Abstract
Background Cancer providers strive to deliver high quality care, yet provider-patient communication breakdowns can occur and may contribute to adverse events and errors. A better understanding of cancer providers’ perceptions of communication breakdowns could improve patient and provider satisfaction and patient safety. This study investigated providers’ attitudes and experiences of communication breakdowns in cancer care.
Methods We recruited cancer care physicians and nurses at Kaiser Permanente Georgia, Group Health Cooperative, and Fallon Clinic for 1-hour focus groups. Discussions centered on three topics: communication breakdowns that contribute to adverse events or medical errors, unmet patient expectations, and suggestions for improvement. Recurrent themes are currently being identified using qualitative analysis. Preliminary results are presented below.
Results Nine focus groups were held with 48 providers (25 MD, 20 RN/NP, 3 other). Preliminary analysis reveals that providers feel that cancer presents unique communication challenges due to the strong emotional component of the diagnosis, the potential for blame for self or others, and, given the clinical choices patients face, information overload. Communication breakdowns between providers were generally seen as common; examples included breakdowns in information sharing and uncertain responsibility for talking to patients about prognosis. Examples of provider/patient communication challenges included physicians giving either false hope or alternatively no hope, and patients sometimes not telling providers about side effects and symptoms. Unmet patient expectations were frustrating for some providers, and reflected two related areas:
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patient expectations that providers viewed as unrealistic; and
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patient expectations resulting from their interactions with multiple providers.
Providers felt that patients sometimes hesitate to mention their concerns about communication breakdowns for fear of disrupting their care. Providers believed communication breakdowns reflected both deficits in individual communication skills and system failures. Support was high for system-based strategies for improving communication, including new patient orientation, care coordinators, and a reporting system for communication breakdowns.
Conclusions Cancer care providers believe communication breakdowns are common, reflect both deficits in provider skills and system failures, and often are unreported by patients. Providers and health systems should consider educational and structural changes to better address these concerns.
