Patient–health care provider communication during chemotherapy treatment: the perspectives of women with breast cancer
Introduction
Women with breast cancer undergoing chemotherapy face numerous real and potential physical and emotional problems. In order to prevent adverse effects of chemotherapy, effective communication between patients and health care providers is essential. Changes in health care and the trend toward ambulatory care present challenges for both patients and health professionals in exchanging meaningful information. Outpatients must take responsibility in reporting their conditions, while health care providers are expected to provide relevant information and to understand the concerns of patients at home. In such an environment, the potential for communication breakdown can be great. Lack of communication can result in such problems as inaccessibility to meaningful information, misinterpretation in managing side effects, and lack of trust in the patient–health care provider relationship. Understanding the communication process that takes place between patients and their cancer care specialists during chemotherapy treatment is essential for promoting shared decision-making and partnering in care [1], [2].
Patient–health care provider communication is a critical dimension of health care. The literature indicates that communication between patients and their health care providers can affect patient outcomes and behavior [3]. For cancer patients, communication with health professionals has been reported to be one of the most important aspects of their treatment [2], [4], [5], [6]. Yet, despite this recognition, there remains substantial evidence to indicate that in clinical practice communication between cancer patients and health care providers is often problematic [1], [2], [4], [7], [8].
A concern clearly articulated by women with breast cancer is the need for better communication with their health care providers as it relates to the provision of information, shared decision-making, and respect for their needs and concerns [1]. Past research on communication during the breast cancer experience has mainly focused on factors affecting treatment decision-making behavior [9], [10], [11], [12], [13], [14], patient participation in care [10], [15], [16], and assessment of information needs [16], [17], [18]. While this research has contributed to the communication literature, its emphasis has been to examine communication issues that arise at the time of diagnosis and consent to treatment. No previous research was found describing how information was exchanged once treatment had been initiated and patients met periodically with their health care team for follow-up assessment. There is a lack of information describing the communication process between patients and health care providers during the treatment phase, especially from the patients’ perspective.
Therefore, the purpose of the present study was to gain an understanding of the communication that occurs between women with breast cancer and health care professionals during the time women are undergoing chemotherapy treatment as outpatients. In particular, the aims were to document patients’ viewpoints of their interactions with health care professionals, and identify factors that helped or hindered the communication process.
Section snippets
Study design
A qualitative research methodology was used to describe women’s experiences of interacting with health care professionals while undergoing chemotherapy treatment for breast cancer.
Setting and sample
Potential study participants were identified from chemotherapy outpatient lists at two regional cancer centers. Eligibility criteria for study participants included women over the age of 18 who were aware of their diagnosis of breast cancer, were currently undergoing outpatient chemotherapy treatments or had recently
Sample
Table 1 describes the profile of the 40 participants. The majority of women interviewed was between the ages of 40–60 years old, married, had some post-secondary education experience, and spoke English as their first language. The sample included women in different stages of their chemotherapy treatment. Twelve women had completed two or three treatment cycles, while the rest of the participants had completed four or more cycles of chemotherapy. Three women had completed their last prescribed
Discussion
Communication is essential to both the process and outcome of cancer care. The recognition that communication plays a central role in the provision of quality patient care and that effective communication improves health outcomes has led to an increase in learning more about interactions between patients and their providers. While communication between patients and their health care providers is important throughout the entire cancer experience, it is especially crucial during the treatment
Conclusions
Analysis of patient–provider interactions from the patient’s perspective can provide an alternative lens in understanding communication between patients and health care professionals. The present study focusing on women with breast cancer and their perceptions of communication with cancer care specialists during chemotherapy yields some important messages. The descriptions of patient factors affecting communication provide insight into how patients are changing their behaviors and expectations
Acknowledgements
This research was funded by a grant from the Canadian Breast Cancer Foundation.
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During the time the study was conducted, Dr. Bakker was the Nurse Researcher and Ms. Bennett was a Research Officer at the Northeastern Ontario Regional Cancer Center, Sudbury, Ontario.