Pediatric oncology nurses’ perceptions of prognosis-related communication

Abstract

Background: Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose: Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method: Mixed-methods, multi-phase design. This paper highlights the qualitative portion of the study. Findings: Three themes were identified: Importance of Collaboration, Impact of PRC, and Delivery of Prognostic Information. Discussion: Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations.

Nurses' experiences and attitudes toward diagnosis disclosure for cancer patients in China: A qualitative study

“…Similar feelings were reported in previous studies . Nurses in our study reported that a lack of collaboration between physicians and nurses forced them to work uninformed; they did not know what information had been conveyed to patients, which made them feel distressed.…”

“…In Newman's study, the researchers thought that nurses needed to educate and demonstrate to their physician colleagues the value and benefit that could be achieved from collaborative partnerships with nurses in disclosure and nurses playing a more prominent role in disclosure …”

“…These ethical challenges highlight further needs for improved communication and training for the expansion of the roles that nurses can perform on interprofessional health care teams in diagnosis delivery. Interprofessional collaboration is necessary during CDD to optimize and ensure quality patient care . How to collaborate and what nurses roles will be in CDD remain to be explored in the future.…”

“…Although physicians hold the responsibility and authority for CDD, nurses are active participants in the diagnosis process and prognosis‐related communication . The exact roles and responsibilities of nurses during CDD are not well delineated . Studies have found that patients or family members might think that physicians are too busy and prefer to ask nurses about the truth about their illnesses, which creates an ethical dilemma for nurses regarding whether and how to reveal the truth .…”

Teamwork in prognostic communication: Addressing bottlenecks and barriers

“…Nurses are often excluded from the disclosure process and at times are explicitly instructed not to discuss prognosis with patients. 22 This exclusion can decrease the ability of nurses to fully support their patients and can lead to mixed messages that confuse or frustrate families. 22,23 This current individual-based model of prognostic disclosure lacks redundancy and creates a communication bottleneck.…”