Communication In Cancer Care Research Articles

COMFORT™SM communication for oncology nurses: Program overview and preliminary evaluation of a nationwide train-the-trainer course

ObjectiveThe COMFORT Communication Course for Oncology Nurses is a train-the-trainer program funded by the National Cancer Institute (R25) that provides nationwide communication training to improve patient-centered communication in cancer care. The purpose of this article is to provide an overview of the program and present an evaluation of three courses. MethodsThe curriculum contains seven modules addressing palliative care communication. Pre-course survey of needs, post-course feedback, and follow-up at 6 and 12 months were used to evaluate the program. ResultsTo date, three courses have been presented to 269 nurses from 34 states and Washington D.C. Post-course evaluations showed high satisfaction with course design, content, and faculty. At 12 months, course participants had implemented institution-wide system changes and communication skill building. On average, each nurse trained 37 other healthcare providers. ConclusionsThe COMFORT communication course provides the essential communication skills and tools oncology nurses need to provide quality care across the cancer continuum. Practice implicationsTraining is needed to prepare oncology nurses with the skills to provide patient-centered communication across the cancer continuum. These skills include training others in communication and implementing process improvement. The COMFORT communication train-the-trainer model is an effective approach to meet this need.

Interprofessional Management of Cancer Survivorship: New Models of Care.

To examine interprofessional models of care and care delivery for cancer survivorship, focusing on nursing as key providers of care. National summary statements and literature review. The need for cancer survivorship care is established. Treatment summaries and survivorship care plans are mandated documents expected to guide the delivery of survivorship care. However, the optimal delivery method, infrastructure, provider, and (cost-) effectiveness for the delivery of cancer survivorship care is unknown. Utilizing commonly occurring scenarios in cancer survivorship, this article discusses the visit structure, content care delivery structure, and possible care providers. These real-life situations can help the cancer care community to develop optimal algorithms of care and identify members of the interprofessional team for the survivorship care delivery.

Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies: A Qualitative Analysis.

Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies. We assessed VA women's health providers' and administrators' perceptions of coordination challenges for Veterans' gynecologic cancer care, and potential approaches for addressing these challenges. We carried out semistructured qualitative interviews with field-based key informants (VA gynecologists, women's health medical directors, and other staff directly involved in women's health care coordination) at 15 VA facilities. Transcripts were summarized in a template to capture key points. Themes were identified and iteratively revised (inductively/deductively) via a collaborative decision-making process utilizing matrices to compare content across interviews. Key informants (n=23) noted that services for patients with gynecologic cancers are provided through a combination of VA and community care with wide variation in care arrangements by facility. Care coordination challenges included care fragmentation, lack of role clarity and care tracking, and difficulties associated with VA and community provider communication, patient communication, patient records exchange, and authorizations. Care coordination roles suggested for addressing challenges included: care tracker, provider point-of-contact, patient liaison, and records administrator. Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.

Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol.

BackgroundCancer is the second most common cause of mortality in the United States. Cancer screening and prevention services have contributed to improved overall cancer survival rates in the past 40 years. Vulnerable populations (i.e., uninsured, low-income, and racial/ethnic minorities) are disproportionately affected by cancer, receive significantly fewer cancer prevention services, poorer healthcare, and subsequently lower survival rates than insured, white, non-Hispanic populations. The Affordable Care Act (ACA) aims to provide health insurance to all low-income citizens and legal residents, including an expansion of Medicaid eligibility for those earning ≤138% of federal poverty level. As of 2012, Medicaid was expanded in 32 states and the District of Columbia, while 18 states did not expand, creating a ‘natural experiment’ to assess the impact of Medicaid expansion on cancer prevention and care.MethodsWe will use electronic health record data from up to 990 community health centers available up to 24-months before and at least one year after Medicaid expansion. Primary outcomes include health insurance and coverage status, and type of insurance. Additional outcomes include healthcare delivery, number and types of encounters, and receipt of cancer prevention and screening for all patients and preventive care and screening services for cancer survivors.DiscussionCancer morbidity and mortality is greatly reduced through screening and prevention, but uninsured patients are much less likely than insured patients to receive these services as recommended. This natural policy experiment will provide valuable information about cancer-related healthcare services as the US tackles the distribution of healthcare resources and future health reform.Trial RegistrationClinicaltrails.gov identifier NCT02936609.

