Please enjoy the following dialogue between Dr. Hinds, Editor-in-Chief, and Dr. Sally Thorne regarding her article “Poor Communication in Cancer Care: Patient Perspectives on What It Is and What to Do About It” (Thorne et al.) published in CANCER NURSING Volume 36, Issue 6 (Nov/Dec):
Dr. Hinds: How is it that, as a nurse researcher studying the communications that affect cancer patients, you explain your focus on physicians rather than nurses?
Dr. Thorne: A challenge for an interdisciplinary team led by nurses and doing ongoing work in this field is that researchers across the spectrum discover that the poor communication is both more frequent and more toxic when it comes from the physician overseeing the cancer care. Over the years, of the 600 cancer patients we have interviewed on communication questions, this pattern has been consistent. We have been hesitant to report it as such in order to sidestep nurse-doctor politics that might discredit the findings, and have instead tended to reference physician colleagues making a similar point in the literature on the basis of their studies (eg William Miller). We have taken this position not to be cowardly, but rather to position our work on a respectful foundation that can conceptualize the essence of a problem in the least polarizing manner possible in order to maximize application to practice.
In this paper, we are making what we see as a radical transition in the wider dialogue about cancer communication by shedding light on this difficult issue in a manner that sidesteps overt criticism of the inability of physicians to monitor and manage unprofessional behavior in this regard by challenging nurses to expand their advocacy for collective accountability for the “patient safety” component of this issue. We are calling on nurses collectively to identify communication environment as a component of the care culture over which they can theoretically exert considerable influence. That of course presupposes nursing competence in the full scope of ethical, relational and advocacy domains. What to do about the problem of substandard nursing? There is an extensive body of literature pertaining to oncology nursing practice that contains sensible and appropriate acknowledgement of communication competencies as fundamental to specialty practice. We know that communication and relational competencies are fundamental curricular components in nursing education and are taken up in all certification and specialty courses for oncology nursing. We do recognize, however, that by virtue of the diversity of settings in which cancer patients may encounter nurses and the complexity of health human resources issues across health care systems in various jurisdictions, that skill mix and competency issues are difficult to address.
Clearly, on the basis of our research, we would forcefully argue that introducing more communication training opportunities is not the panacea, and that we must collectively aspire toward care delivery systems that can identify poor practice and protect patients from its effects. There are clear roles for managers and administrators, stepping up to enact better oversight, mentorship and performance assessment mechanisms, but also for nurses individually and collectively, to advocate, encourage, inspire, and guide their colleagues toward better practice.
Do you have thoughts you’d like to share, or questions you’d like to ask Dr. Thorne? Please feel free to comment on our blog!