A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

Villalobos, Matthias; Coulibaly, K.; Krug, Katja; Kamradt, Martina; Wensing, Michel; Siegle, Anja; Kuon, Jonas; Eschbach, C.; Tessmer, Germán Adolfo; Winkler, Eva C.; Szécsényi, Joachim; Ose, Dominik; Thomas, Michael

doi:10.1111/ecc.12794

Cited by 19 publications

(26 citation statements)

References 40 publications

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“…The need for specific provision of psychological support [9–11,2–25] rather than a vague offer, shows clearly the necessity to revise the previously practised access to psycho-oncological measures. Villalobos et al [33] suggest the implantation of a longitudinal communication approach, to promote flexibility for respecting the individuality of patients with lung cancer, as one way of improvement.…”

Section: Discussionmentioning

confidence: 99%

“I can’t get it into my head that I have cancer…”—A qualitative interview study on needs of patients with lung cancer

et al. 2019

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Background Caring for patients with advanced lung cancer is of high relevance in different clinical settings. Lung cancer is among the most common causes of death from malignant neoplasms worldwide; with increasing prevalence and mortality. Aim To get a better understanding of individual patients’ needs, exploring the experiences and meaning of living with advanced lung cancer at the end of life, and to develop strategies for improving patient-centred care in Germany. Design Qualitative explorative interview study with patients, using grounded theory. Setting/Participants A sample of 17 adults living with advanced lung cancer in Lower Saxony/Germany was recruited in two university hospitals. Patients were asked to tell of their experiences of living with advanced lung cancer. The emphasis of this study was the period of palliative tumour therapy. Results The main phenomenon of living with advanced lung cancer is the feeling of having to redefine one’s own existence, such as social roles within and outside the family. The diagnosis trigger powerlessness, which can lead to information passivity, followed by acceptance of aggressive tumour treatment. Patients perceive a high degree of psychological and social stress, without being able to express this. There is a lack of regular appropriate psychosocial care accompanying chemotherapy. Patients ascribe their physical suffering to the side effects of tumour treatment, which may trigger a desire to die. Finally, patients tend to hide their individual needs, even when asked. Conclusions Regarding the patients’ needs, greater emphasis must be placed on psychosocial care as part of the biopsychosocial model to adequately consider the patients’ concerns. Assessments can be helpful to enhance communication at an early stage across all professions into the multi-professional therapy.

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Section: Discussionmentioning

confidence: 99%

“I can’t get it into my head that I have cancer…”—A qualitative interview study on needs of patients with lung cancer

et al. 2019

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“…For MC 3, tumour progression and the facilitation of prognostic awareness are paramount. MC 4 focuses on the transition to best supportive care as all possible disease-modifying interventions are exhausted including patients preferences [11]. Additional file 3 (supplementary material) includes a detailed description of aspects and examples.…”

Section: Checklist For Mcsmentioning

confidence: 99%

“…In spite of knowing about the positive effects of communication, patients, caregivers and healthcare providers often perceive communication skills of healthcare staff to be suboptimal and fragmented. Therefore, training of communication skills is recommended [7,11] as well as a team approach to communication with patients, involving physicians and nurses. However, the actual application of communication skills in a team approach in routine practice remains difficult.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

et al. 2020

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Background: Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice. Methods: A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests. Results: A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%). Conclusion: The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved. Trial registration: DRKS00013469 / Date of registration: 22.12.2017.

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“…1 This suggests that quality of health professional-patient communication is linked to the quality of communication and coordination within the team, 2 and that informal caregivers also play a crucial role in managing patients' cancer disease. 3,4 Nevertheless, literature highlights that many clinical contexts are still lacking a good-quality patient-health professional communication regarding end-of-life preferences and prognosis disclosure, 5,6 and information preferences for patients with advanced cancer are still unmet. 7 As information transmission enables patients to make informed choices about their own healthcare, it can be said that, in cancer care, disclosure issue is still an ethically challenging clinical problem.…”

Section: Introductionmentioning

confidence: 99%

“…10 On the contrary, prognostic disclosure has been associated with more realistic patients' expectations of life expectancy, 11 and discussions on prognosis seem to strengthen the relationship between patient and oncologist. 12 Literature has also shown that good collaboration among health professionals is essential for high-quality care 4 and that patient-centred care is enhanced by both good inter-professional communication and acknowledgement of the interdependence of each one's role. 13 However, the perspectives of patients, caregivers, physicians and nurses have been seldom studied all together.…”

Section: Introductionmentioning

confidence: 99%

Ethical perspectives in communication in cancer care: An interpretative phenomenological study

et al. 2020

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Background: In cancer care, many clinical contexts still lack a good-quality patient–health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. Objective: To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. Methods: A qualitative study using interpretative phenomenological analysis was performed. Participants and research context: Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. Ethical considerations: Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. Results: Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. Conclusion: The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them ‘to choose with dignity and being aware of it’. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.

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A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

Cited by 19 publications

References 40 publications

“I can’t get it into my head that I have cancer…”—A qualitative interview study on needs of patients with lung cancer

“I can’t get it into my head that I have cancer…”—A qualitative interview study on needs of patients with lung cancer

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Ethical perspectives in communication in cancer care: An interpretative phenomenological study

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