Understanding the influences and impact of patient-clinician communication in cancer care.

BackgroundPatient‐clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood.ObjectiveWe propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient‐clinician communication can be summarized and further built.DesignWe use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use.Key resultsUsing this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients’ perspective and affective‐cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post‐surgical treatment and end‐of‐life care decisions, and those specifying particular physician communication strategies when recommending cancer screening.ConclusionsTransparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient‐clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient‐clinician communication impacts care outcomes in the context of cancer and health care more broadly.

Transforming Community Cancer Care: The Ottawa Regional Cancer Foundation’s Cancer Coaching Practice

Community services are an increasingly important part of the healthcare landscape. Services that work to empower patients and their caregivers are having a positive impact on health outcomes and helping to reduce per capita costs of healthcare. According to the 2015 Canadian Cancer Statistics Report, by 2030 the annual number of new cancer cases in Canada is expected to increase by 79% [1]. Community-based cancer services, in particular, are urgently required to meet the growing demand for care as the complexity of the disease and its treatment continues to grow. RÉSUMÉ Les services communautaires jouent un rôle de plus en plus important dans les soins de santé. Les services qui veillent à habiliter les patients et leurs proches aidants ont un effet positif sur les résultats en matière de santé et aident à réduire les coûts par personne des soins de santé. D’ici 2030, le nombre annuel de nouveaux cas de cancer au Canada devrait augmenter de 79 % selon le rapport Statistiques canadiennes sur le cancer 2015 [1]. Des services communautaires pour le traitement du cancer, notamment, sont requis de toute urgence afin de répondre à la demande croissante de soins, alors que la complexité de la maladie et de son traitement ne cesse de croître.

Documenting goals of care (GOC) and prognosis of patients with advanced cancer: A tertiary cancer centre review of internal and external correspondence.

e21512 Background: Patients with advanced cancer require clear communication and documentation of GOC and prognosis to inform optimal care planning between the patient, family, specialist and primary healthcare providers. Such documentation may be lacking despite multiple inpatient and outpatient (OP) interactions prior to death. We aimed to review the frequency, content and timing of GOC/prognosis documentation during the last year of life of advanced cancer patients. Methods: All patients who died during palliative care admission at our tertiary centre in 2015 were identified. Patients with incurable solid cancer and reviewed ≥1 times in oncology OP clinic were included. We reviewed all oncology OP consultation notes and letters, oncology discharge summaries and advanced care plans (ACP) over a 12 month period before death. Both internal (OP notes) and external documents (OP letters; discharge summaries) were reviewed in detail for documentation of GOC and prognosis (qualitative/quantitative description). Results: 147 patients were included in the analysis. There was a median of 6 OP consultations and 6 hospital encounters (including admissions) per patient. Median time from first OP consultation to death was 7.7 months. Most patients had documentation of GOC in OP notes (61%) however only 24% had prognosis documented. 63% of OP visits resulted in a letter to external doctors. 58% of patients had ≥1 OP letter documenting GOC (median time before death, 3.9 months) and 16% had a letter documenting prognosis (median time before death, 2.8 months). 73% of patients had a ward admission yet 5% of discharge summaries specified prognosis. Only 15% of patients had an accessible ACP on record. Conclusions: We observed a lack of documentation of GOC and particularly prognosis in internal and external hospital correspondence despite multiple interactions prior to patient death. Although discussion of GOC and prognosis may occur within a consultation, lack of documentation in correspondence reduces insight into patient clinical trajectory and may result in differing care between providers. There is a need for improved communication and documentation in advanced cancer care.

