TURKISH JOURNAL OF ONCOLOGY

Summary

Cancer is a leading cause of premature death worldwide. A cancer diagnosis can cause psychological distress in patients, such as anxiety, fear of the future, and depression. Given the increasing life expectancy and home confinement periods for oncology patients, communication between family members and physicians is clearly critical. This study aims to gather information on the importance of communication between the families of oncology patients and oncology physicians, the causes of problems in this area, and their solutions. A multifactorial approach is appropriate when addressing communication problems between physicians and patient relatives. Communication improvement programs should be widespread, and physician participation in these programs should be increased. Physicians should be open to communication and patient in answering questions from patient relatives. They should remember that the most important expectation of patient relatives from physicians is trust and information. Family members should be educated to have realistic expectations regarding the process. They should be warned to be cautious about information of unknown origin obtained from the internet and media outlets. It is crucial for family members to share their doubts regarding the accuracy of this information with the treating physician, and for the physician to address these concerns with patience. In addition to factors related to the physician and the patient’s family member, restructuring the healthcare system to better accommodate the needs of the patient’s family member is also a key factor to consider in resolving communication issues between the physician and the patient’s family member.

Summary

Introduction

INTRODUCTION

According to global cancer data, it has been found that approximately one in five men or women is diagnosed with cancer, and one in nine men and one in twelve women die from cancer.[1] Cancer, along with cardiovascular causes, is one of the leading causes of premature death worldwide.[2] Cancer is a global health issue that causes mortality and morbidity and, as such, can have a profound impact on patients and their families. A cancer diagnosis can lead to psychological distress in patients, including anxiety, fear of the future, and depression.[3-5] The challenging process of chemotherapy and radiation therapy following a cancer diagnosis can also reduce patients’ quality of life and exacerbate psychological problems associated with the disease. In addition, anxiety about the possibility of the disease recurring after treatment is completed is one of the causes of psychological disorders observed in oncology patients.[4] Open communication between the patient and the treating oncologist is crucial throughout all stages of the patient’s journey following a cancer diagnosis; in fact, studies have shown that effective communication between the patient and the physician can have a positive impact on the patient’s health outcomes.[6-8] Although it is clear how important patient-physician communication is in the disease management process, relatives of oncology patients may request that the treating physician not share the patient’s oncological diagnosis and treatment plan with the patient.[9,10] This situation, which oncology physicians frequently encounter in Turkey, makes managing the process quite challenging from the physician’s perspective and, at the same time, renders communication between the physician and the patient’s family members far more critical. Unfortunately, there are very few studies in the literature that examine communication between patients’ relatives and physicians, compared to those that investigate patient-physician communication. The aim of our study is to compile information regarding the importance of communication between the relatives of oncology patients and oncology physicians, as well as the causes of and solutions to the problems in this area.

COMMUNICATION PROBLEMS BETWEEN ONCOLOGY PATIENTS’ FAMILIES AND ONCOLOGY PHYSICIANS

The Importance of Communication with The Physician and Its Contribution to the Treatment Process
It is well known how important a healthy and trustworthy patient-physician relationship is during the patient’s treatment process.[11] It has been observed that studies examining communication between patients’ relatives and physicians are significantly fewer in number compared to those examining the patient-physician relationship. A review aimed to identify the psychosocial needs of breast cancer patients and their relatives.[12] The study found that relatives wanted to be informed about the prognosis and the course of the disease; however, they were unable to obtain sufficient information on these topics. A study highlighted the importance of the patient-physician relationship and supported this claim by providing examples of cases in which family members could influence patient-physician communication in either a negative or positive direction.[13] The study concluded that establishing healthy communication among the physician, the patient, and the patient’s family plays a vital role in selecting the appropriate treatment for the patient and ensuring its proper implementation. In the meta-synthesis conducted by Hoeck et al.,[14] it was emphasized that a cancer diagnosis not only affects the patient but also has a negative impact on the patient’s family members, and that cancer is a family disease. It has been demonstrated that the psychosocial interactions established by patients and their families have a significant impact on the patient’s acceptance of their diagnosis, their ability to adapt to the process, and their psychological well-being. A review has found that, as the duration of home care for cancer patients increases, the supportive roles played by their relatives are becoming increasingly important.[15] In a Finnish study conducted by Eriksson et al.,[16] researchers investigated what relatives of cancer patients thought about the actions of healthcare professionals in providing information and emotional support. A survey was conducted among the relatives of patients in 168 cancer wards across Finland. It was found that informing relatives about the patient’s cancer diagnosis is critically important; however, unfortunately, fewer than one-third of the relatives received sufficient information about the patient’s diagnosis. It has been noted that physicians should communicate more frequently with patients’ relatives regarding the patient’s cancer diagnosis. In a Norwegian study conducted by Ekstedt et al.,[17] it was stated that the relatives of cancer patients are the patient’s most important source of social and emotional support. Furthermore, it has been noted that as diagnostic and treatment options improve and, consequently, cancer-related survival rates increase the responsibility of family members to support the patient in every way grows; and that when family members receive support, this has a positive impact on the patient’s well being. In the study, a 24 member multidisciplinary team consisting of social workers, doctors, and nurses held a group discussion on the topics under consideration, after which the discussion was subjected to hermeneutic analysis. According to the analysis, it was concluded that the healthcare system needs to be revised to focus more on patients’ families and provide them with greater support. A Brazilian study aimed to examine the perspectives of nurses working in a palliative cancer care unit regarding family involvement in the palliative cancer care process.[18] The results of this study, conducted through interviews with 17 nurses, emphasized the importance of adapting and integrating family members into the process, and it was determined that this would improve the patient’s quality of life and comfort.

