Cancer survivors' experiences with breakdowns in patient-centered communication.

Street RL, Spears E, Madrid S, Mazor KM. Cancer survivors' experiences with breakdowns in patient-centered communication. Psycho-oncology. 2019 Feb 1; 28(2):423-429.

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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.