Abstract
Background/Aims Effective patient-provider communication is critical in cancer care but often does not occur. Understanding providers’ perspectives on challenges in cancer care communication could support interventions.
Methods We surveyed providers in primary care, oncology, and oncology nursing at three CRN sites (Group Health Cooperative, WA; Kaiser Permanente, GA; Fallon Clinic, MA). Questionnaires assessed providers’ attitudes and experiences about communicating with cancer patients, situations providers find challenging, and how providers would communicate in two scenarios (error involving multiple providers leading to delayed diagnosis; miscommunication regarding patient symptoms).
Results Questionnaires were received from 406 of the 682 eligible providers (59%). Nearly all (98% (393 of 399)) reported their organizations value good patient-provider communication, and 95% (374 of 393) agreed that they communicate effectively with cancer patients. However, only 62% (239 of 385) agreed that they knew when their cancer patients had unanswered concerns or questions, and 67% (262 of 391) agreed that they were aware of most of the serious communication breakdowns that occurred in their patients’ care. Almost all, 99% (394 of 400) 99% agreed that their organization should encourage patients to alert the system when there has been a serious care breakdown, and 88% (340 of 386) agreed these reports would provide actionable information. Providers found some communication situations especially difficult. A majority (61% (242 of 397)) found it extremely/very difficult to respond to patients’ unrealistic beliefs about prognosis, 55% (217 of 395) found it extremely/very difficult to respond to patients’ concerns about delayed diagnosis, but only 5% (21 of 397) found it extremely/very difficult to respond to patients who are unhappy about care from another clinician. In response to a hypothetical patient who experienced a delayed breast cancer diagnosis, 55% (221 of 399) would provide very limited information to the patient, not explicitly mentioning the error causing the delay.
Discussion Cancer care providers value patient-provider communication but find discussions of prognosis, as well as disclosure regarding care breakdowns and delayed diagnosis, especially challenging. Providers support mechanisms to solicit cancer patients’ concerns about their care. Health systems should explore how to create care delivery environments that improve patient-provider communication.
