What Is the Lasting Impact of Communication Breakdowns During Cancer Care?

Theoretical Background and research questions/hypothesis:  The emotional distress and clinical complexity accompanying a cancer diagnosis can imperil effective communication between clinicians and patients.  Uncaring or ineffective communication can have significant consequences, damaging the patient-clinician relationship and interfering with care.  Potentially, patients may feel disempowered, hesitate to voice concerns, or lose trust in the healthcare system. We examined the after-effects of poor communication experiences in cancer care.

Methods:  We conducted semi-structured qualitative interviews with breast or colorectal cancer patients who reported a preventable problem in their care, and who believed they were harmed as a result.  We identified patients through administrative data at three healthcare systems in Washington, Georgia, or Massachusetts.  Interviews focused on the patient’s perception of the problem, its impact, and the patient’s and provider’s actions as a result.  Interviews were transcribed and coded for major and minor themes.  Coding captured the nature of the communication problem, and its impact on subsequent interactions with, or attitudes toward their doctor or the health care system.

Results:  We interviewed 78 patients; 39 reported one or more communication problems, occurring at all phases of care from suspicion of cancer, through diagnosis and treatment.  Problems pertained to the clinician’s manner (perceived as cold, stern, uncaring) as well as unmet informational needs.  Negative consequences included diminished trust, changing doctors, hesitancy to seek care, and persistent frustration or distress.  Some patients were so distressed that they avoided visits and skipped treatment.  Still, other patients reported a positive outcome of being more proactive in their care.

Conclusions:  As patients contend with significant physical and psychosocial challenges of cancer, effective and caring communication is essential.  Poor communication may have a lasting impact, negatively influencing subsequent encounters and trust.  Clinicians should be aware of potential lasting effects of their patient encounters.    

Implications for research and/or practice:  Future research is needed to determine the extent to which poor communication affects treatment compliance. Patient empowerment and education efforts may also be warranted to help patients recognize and address communication problems proactively.