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Cancer survivors' experiences with breakdowns in patient‐centered communication
Author(s) -
Street Richard L.,
Spears Erica,
Madrid Sarah,
Mazor Kathleen M.
Publication year - 2019
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.4963
Subject(s) - active listening , commission , thematic analysis , perspective (graphical) , distress , health care , information exchange , health communication , psychology , emotional distress , medicine , nursing , clinical psychology , anxiety , qualitative research , psychiatry , psychotherapist , communication , business , social science , telecommunications , finance , artificial intelligence , sociology , computer science , economics , economic growth
Abstract Objective This study analyzed cancer survivors' communication experiences that fell short of being patient‐centered. Patients' descriptions of communication “breakdowns” were analyzed according to domain (eg, information exchange, fostering relationships, and managing emotions), whether it was a breakdown of commission (what was communicated) or omission (what should have been communicated) and whether it involved a clinician or the health care organization. Methods Cancer survivors (from an online panel of patients) completed the Patients Assessment of Communication Experience measure. Ratings less than “excellent” elicited a prompt asking where communication fell short. Communication breakdowns were categorized as one of commission/omission, if it involved a clinician/health care system, and within which communication domain. Thematic analysis explored how communication breakdowns affected respondents' cancer care experiences. Results Overall communication was rated as less than excellent by 153 respondents, of which 79 identified a specific communication breakdown. Over half ( n = 43, 54%) were problems of omission, mostly attributed to interaction with health care organizations ( n = 25). Breakdowns of commission ( n = 36, 46%) occurred primarily within clinical encounters ( n = 32). Most breakdowns were problems of information exchange (49%) or fostering relationships (27%). Three overarching themes emerged—emotional fallout from unmet information needs, inattention to patient perspective, and uncertainty about navigation and team communication. Conclusions Patient‐centered communication breakdowns create distress that worsens patients' cancer care experiences. Communication skills training for clinicians should address listening, perspective taking, and assessing/satisfying patients' information and emotional needs. Health care organizations should enhance processes to provide timely, useful information to patients.