Poor communication in cancer care: patient perspectives on what it is and what to do about it.

BACKGROUND: Communication in cancer care is a recognized problem for patients. Research to date has provided limited relevant knowledge toward solving this problem.
OBJECTIVE: Our research program aims to understand helpful and unhelpful communication from the patient perspective and to document changes in patient needs and priorities over time. In this analysis, we focus on patient perceptions of poor communication.
METHODS: Using a qualitative longitudinal approach informed by interpretive description methodology, we are following a cohort of adult cancer patients across their cancer journey. We used constant comparative analysis of repeated interviews to examine thematic patterns in their perceptions and interpret both commonalities and diversities.
RESULTS: Patient accounts reveal 3 types of poor communication. "Ordinary misses" are everyday missteps for which maturation and socialization may be an adequate solution. "Systemic misunderstandings" are assumptive gaps between patients and professionals, which may be addressed through qualitative research. "Repeat offenders" are a subset of clinicians whose communication patterns become a particular source of patient distress.
CONCLUSIONS: This typology offers a novel way to conceptualize the problem of poor communication in cancer care toward more effective solutions for the communication problem. Managing the communication of a problematic subset of clinicians will likely require strategic interventions at the level of organizational culture and models of care. IMPLICATIONS FOR PRACTICE: Nurses can play a meaningful role in detecting and buffering sources of poor communication in the practice context. Addressing poor communication may be a further reason to advocate for interprofessional team-based care models.