Areas for quality improvement in pediatric supportive oncology services.

e22022 Background: In 2013, the Institute of Medicine report recommended that supportive oncology services be initiated at time of diagnosis. Providers of pediatric cancer care in the Chicagoland community, supported by The Coleman Foundation, sought to define areas for quality improvement of supportive oncology delivery to children. Methods: Focus groups and surveys with clinicians providing pediatric cancer care and supportive services at 14 sites were used to prioritize areas needing improvement. Results: 100% (14/14) of sites participated. Of the eligible sites, 6 were pediatric cancer treatment sites and 8 cancer care community organizations. Sites demonstrated consistent agreement for 8 of the 12 areas of focus for improvement. Over 50% of sites reported areas of focus (table) as important or very important. Conclusions: Sites identified the need for quality improvement in delivery of psychosocial, survivorship and palliative care for pediatric cancer patients. Survey results demonstrate a need for collaboration and efforts to guide care delivery improvement across sites. [Table: see text]

Optimistic honesty: understanding surgeon and patient perspectives on hopeful communication in pancreatic cancer care

BackgroundPrognosis conversations between surgical oncologists and patients with pancreatic cancer are critically important and challenging. Surgeons and their patients often have discrepant understandings of prognosis despite extensive conversations. Little is known about how surgeons approach prognosis conversations with these patients; patients' experiences with these conversations are also not well understood. This qualitative study sought to better understand surgeon and patient perspectives on communication in pancreatic cancer care with a view toward improvement. MethodsGrounded theory methodology was used. Semi-structured interviews were conducted with surgical oncologists and patients who had undergone surgical resection with curative intent for periampullary cancer. Data were collected and analyzed inductively and iteratively to the point of theoretical saturation. Results10 surgeons and 10 patients participated. Three inter-linking concepts were found to drive surgeon–patient conversations: understanding, trust and hope. Surgeons delicately and purposefully tailored information for patients, striving to deliver essential though honest, empathetic and hopeful messages. Patients desired simple, truthful explanations that demonstrated caring and fostered optimism. ConclusionSurgeons and patients with pancreatic cancer value optimistic honesty in tailored prognosis conversations. Perceived discrepancies in surgeon–patient understanding must be contextualized within efforts to establish a sufficient understanding, high level of trust, and optimistic stance of hope.

Gynecologic Oncologist Perspective About ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer.

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer was simultaneously published in 3 prestigious journals and is sure to have a huge impact on the clinical practice of gynecologic oncology community and other gynecologic cancer care providers.It is a tremendous report representative of great effort. Hovewer, as practicing gynecologic oncologists, endometrial carcinoma is the most common clinical entity encountered in our routine daily practice; as such, we find some of the report confusing and object to some of its findings, as detailed in this brief report.We also attempted to summarize the differences between the well-known NCCN guidelines and the ESMO-ESGO-ESTRO Consensus Conference guidelines and try to give the point of view of gynecologic oncologic perspective. It is obvious that differences in the management of endometrial carcinomas will continue to be debated by the scientific community.

Oncologists and hematologists’ perceptions of fertility-related communication – a nationwide survey

Background: Despite the negative impacts of several cancer treatments on fertility, many patients do not recall having fertility-related discussions with their physicians. This study was conducted to identify those factors related to physicians’ discussing the treatment impacts on fertility with cancer patients of reproductive age.Material and methods: In this nationwide survey of cancer care physicians (n = 329, response rate 55%), oncologists and hematologists (mainly) completed a questionnaire on practice behavior, barriers, attitudes and confidence in knowledge regarding treatment-related fertility risks. Logistic regression analyses were conducted to identify factors associated with not routinely discussing fertility issues with patients.Results: Most of the physicians agreed that they were responsible for discussing fertility issues with patients of reproductive age (91%), but approximately 30% did not do so regularly. Those factors decreasing the likelihood of discussion were: patient already had children (female/male OR 3.0/6.9), high workload (OR 3.3/4.8), seeing <5 female/male patients of reproductive age weekly (OR 3.2/3.4) and access to a reproduction clinic (OR 5.2/4.2).Conclusions: Most Swedish oncologists and hematologists regularly discuss impact of treatment on fertility with their patients. Those factors having a negative impact on fertility discussions may guide targeted organizational and educational efforts to further improve fertility-related communication in cancer care.

Smart Choices for Cancer Education Professional Development: Your Voice and Visibility for Leadership.

