femenino , Masculino , Países Bajos , Adulto , Entrevistas como Asunto , Investigación Cualitativa , Personal de Salud/psicología , Persona de Mediana EdadRESUMEN
BACKGROUND: The growing population of breast cancer (BC) survivors underscores the need for improved knowledge and engagement in long-term follow-up care. The main aim of this study was to evaluate BC survivors' knowledge regarding their diagnosis and treatment, satisfaction with the information provided, and perception of oncologists' communication skills. METHODS: A 36-question survey was administered to 181 BC survivors (women diagnosed with stage I-III BC) to assess their knowledge about diagnosis and treatment. Knowledge was estimated by comparing survivors' responses with medical records. Chi-square and Fisher tests were used to evaluate associations. RESULTS: Knowledge was lower for essential diagnostic characteristics (10.5â¯%, receptor status and clinical stage) than for essential treatment characteristics (82.3â¯%, receipt of surgery, radiotherapy, chemotherapy, endocrine therapy, and/or HER2-targeted therapy). Survivors with at least high-school education and those diagnosed <â¯5 years prior were more likely to correctly identify essential diagnostic characteristics (pâ¯=â¯0.007 and pâ¯=â¯0.048, respectively); no significant association was observed with age. No associations were observed between essential treatment characteristics and age (pâ¯=â¯0.79), education level (pâ¯=â¯0.26), and time since diagnosis (pâ¯=â¯0.86). Most BC survivors agreed their oncologists adequately transmitted their diagnosis and treatment information (95â¯%). CONCLUSIONS: BC survivors in our study were more knowledgeable about treatment than diagnosis. Participants reported high satisfaction with their medical oncologists' communication skills and the information provided. Our study highlights knowledge gaps, factors affecting recall of medical details, and the critical role of oncologists' communication.
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Neoplasias de la Mama , Supervivientes de Cáncer , Conocimientos, Actitudes y Práctica en Salud , Sobrevivientes , Humanos , Femenino , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Neoplasias de la Mama/psicología , Persona de Mediana Edad , Estudios Transversales , Supervivientes de Cáncer/psicología , Adulto , México , Anciano , Encuestas y Cuestionarios , Comunicación , Relaciones Médico-Paciente , Sobrevivientes/psicologíaRESUMEN
OBJECTIVES: To explore the communication preferences of adolescents with cancer regarding the discussion of survivorship and late effects (LE) and to identify key communication functions and areas for improvement in LE communication. METHODS: This qualitative secondary analysis applied the adolescent oncology functional communication model to 17 semi-structured interviews conducted with adolescents (aged 12-22 years) to understand their LE communication preferences. Purposive sampling identified participants undergoing cancer treatment or who had completed pediatric cancer treatment within the past five years. Interviews occurred between April 2022 and April 2023; they were audio-recorded, transcribed, and individually coded. Thematic analysis identified themes that emerged within the communication functions. RESULTS: Participants identified "exchanging information" and "managing uncertainty" as critical functions in survivorship communication, but highlighted areas for improvement. Many adolescents appreciated receiving information early, however the volume of content was overwhelming, and some felt unprepared for survivorship despite information. Adolescents emphasized the importance of mental health support and peer validation, pointing to gaps in psychosocial resources and the desire for more shared experiences with fellow survivors. Modifiers to communication preferences which influenced how adolescents wanted to receive information about late effects included the phase of treatment (active treatment vs. survivorship), individual learning preferences, existing parent-child dynamics, and diagnosis/prognosis. CONCLUSIONS: Utilizing communication functions as a framework allowed us to better understand adolescent preferences and identify areas for improvement within early communication about survivorship and LEs. Understanding the modifying factors that influence adolescent preferences will help tailor communication strategies to better meet their needs. PRACTICE IMPLICATIONS: This study applied a validated framework to survivorship and late effects communication with adolescents, a vulnerable patient population in pediatric oncology, highlighting important areas for improvement. The findings can be utilized to guide future adolescent- specific interventions aimed at improving adolescent engagement in survivorship care and risk-based screening.
