TY - JOUR
T1 - Cancer survivors' experiences with breakdowns in patient-centered communication
AU - Street, Richard L.
AU - Spears, Erica
AU - Madrid, Sarah
AU - Mazor, Kathleen M.
N1 - Funding Information:
Data collection for this study was funded by the National Cancer Institute (P20CA137219). Dr Street is supported by the Houston VA Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413).
Funding Information:
Data collection for this study was funded by the National Cancer Institute (P20CA137219). Dr Street is supported by the Houston VA Center for Innovations in Quality, Effectiveness, and Safety (CIN 13‐413).
Publisher Copyright:
© 2018 John Wiley & Sons, Ltd.
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
KW - cancer
KW - communication breakdowns
KW - information exchange
KW - oncology
KW - patient-centered communication
KW - physician–patient relationships
UR - http://www.scopus.com/inward/record.url?scp=85059117268&partnerID=8YFLogxK
U2 - 10.1002/pon.4963
DO - 10.1002/pon.4963
M3 - Article
C2 - 30548100
AN - SCOPUS:85059117268
SN - 1057-9249
VL - 28
SP - 423
EP - 429
JO - Psycho-Oncology
JF - Psycho-Oncology
IS - 2
ER -