Richard L Street1,2, Erica Spears3, Sarah Madrid4, Kathleen M Mazor5. 1. Department of Communication, Texas A&M University, College Station, Texas, USA. 2. Department of Communication, Baylor College of Medicine, Houston, Texas, USA. 3. Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, Texas, USA. 4. Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA. 5. Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, Massachusetts, USA.
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.
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.
Authors: Matteo Fabbri; Lila J Finney Rutten; Sheila M Manemann; Cynthia Boyd; Jennifer Wolff; Alanna M Chamberlain; Susan A Weston; Kathleen J Yost; Joan M Griffin; Jill M Killian; Véronique L Roger Journal: Am J Manag Care Date: 2020-10 Impact factor: 2.229
Authors: Richard L Street; John V Petrocelli; Azraa Amroze; Corinna Bergelt; Margaret Murphy; J Michael Wieting; Kathleen M Mazor Journal: J Patient Exp Date: 2020-05-26