Reflecting on patient experiences, behaviours and subsequent effects on cancer care and outcomes

Abstract

Reflecting on patient experiences, behaviours and subsequent effects on cancer care and outcomes Keywords: patient experiences, outcomes, health behaviour, professional behaviour, cancer care. Improving patient experience in the prevention and management of cancer is an issue that all health professionals grapple with; critical areas include better alleviation of symptoms, understanding of health behaviours, more expedient diagnosis and treatment, prevention of recurrence , understanding of needs and provision of support. This issue of EJCC presents several pieces of research from around the world, including resource-challenged settings , with the aim of better understanding and dealing with patient experience, and also understanding why health care professionals might fail their patients in providing timely cancer care and guidance. We see how behaviours of young people, health care professionals and patients have a significant effect on care received, and in turn, cancer outcomes, prompting us to examine our inter-personal interactions and the information we give to our patients and the public. Durif-Bruckert et al. (2015) explore the dynamic between doctors and patients and how they achieve shared decision-making about surgical treatment for early-stage breast cancer. Interestingly, they used a mixed approach of observation, interviews and questionnaires, to unpick and challenge commonly held notions and behavioural models regarding how doctors and patients interact in a modern health care environment; the concept of participation (in terms of information time from the consultation and different concerns at each stage of breast cancer), appears very important to patients using shared decision-making approaches. Moreover, patients were seen to choose to engage in shared decision-making in varying ways across the disease continuum-it is a dynamic, shifting process, which can induce anxiety in patients and also highlights how traditional medical authority has changed. Importantly, Durif-Bruckert et al.'s study highlights the level of understanding, or lack, of information provided by the doctor, emphasising how we need to think about new and novel approaches to information giving, and shared decision-making. We also need to consider that in blindly adhering to a shared decision making model, we may well assign patients a role counterintuitive to their wishes for receiving 'best care', and therefore increase vulnerability-shifting back to care with paternalistic undertones, and challenging patients' need for autonomy. These are not easy issues to negotiate; they compel us to reflect, as health care professionals, on how we interact with our patients' treatment decisions. A very different study exploring the support of women with intellectual disability in undertaking breast screening is reported by Willis et al. (2015); however, the findings have a similar theme: the quality and quantity of support women received was, in part dependent on who supported them, as well as their own intellectual disability. This work...