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Supervivientes de Cáncer , Comunicación , Neoplasias , Supervivencia , Humanos , Adolescente , Femenino , Masculino , Incertidumbre , Supervivientes de Cáncer/psicología , Investigación Cualitativa , Niño , Neoplasias/psicología , Neoplasias/terapia , Adulto Joven , Entrevistas como AsuntoRESUMEN
INTRODUCTION: Consistent urologic oncology follow-up after radical cystectomy (RC) improves survival. However, there is scarce literature describing postoperative communication. We aimed to identify differences in postoperative communication patterns and healthcare utilization among English-speaking patients (ESPs) and patients with limited English proficiency (LEP) following RC. METHODS: We conducted a single-institution, retrospective cohort study, examining patients who underwent RC for bladder cancer. We used propensity score matching to match 50 ESPs and 50 patients with LEP on age and sex. We abstracted patient demographics, postoperative communication and healthcare utilization within 90 days of surgery. We fit multivariable linear regression to investigate factors associated with postoperative communication frequency. RESULTS: Postoperative communication was common, with 82% of patients placing ≥1 phone call/message. ESPs communicated more than patients with LEP (6.04 vs. 3.80 average calls/messages), though this difference was not statistically significant (P = 0.08). ESPs were more likely to initiate the communication themselves and have postoperative communication result in reassurance from the surgical team (P = 0.03), while patients with LEP were more likely to have a family member communicate on their behalf (P < 0.001) and have postoperative communication result in outpatient evaluation/treatment (P = 0.01). Patients with a neobladder reconstruction placed an increased number of phone calls/messages. There were no differences in postoperative healthcare utilization between the 2 groups. CONCLUSIONS: Postoperative communication is frequent following RC. ESPs communicated nearly twice as often as patients with LEP, suggesting a clinically relevant difference in patient communication following radical cystectomy. Primary language spoken is not associated with differences in postoperative healthcare utilization.
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Comunicación , Cistectomía , Dominio Limitado del Inglés , Neoplasias de la Vejiga Urinaria , Humanos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/psicología , Masculino , Cistectomía/métodos , Femenino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
Context: Serious illnesses like cancer disproportionately affect American Indians and Alaska Native (AI/AN) Peoples. AI/AN patients deserve culturally responsive healthcare at all times, and especially when journeying through serious illness. Objectives: To learn about specific clinician-related factors that AI/AN cancer survivors, caregivers, Tribal leaders, and traditional healers want from their clinicians while experiencing cancer. Methods: We utilized qualitative interviews and Indigenous talking circles to explore perspectives on what type of clinician education, communication approaches, and clinical resources are desired so that clinicians may provide culturally responsive care to AI/AN peoples experiencing cancer. Analysis was completed via a team of Native and non-Native researchers analyzing narrative data from AI/AN cancer survivors, caregivers, Tribal leaders, and traditional healers. Results: Interviews and talking circle qualitative analysis revealed 3 major themes related to clinician needs: cultural considerations, psychosocial support, and trust. Conclusion: Any clinician caring for AI/AN peoples with serious illness such as cancer needs to understand clinician-related factors that AI/ANs say impact their care when experiencing serious illness. It is important for clinicians to engage in cultural education and work to improve systemic deficiencies such as a lack of psychosocial support. An overarching theme was also the need for clinicians to seek to develop trustworthiness and earn trust when caring for AI/AN patients experiencing serious illness.
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Indio Americano o Nativo de Alaska , Competencia Cultural , Asistencia Sanitaria Culturalmente Competente , Neoplasias , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actitud del Personal de Salud , Supervivientes de Cáncer/psicología , Cuidadores/psicología , Comunicación , Asistencia Sanitaria Culturalmente Competente/organización & administración , Entrevistas como Asunto , Neoplasias/etnología , Neoplasias/terapia , Neoplasias/psicología , Investigación Cualitativa , Apoyo Social , Confianza , Indio Americano o Nativo de Alaska/psicologíaRESUMEN
INTRODUCTION: Women ≥70 years with low-risk breast cancer face nuanced therapy decisions. Using qualitative analysis, we aimed to determine how oncologists and patients integrate geriatric considerations into complex treatment conversations. MATERIALS AND METHODS: We recruited women aged ≥70, newly diagnosed with clinical T1-2N0 hormone receptor-positive/HER2-negative disease between October 2020 and March 2023 from a large cancer center and audio-recorded and transcribed their consults with surgical, medical, and radiation oncologists. We identified geriatric issues included in conversational content and the dynamics of patient/oncologist communication. Data collection and analysis were simultaneously performed. We also assessed participant decision-making preferences, frailty, and life expectancy. RESULTS: Of 48 eligible patients approached, 27 (56 %) participated with eight surgical oncologists, 17 with 11 medical oncologists, and four with three radiation oncologists (n = 48 consultations recorded). Fourteen patients (48 %) were ≥ 75 years, 23 were non-Hispanic White (76 %). Patients preferred to share (n = 15, 58 %) or make their own treatment decisions (n = 10, 39 %), rather than defer to the oncologist. Oncologists presented an explicit treatment choice in 16 conversations (35 %). Chronological age was discussed in 27 (56 %) conversations, comorbidities in 44 (92 %), and multimorbidity in two (4 %). Other geriatric considerations were discussed in the minority of conversations [physiologic age: 20 (42 %); function: 20 (42 %); quality-of-life: 5 (10 %); life expectancy: 5 (10 %); polypharmacy: 2 (4 %)]. DISCUSSION: Despite numerous treatment options, oncologists neither commonly offer older women with low-risk breast cancer explicit treatment choices, nor discuss geriatric issues besides comorbidity. Training oncologists in communication around geriatric issues may lead to more person-centered breast cancer care.
