When discussing the transition to palliative care for patients with breast cancer, oncologists have to find a balance between giving explicit information while not overwhelming patients and being ...realistic while remaining hopeful. It is unclear whether patients prefer more or less explicit prognostic information, and reassuring patients that they will not be abandoned may provide realistic hope. We assessed the effect of explicit prognostic information and reassurance about nonabandonment at the transition to palliative care.
An experimental 2 × 2 study was used. Four scripted videos of a bad news conversation were created that differed only in the level of "explicitness of prognosis" and "reassurance about nonabandonment" (high v low). Patients with and survivors of breast cancer (n = 51) and healthy women (n = 53) watched the video-vignettes. The effects of the different communications on participants' anxiety, uncertainty, self-efficacy, and satisfaction were assessed by using multilevel analyses that explored the moderating influences of monitoring/blunting scores.
The highly explicit/highly reassuring video yielded the most positive outcomes, and the less explicit/less reassuring video, the most negative (P ≤ .05 for all outcome measures except anxiety). The main effects found were that explicitness and reassurance decreased participants' uncertainty (P < .001 and P = .002, respectively) and anxiety (only after reassurance; P = .001) while increasing self-efficacy (P = .004 and P < .001, respectively) and satisfaction (P < .001 and P < .001, respectively). High monitors seemed least positive, mainly following explicitness.
Explicit prognostic information may lead to better outcomes than general information. In addition, reassurance about nonabandonment might provide realistic hope but should be lived up to. More research is needed to translate these findings into clinical care.
Background
Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients ...with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives.
Methods
An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered “yes,” they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis).
Results
Communication regarding information provision, prognosis discussion, decision‐making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision‐making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy 49% and giving too much prognostic information 60%). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication.
Conclusions
This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.
Communication may be potentially harmful in relation to 1) information provision, 2) prognosis discussion, 3) decision‐making, or 4) empathy. This article describes both preventable pitfalls (eg, patient vs Ms X) and delicate challenges (eg, introducing the option of no anticancer therapy) where exploring patients' needs and preferences may help.
The increasing focus on doctor-patient communication in training and the number of studies and articles on the subject prove what we have known about the importance of doctor-patient communication ...for quite some time. Nevertheless, a lot of patients still feel they are not really listened to: the Dutch Federation of Cancer Patient Organisations (NFK) is persistently confronted with patients' complaints about bedside manner and communication (personal communication). Thus, the former president of the NFK, Dr. Els Borst-Eilers, considered a new form of communication training aiming awareness of health professionals of oncology patients' perception of events during diagnosis and treatment. Copyright Elsevier B.V.
Abstract
Background
There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists’ and patients’ ...views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy.
Methods
Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software.
Results
Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients’ unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more.
Conclusions
Integrating oncologists’ and patients’ views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate – tailored – information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
Abstract Objective Scripted consultations provide the opportunity to vary and study the effect of specific elements of medical communication. These scripted consultations are role-played, videotaped ...and then judged by analogue patients. Most studies applying this methodology have provided little insight into how they created internally and externally valid written and role-played scripts. In this paper we aim to address this gap by providing a detailed description of a scripted video-vignette study's methodology. Methods Following the five phases of creating and implementing scripted video-vignettes the current study's methodology is described: (1) deciding if video-vignettes are appropriate, (2) developing a valid script, (3) designing valid manipulations, (4) converting the scripted consultations to video, (5) administering the videos in an experiment. Results Following these phases and four validation steps internally and externally valid vignettes were developed. Conclusions The detailed description of the current study's methodology produced general recommendations for scripted video-vignette studies, such as the importance of validating both the written as well as the role-played scripts and involving both experts and lay people in validating the scripts. For other choices no golden standard exists. Practice implications The presented methodology and recommendations may serve as a source of inspiration for future scripted video-vignette studies.
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