The Nurse’s Role in Prognosis-Related Communication in Pediatric Oncology Nursing Practice

Abstract

The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses’ operational definition of PRC, (2) nurses’ roles in PRC, and (3) nurses’ preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.

Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review

“…Individual‐level factors were identified in 100 studies, related to individual characteristics of the clinician, parents, or patients, or characteristics of the clinician–patient–family interaction. Clinician characteristics and behaviors that were examined as potential influences on communication included: complexity of language and terminology, 33–38 pacing of information, 39–43 demonstrations of competence, 42,44–48 level of comfort or training related to sensitive topics, 4,42,49–62 perceived importance of certain topics, 51,61–68 concerns about harms of discussing certain topics, 69–72 exploration of family's values and taking them seriously, 38,40,41,73–77 and demonstrations of empathy and caring 7,38,39,78,79 . Some studies identified a tension between a desire to show empathy and a need to create appropriate emotional distance to allow for effective communication and decision‐making 57,64,70,80,81 …”

“…Hierarchy within teams and perceived authority seemed to affect clinicians’ communication practices, especially related to prognostic discussions and introduction of palliative care 16,55,70 . Clear delineation and delegation of this authority seemed to facilitate communication 16,42,55,60,124 . Two studies described negative family experiences related to receiving contradictory information from different team members 16,45 .…”

La práctica de la enfermería oncológica pediátrica en América Latina y el Caribe

“…• Transmite información clara sobre la atención de la salud a grupos étnicamente diversos a través de diferentes medios (68,70,72,77,78).…”

“…• Demuestra la capacidad de incorporar estrategias de comunicación al tratar información específica sobre el cáncer con los pacientes y sus familias a fin de mejorar la alfabetización en salud y mejorar el acceso, la comprensión y el uso de la información sobre salud (65,78).…”

“…• Establece un diálogo abierto con las familias, considerándolas como colaboradoras del equipo, respetando sus creencias tradicionales y creando un ambiente donde se sientan cómodas para comunicarse (68,70,78).…”