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Neoplasias de la Mama , Relaciones Médico-Paciente , Humanos , Femenino , Neoplasias de la Mama/terapia , Neoplasias de la Mama/patología , Neoplasias de la Mama/psicología , Anciano , Anciano de 80 o más Años , Comunicación , Prioridad del Paciente , Oncólogos , Toma de Decisiones , Esperanza de Vida , Investigación Cualitativa , Toma de Decisiones Conjunta , Receptores de Estrógenos/metabolismo , Oncología MédicaRESUMEN
BACKGROUND: Posterior fossa tumours (PFT) are the most common childhood brain tumours, and children treated for these tumours are at increased risk of persistent speech, language and/or communication difficulties. Such difficulties have often been described in association with the postoperative complication cerebellar mutism syndrome (CMS), but can also occur in children without a period of mutism. Speech and language difficulties may affect communication, participation and social relationships. However, little is known about how children themselves experience communication in everyday life following PFT surgery. AIM: This study aimed to describe children's experiences of communication in their everyday lives following PFT surgery. METHODS: An inductive qualitative content analysis was conducted based on semi-structured interviews with 10 children, aged 6 to 18 years at the time of the interview, carried out at least 1 year after PFT surgery. Interviews were adapted to the children's communicative abilities, using augmentative and alternative communication (AAC) when needed, and a flexible, child-centred approach was used to capture their experiences. RESULTS: Two overarching themes were identified: The theme A thin line between belonging and not belonging captured children's experiences of inclusion and exclusion through everyday communicative events; The theme Navigating reality towards normality captured how children expressed who they were and managed how they were perceived. CONCLUSIONS: While speech, language and/or communication difficulties were not explicitly mentioned, the children's descriptions reflected how the consequences of such difficulties shaped everyday communication and participation. Small, everyday moments could affirm or undermine belonging, and familiar friendships provided continuity during a time of change. Children also expressed needs, set boundaries and protected their identity while adapting to new circumstances. The findings underline the importance of listening to children and planning support that is flexible, responsive and grounded in their perspectives. WHAT THIS PAPER ADDS: What is already known on the subject Previous studies have described speech, language and/or communication difficulties following posterior fossa tumour surgery. In children with speech and language impairments, such difficulties have been linked to fewer peer interactions, social withdrawal and difficulties maintaining friendships and participating in group activities. What this paper adds to existing knowledge This study offers a unique insight into children's own experiences of communication after PFT surgery. These experiences have not previously been described from the children's perspective. The study captures how children experience everyday communication, showing how it can support or disrupt a sense of belonging depending on how communication unfolds in different contexts. What are the potential or actual clinical implications of this work? The findings of this study have implications for healthcare providers, school health services and educational settings. Professionals should not rely solely on observation but actively invite children to share their experiences. Supporting pre-existing friendships and informing classmates may contribute to more understanding and positive responses.