The purpose of this article is to provide reflections about the important and exciting opportunities for cancer education career advancement and professional development. Advancement in professional, personal, and career growth for clinicians and health professionals is critical to improve quality cancer care and updated health communication with patients and families. Valuable insights from my recent 2-year term as treasurer, Board of Directors, Cancer Patient Education Network, are shared inspiring others to build their rewarding professional development. The professional leadership opportunity gave me a new energy level to be invested in rapidly changing cancer education with so many diverse cancer education professionals. Professional cancer education associations are dedicated to advancing patient-centered care through professional networks. They create welcoming environments with significant networking and mentoring opportunities. Cancer education touches many lives, and the cancer education associations strongly support new advances. I encourage early or mid-career cancer education professionals to discover how their increased interest may spark leadership and inspire participation in our cancer education professional associations.

Balancing health care needs in a changing context: nursing highlights from the 2016 European Oncology Nursing Society Congress (EONS10), 17-18 October 2016, Dublin, Ireland.

European cancer nurses have to face many challenges as a result of the rapidly changing economic and political context in which balancing health care needs has become strategic for healthcare delivery. Currently, cancer nurses must overcome many obstacles arising from clinical, organisational, and educational issues. Within this scenario, the European Oncology Nursing Society (EONS) shaped its tenth congress programme to boost discussion and reflections, to share experiences and research, and to see how cancer nurses try to anticipate and embrace changes. The aim of this was to promote innovative solutions and to address the many issues involved with cancer care.EONS10 was held on 17–18 October in Dublin, Ireland. The congress was attended by more than 500 delegates. The programme covered the following themes: caring for families and carers, inequalities and access to cancer care, caring for patients with haematological cancers, palliative care, communication and information exchange, community cancer care (i.e. parallel sessions), roles and responsibility for advanced nursing practice, International Psycho-Oncology Society (IPOS)-Academy workshops (i.e. workshops), cancer survivorship, clinical leadership and new roles, oncology nursing research, symptom experiences and management, palliative care (i.e. proffered papers), poster presentations, and satellite symposia. The aim of this paper is to highlight and discuss the contents of the EONS10 congress.

Understanding the influences and impact of patient-clinician communication in cancer care

Understanding the influences and impact of patient-clinician communication in cancer care

Engaging Patient Advocates and Other Stakeholders to Design Measures of Patient-Centered Communication in Cancer Care.

Patient-centered communication (PCC) is an essential component of patient-centered care and contributes to patient satisfaction, health-related quality of life, and other important patient outcomes. The aim of this study was to develop and test survey questions to assess patients' experiences with PCC in cancer care. We used a conceptual model developed by the National Cancer Institute as our framework. The survey questions align with the six core functions of PCC defined in the model: Exchanging Information, Managing Uncertainty, Enabling Patient Self-Management, Fostering Healing Relationships, Making Decisions, and Responding to Emotions. The study focused on colorectal cancer patients. We conducted two rounds of cognitive interviewing to evaluate patients' ability to understand and provide valid answers to the PCC questions. Interviews were conducted in Maryland and North Carolina in 2014. We involved a patient advocacy group, Fight Colorectal Cancer, and a multidisciplinary panel of stakeholders throughout the measurement development process to ensure that the survey questions capture aspects of PCC that are important to patients and meet the needs of potential end users, including researchers, healthcare organizations, and health professionals. Patient and other stakeholder input informed revisions of draft survey questions, including changes to survey instructions, frame of reference for questions, response scales, and language. This study demonstrated the feasibility and value of engaging patients and other stakeholders in a measurement development study. The Patient-Centered Outcomes Research Institute (PCORI) conceptual model of patient-centered outcomes research provides a useful guide for patient engagement in research. Research funders should call for meaningful roles for patients and other stakeholders in health research, including in the development of patient-centered outcomes.

Patient satisfaction and alliance as a function of the physician's self-regulation, the physician's stress, and the content of consultation in cancer care.

To investigate which characteristics of the physician and of the consultation are related to patient satisfaction with communication and working alliance. Real-life consultations (N=134) between patients (n=134) and their physicians (n=24) were audiotaped. All of the patients were aware of their cancer diagnosis and consulted their physician to discuss the results of tests (CT scans, magnetic resonance imaging, or tumor markers) and the progression of their cancer. The consultations were transcribed and coded with the "Defense Mechanisms Rating Scale-Clinician." The patients and physicians completed questionnaires about stress, satisfaction, and alliance, and the data were analyzed using robust linear modeling. Patient satisfaction with communication and working alliance was high. Both were significantly (negatively) related to the physician's neurotic and action defenses-in particular to the defenses of displacement, self-devaluation, acting out, and hypochondriasis-as well as to the physician's stress level. The content of the consultation was not significantly related to the patient outcomes. Our study shows that patient satisfaction with communication and working alliance is not influenced by the content of the consultation but is significantly associated with the physician's self-regulation (defense mechanisms) and stress. The results of this study might contribute to optimizing communication skills training and to improving communication and working alliance in cancer care.

Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication.

Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.

French general practitioners’ sense of isolation in the management of elderly cancer patients

Cancer care in people over 75 years of age is particularly complex and requires collaboration between oncologists, geriatricians, GPs and other professional and family carers. To improve the care pathways for elderly people living with cancer, the French health authorities have created a network of oncologists and geriatricians; however, GPs experience difficulties in establishing their place in this network. This study aimed to analyse the impressions of French GPs involved in the care of elderly patients with cancer, including their feelings regarding their relationships with their oncologist and geriatrician colleagues. A qualitative approach using focus groups was employed. The proceedings of these focus groups were recorded, retranscribed and subjected to thematic analysis. Although heavily involved in the care of their elderly patients living with cancer, the GPs who participated reported feeling isolated in their role at each step during the course of the disease. The principal themes addressed were screening and diagnosis, therapeutic decisions, multidisciplinary consultation meetings, the announcement of the diagnosis and monitoring at home. Their relationships with their oncologist colleagues showed much room for improvement, and they were unaware of the oncogeriatric network. Improving the communication between GPs, oncologists and geriatric medicine seems to be one response to the isolation that GPs feel when caring for older people with cancer. At the primary care level, integration of GPs into the oncogeriatric network and the creation of a cancer care communication system in collaboration with the relevant hospital teams may be effective solutions.

Understanding the supportive care needs of Hispanic men cancer survivors

ABSTRACTObjective. To date, there is a paucity of research and information on Hispanic men cancer survivors (HMCS), who comprise part of the largest and fastest growing racial/ethnic minority group in the country. The purpose of this paper is to provide a deeper understanding of the supportive care needs of HMCS.Design. Three focus groups with a community sample of HMCS (n = 18) and interviews with providers (n = 5) were conducted to explore the supportive care needs of Hispanic men who had been diagnosed with cancer within the last five years. The data were analyzed using applied thematic analysis techniques.Results. Findings from focus groups and interviews are presented concurrently. The overarching themes that emerged were the need for: culturally sensitive cancer care and better communication with providers; cancer treatment-related information and comprehensive survivorship care; support and to connect with other cancer survivors and the need to negotiate changing gender role expectations and still provide for their family.Conclusion. Study findings contribute to the literature by presenting the supportive care needs of HMCS and illustrate the need for continued research to address disparities in access to cancer information and in the provision of culturally sensitive care. We provide recommendations and suggestions to address the supportive care needs of HMCS.

Exceptional patients and communication in cancer care-are we missing another survival factor?

There is increased awareness of the issue of exceptional survival beyond expectations among cancer patients with poor prognosis, and researchers are starting to look closely at this phenomenon. In this study, we explored the perceptions of these "exceptional patients" as to their understanding and insight into their unusual experience. We used a qualitative approach consisting of in-depth, open-ended interviews with exceptional patients in two locations, Texas and Israel, from 2007 to 2014. The interviews were audio-recorded and qualitatively analyzed, and gave rise to illness narratives entailing detailed descriptions of patients experience over the course of their disease and treatment. A qualitative content analysis focusing on contextual meaning was utilized. Twenty-nine patients participated in our study. The mean years since diagnosis was 9.55years (range, 4-23years). All patients had received conventional treatment, including surgery, chemotherapy, and radiation therapy. One of the prevailing themes in these interviews was related to the patient-doctor relationship. Most participants mentioned that the support they received from one or more physicians was a crucial factor for their exceptional survival. The significance of patient-doctor relationship in cancer survival requires further research. This research is especially important as it adds to the current trend of patient centered care and points to the added value of relationship between health providers and patients. This relationship, as perceived by these exceptional patients, can be a factor that adds to improved survival in cancer care.