A qualitative study of mechanisms influencing social inequality in cancer communication

Abstract

Objective To understand and describe mechanisms influencing social inequality in cancer communication between patients, companions and healthcare professionals. Methods The study was based on observations of 104 encounters and 30 semi‐structured interviews with nurses and medical doctors on three Danish oncology wards. Observations, interviews and subsequent analysis were guided by the theoretical framework of cultural health capital developed by Shim to investigate mechanisms that may generate social inequality in cancer communication. The analysis addressed both interactive processes and interpretative meanings. Results Information exchange was affected by (1) patient insight and preparation, (2) the presence of companions, and (3) communicating on patients' “home ground.” Patients who, on the basis of language and hygiene, were assessed to have low capacity, received less information. Lack of mutual exchange of information left healthcare professionals and patients with fewer opportunities to provide—or receive—the best treatment. Conclusion Exchange of information between patients, companions and healthcare professionals is co‐constructed in a mutual dynamic. To avoid social inequality in cancer communication, it is crucial that questions and answers allow proportionate insight into disease and treatment both for patients and for healthcare professionals.

Obstacles for patients with a low socio‐economic status treated within the head and neck cancer pathway: A multiple case study

“…They suggested that even when health professionals would try to communicate with the patients on other terms to make the conversations more successful, this had the opposite effect. The authors, therefore, argued that social inequality was increased in the communication between these patients and health professionals and argued for the need for additional support for patients who attended visits without relatives and possessed only a limited health capital (Dencker et al, 2021).…”

“…Dencker et al (2021) showed that patients without relatives and with limited health capital often communicated poorer with health professionals than did other patients because they were often less actively involved in the conversations with the health professionals during consultations. They suggested that even when health professionals would try to communicate with the patients on other terms to make the conversations more successful, this had the opposite effect.…”

“…Moreover, Merrild et al (2016) showed how especially patients of a low social class had difficulties overseeing several elements in a conversation with the doctor, why the decisive theme for the conversation was often focused on issues the doctor found important, creating an unequal interaction during the consultation (Merrild et al, 2016). Dencker et al (2021) showed that patients without relatives and with limited health capital often communicated poorer with health professionals than did other patients because they were often less actively involved in the conversations with the health professionals during consultations. They suggested that even when health professionals would try to communicate with the patients on other terms to make the conversations more successful, this had the opposite effect.…”

A support nurse may strengthen the participation of patients with low socio‐economic status in treatment pathways of head and neck cancer: A theory‐based evaluation

“…In addition, results from an integrated review showed that nurse navigators increased trust not only between the nurse and the patient but also between the patient and the other health professionals, which had a considerable impact on the continuum of care and the communication process during the treatment pathway (Pautasso et al, 2018). Likewise, Dencker et al (2021) found that patients who were accompanied during cancer consultations were more likely to communicate well with the health professionals (Dencker et al, 2021). Similarly, we found that the interaction between patients and health professionals was influenced by the support nurse's presence during the consultations as she was able to act as the communication link between the patient and the health professionals.…”

Effects of Demographic and Socio-Economic Factors on Investigation Time of Lung Cancer Patients in Denmark: A Retrospective Cohort Study

“…A possible explanation could be differences in communication between patients and healthcare professionals. 27 Previous studies 28,29 have shown that patients with low SEP did not engage actively in consultations and did not receive the same degree of information on treatment. Limited health literacy will make considerations of potential benefits and harms of treatment more difficult, and thus cause a delay to treatment.…”