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Trastornos de la Comunicación , Neoplasias Infratentoriales , Complicaciones Posoperatorias , Humanos , Niño , Masculino , Adolescente , Femenino , Neoplasias Infratentoriales/cirugía , Neoplasias Infratentoriales/psicología , Investigación Cualitativa , Trastornos de la Comunicación/psicología , Trastornos de la Comunicación/etiología , Complicaciones Posoperatorias/psicología , ComunicaciónRESUMEN
Effective communication in oncological reconstructive surgery is fundamental to ensuring patient comprehension, trust, and informed consent. Yet, the use of deviant terminology-language that is misleading, euphemistic, or excessively technical-can obstruct doctor-patient understanding. This article examines how such terminology, common across both clinical and promotional settings, affects patients' interpretation of reconstructive and restorative procedures following cancer treatment. Expressions such as "minimally invasive" or cosmetic marketing terms like "mommy makeover" may obscure the complexity and risk of interventions, while excessive jargon can alienate patients. These linguistic distortions risk undermining informed consent and shared decision-making. To address this, surgeons working within oncological contexts should prioritise plain language, apply the teach-back method, and adopt standardised terminology supported by professional associations. Furthermore, cultural competence and visual decision aids can enhance comprehension, particularly among diverse patient populations. By aligning terminology with medical accuracy and patient needs, reconstructive surgeons can promote transparency, safety, and patient-centred care throughout the oncological journey.
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Comunicación , Neoplasias , Relaciones Médico-Paciente , Procedimientos de Cirugía Plástica , Terminología como Asunto , Humanos , Procedimientos de Cirugía Plástica/ética , Neoplasias/cirugía , Relaciones Médico-Paciente/ética , Consentimiento InformadoRESUMEN
CONTEXT: Communication skills are essential in cancer care, and international guidelines recommend communication training for all cancer care providers. Both clinical communication and training methods are influenced by culture. As oncology and palliative care expand globally, procedures are needed to adapt evidence-based communication training for diverse contexts. OBJECTIVE: To adapt a serious illness communication training intervention in Rwanda. METHODS: Guided by the Cultural Adaptation Process model, we conducted focus groups to understand communication training needs and gather feedback on a U.S. tool, the Serious Illness Conversation Guide (SICG). Based on identified needs, we made initial adaptations to an SICG-based training, incorporating tools from another U.S. program (VitalTalk). We piloted this training with 14 clinical psychologists, using lecture, demonstration, scripted roleplay, and small group discussion. Effectiveness was assessed through 5-point scales and qualitative feedback. RESULTS: Seventeen interdisciplinary oncology providers participated in one of three focus groups. While some had received lectures on communication, all believed additional training is needed. They endorsed the approach of adapting an international program rather than creating a Rwandan training de novo. Based on their input, we adapted and piloted a training that focused on three skills: 1) Set up the conversation and assess understanding; 2) Share information via a succinct "headline;" 3) Respond to emotion. Training methods received mean scores of 4.0 to 4.33 (5 = most effective). Further modifications were suggested to improve cultural concordance. CONCLUSION: Despite vast cultural differences, communication training interventions developed in the U.S. can be effectively adapted in African contexts through co-creation with local providers.
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Comunicación , Personal de Salud , Oncología Médica , Neoplasias , Humanos , Rwanda , Grupos Focales , Personal de Salud/educación , Cuidados Paliativos , Neoplasias/terapia , Neoplasias/psicología , Masculino , Femenino , Oncología Médica/educaciónRESUMEN
ObjectiveTo clarify the influence of daylight access on patients' and their companions' stress perception and coping behavior (communication) in cancer hospital waiting areas.BackgroundIn patient care, managing stress and encouraging effective coping strategies are essential. Daylight has shown as a modulator of stress responses and coping behaviors. Limited research has been done regarding the impact of daylight access on the waiting experience of cancer patients and their companions.MethodsEmpirical data were collected through on-site observations and questionnaire surveys in 30 waiting areas across seven cancer hospitals in China. Based on responses from 419 patients and 371 family companions, we examined differences in stress and communication between groups in the areas with and without daylight access. Multivariate logistic regression models were used to assess the significance of daylight access and communication in predicting stress.ResultsPatients and families in the areas with daylight access communicated more with peers (p ≤ .05) and perceived less stress (p ≤ .10) compared to those in windowless areas. They also communicated more with nurses, though this difference was not statistically significant (p > .10). Participants who engaged in more peer communication reported less stress (p = 0.00). Daylight access and peer communication significantly contributed to stress reduction, explaining over 15% of the variance in stress, along with personal and social variables in modeling.ConclusionAccess to daylight in the waiting areas of cancer hospitals reduces stress and promotes communication among patients and family companions. Healthcare facilities should provide daylight access in their waiting areas to reduce stress and encourage communication.