Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service

Abstract

The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women and 26 men, and their median age was 56 (18-86) years. Their religious status was elicited: 48% described themselves as religious, 25% as traditional, and 27% as secular. According to their physicians, 41 were in remission, 11 had stable disease, 47 had progressive disease and in 4 the disease status was unknown. Patients tended to underestimate the status of their disease: among those with progressive disease, 36% stated that their disease was stable or in remission. Overwhelmingly, patients expected that their oncologists should be patient and skilled in diagnostic procedures (98%), tactful, considerate and therapeutically skilled (90-95%), and skilled in the management of pain and the psychosocial consequences of cancer (75-85%). When there is bad news to be transmitted, 92% of patients indicated that they would want disclosure, while 6% indicated that they would want the news withheld from them but passed on to their family members. Most patients were very satisfied with the clarity of the information they received about their disease (85%) and the sensitivity with which it was transmitted (90%). Although 88% of patients reported that they relied on their oncologist for therapeutic decision making, 45% indicated that they had sought a second opinion and 32% reported seeking the opinion of a rabbinical medical broker. Almost all, 97%, of patients indicated that they felt comfortable seeking advice from their oncologist, and the oncologist was the staff member most often sought out for both information (69%) and support (66%). The data indicate high patient expectations of nursing and medical oncology staff members' skills and behaviors. Despite expressing a high level of satisfaction, a substantial percentage of patients had an inaccurate understanding of their disease status.

Communicating bad news: an integrative review of the nursing literature

“…Similarly, patients in an article from Israel (18) stated that during the breaking of bad news by health professionals, they value eye-to-eye contact, an affective touch and that the information is given in a delicate and sensitive manner. Most received the bad news from doctors and preferred to share the news with their family and the health professional team, while withholding the information from friends and third parties.…”

“…In a study carried out with patients attended an oncology outpatient clinic (18) , knowledge about the disease status and communication of news regarding treatment were evaluated. Some patients reported that the disease was in remission and/or in indeterminate status, however in reality it was in a progressive stage.…”

Investigation of Cancer Patients’ Information Sources, Information Needs and Expectations of Health Professionals

“…[24] Bununla birlikte hastalar hemşireleri doktorlardan daha fazla ulaşılabilir bulmaktadırlar. Çünkü hemşireler hastalarla daha fazla zaman geçirmekte ve iletişime geçmek için daha fazla fırsat olmaktadır.…”

Metaphorical Framing of Obesity

“…Incorrect understanding by patients of their medical condition is common in the field of healthcare. Sappir et al (2000) found that 10% of patients with progressing tumors thought that they were in full or partial remission, 26% thought their prognosis was undetermined, and 44% thought they were stable. Only 30% knew their actual condition.…”