Health care provider communication

Abstract

BACKGROUNDPatients who are facing life-threatening and life-limiting cancer almost invariably experience psychological distress. Responding effectively requires therapeutic sensitivity and skill. In this study, we examined therapeutic effectiveness within the setting of cancer-related distress with the objective of understanding its constituent parts.METHODSSeventy-eight experienced psychosocial oncology clinicians from 24 health care centers across Canada were invited to participate in 3 focus groups each. In total, 29 focus groups were held over 2 years, during which clinicians articulated the therapeutic factors deemed most helpful in mitigating patient psychosocial distress. The content of each focus group was summarized into major themes and was reviewed with participants to confirm their accuracy. Upon completion of the focus groups, workshops were held in various centers, eliciting participant feedback on an empirical model of therapeutic effectiveness based on the qualitative analysis of focus group data.RESULTSThree primary, interrelated therapeutic domains emerged from the data, forming a model of optimal therapeutic effectiveness: 1) personal growth and self-care (domain A), 2) therapeutic approaches (domain B), and 3) creation of a safe space (domain C). Areas of domain overlap were identified and labeled accordingly: domain AB, therapeutic humility; domain BC, therapeutic pacing; and domain AC, therapeutic presence.CONCLUSIONSThis empirical model provides detailed insights regarding the elements and pedagogy of effective communication and psychosocial care for patients who are experiencing cancer-related distress. [See editorial on pages 000–000, this issue.] Cancer 2013. © 2013 American Cancer Society.

The state of transience, and its influence on the wish to die of advanced disease patients: insights from a qualitative phenomenological study

“…However, the participants in this study have emphasized the importance of this proactive screening being carried out in a context of safety and trust. These findings coincide with the Therapeutic Effectiveness model proposed by Chochinov, which advocates the creation of a safe space conducive to the therapeutic encounter [ 39 ]. This space is not limited exclusively to physical aspects; rather, it is a private, quiet space that guarantees confidentiality, allowing the patient to feel that it is their moment [ 39 ] and where healthcare professionals respect the patient´s pace.…”

Intensive Caring: Reminding Patients They Matter

“…We have studied this tone, which we labeled Therapeutic Presence. 16 The latter comprises being compassionate and empathic, being respectful and non-judgmental, being genuine and authentic, being trustworthy, being fully present, valuing the intrinsic worth of the patient, being mindful of boundaries, and being emotionally resilient. Cumulatively, this tone of care, independent of words or actions, affirms patients’ worth, provides the respect they deserve, while affirming they genuinely matter.…”

“…Therapeutic humility means relinquishing the need to fix , along with tolerating clinical ambiguity, accepting and honoring the patient as expert, and trusting in the process. 16 There are cancers that cannot be cured, depressions that resist treatment, and suffering whose intensity seems impenetrable. In those instances, the goal to fix can lead to feelings of failure and an inclination to withdraw.…”

Approaching Spiritual and Existential Care Needs in Health Education: Applying SOPHIE (Self-Exploration through Ontological, Phenomenological, and Humanistic, Ideological, and Existential Expressions), as Practice Methodology

“…Self-reflective practices in health education are integral in recognizing existential and spiritual care needs of self and others by reflecting on self-behavioral responses and belief patterns. It is essential to recognize and reflect on how our own personhood impacts our clinical relationships and care aspects with the patients and families in the practice settings (Chochinov et al 2013). Healthcare educators should integrate spiritual dimensions and use meaningful spiritual competency tools in both education and practice settings to enhance the provision of quality healthcare.…”