Pivotal role of families in doctor-patient communication in oncology: a qualitative study of patients, their relatives and cancer clinicians

Abstract

Families are a unique source of support for many cancer patients. Most advanced communication skills training for oncologists are patient centred and do not cover interactions with family members. The current study used in-depth qualitative interviews of patients, relatives and cancer clinicians with thematic analysis to explore the role of family members in the communication process. Forty-one participants included 10 cancer patients, 10 relatives ensuring proportionate representation of both gender and primary cancer site and 21 doctors representing both medical and surgical oncology. Nineteen of 20 patients and relatives wanted an "open and honest" discussion with their doctors. All patients, relatives and doctors preferred involvement of the family at most stages of cancer treatment. Five themes were identified in relation to communication with family members. The participants highlighted the "importance of family for physical and psychological care," they emphasised the need to "balance patient autonomy and relatives desire to be protective" using varied "negotiating strategies" that are influenced by "socioeconomic circumstances of both patient and family." The doctor-patient-relative communication process was not static with preferences changing over time. The data suggests that communication skills training of cancer clinicians should incorporate modules on better communication with relatives.

Single cases from multiple perspectives: a qualitative study comparing the experiences of patients, patients’ caregivers, surgeons, and nurses when bad news is delivered about cancer

“…The linked cases also demonstrated that caregivers fulfill important roles such as primary caregiving and gathering information, aligning with studies that have reported family as playing a pivotal role in the process of breaking bad news. [ 24 ] Guidelines for involving family members in difficult conversations have recently been suggested in the literature. [ 25 ] The present findings support the explicit recognition and involvement of the caregivers in bad news discussions to support patients; however, caregivers must have the resources to offer this support and do so in a manner that meets the patient's needs.…”

“End-of-life care is more than wound care”: Health-care providers' perceptions of psychological and interpersonal needs of patients with terminal cancer

“…[28] The importance and close involvement of family calls for training and skill in effective communication with family members. [29] Larson and Tobin[30] discussed how to overcome barriers and use effective strategies to have meaningful end-of-life conversations that can facilitate closure and completing personally salient tasks. They also emphasize the need for health-care providers to initiate these conversations in a sensitive and culturally appropriate manner, instead of solely in response to patients’ disclosures.…”

The role of patients’ families in treatment decision-making among adult cancer patients in the Sultanate of Oman

“…A previous study found that financially independent individuals were more in control in their TDM than their family members, as they could seek a second medical opinion without the need for financial support from their family members or get their permission (Sekimoto et al., ). Also, oncologists were found to offer more treatment options to patients who were finically independent to their family members and involve them more in TDM as compared to patients who were finically dependent on their families (Datta et al., ).…”