The Causes of Communication Problems with Physicians
In a systematic review conducted by Ilıc et al.,[19] the information needs of relatives of pediatric cancer patients and the factors that facilitate or hinder the fulfillment of these needs were examined. The study revealed that patients’ relatives sought different information throughout the entire process from diagnosis and treatment to follow up and rehabilitation and that patients’ siblings tended to ask different questions than their parents. It was observed that patients’ siblings were more likely to ask questions regarding the cause of the disease and their own risk of developing it. The study found that the most important factor determining whether patients’ relatives receive adequate information is the competence of the healthcare professional. Among these competencies, the ability to communicate effectively with patients’ relatives, encourage them to ask questions, provide accurate and clear explanations, and demonstrate patience, sensitivity, honesty, and empathy stood out as particularly significant factors. It has been found that when a healthcare professional explains the relevant situation in an understandable way without using medical jargon, it is important for the patient’s family members to receive the information they need. Healthcare professionals should be aware that patients’ families may request different types of information; they should encourage patients’ families to ask questions freely and create a calm and peaceful environment in which this communication can take place. An Iranian study based on interviews with 14 patients and 11 physicians addressed issues in patient-physician communication.[20] The study categorized communication problems into five main categories: Misperceptions regarding the physician’s identity, the physician’s unprofessional attitude, the physician’s sense of superiority, the patient’s cultural differences, and the lack of patient-supportive units within the healthcare system. It has been noted that the media plays a role in creating a misperception of the physician’s identity and in leading patients to develop irrational expectations. A doctor’s failure to take the patient’s question seriously, lack of empathy, and failure to use nonverbal communication are among the factors listed under the heading of unprofessional conduct. Failing to give the patient’s complaints sufficient attention stands out as the most significant factor listed under the heading of the doctor viewing themselves as superior. It has been suggested that the patient’s cultural differences play a role in leading them to develop unrealistic expectations regarding the diagnosis and treatment process. The large number of patients; the resulting inability to devote sufficient time to each patient; and the lack of an environment conducive to effective communication have been identified as factors contributing to problems in patient-physician communication. It has been established that communication problems within the healthcare system cannot be resolved simply by training healthcare professionals in communication; rather, it is necessary to educate patients’ families on this matter as well and to structure healthcare systems in a way that supports them. Çetin et al.,[21] evaluated the results of a survey administered to the relatives of 168 cancer patients undergoing treatment in radiation oncology. Patients were asked questions under the headings of empathy, information, and trust. It has been observed that an increase in the time a physician spends with a patient and their family member has a significant impact on all three areas: Trust, information sharing, and empathy. Additionally, it has been found that an increase in the family member’s educational level positively influences communication between the family member and the physician.

Today, most patients and their families use the internet and media outlets to learn about health issues.[22-24] A Korean study examining the impact of internet use on the patient-physician relationship from the perspective of physicians found that while internet use can increase patients’ and their families’ knowledge about health issues, it can also negatively affect patient-physician communication.[22] Patients and their families may form incorrect conclusions about the illness based on information they find online and may become unnecessarily anxious. Doctors have emphasized their concern that all of these factors could hinder effective doctor-patient communication. In a study conducted by Iverson et al.,[23] while concerns were raised that internet use could disrupt the patient-physician relationship, the authors emphasized its potential to improve patient adherence to treatment. A review examined the impact of internet use on the patient-physician relationship.[24] The study found that internet use can have both positive and negative effects on the patient-physician relationship. The information obtained can help patients adhere to their treatment regimen; however, inaccurate information from unverified sources can undermine a patient’s trust in their physician and harm the patient-physician relationship. It has been noted that the quality of online information sources is crucial for fostering a positive patient-physician relationship. Programs broadcast on media outlets also have the potential to influence communication between physicians, patients, and their relatives.[20,25] In a study conducted by Dönmez et al.,[25] the communication challenges faced by physicians in their interactions with patients, patients’ relatives, and other healthcare workers were evaluated through two TV series aired in Turkey that focus on fictional scenarios experienced by hospital staff. It is noteworthy that the physicians playing the lead roles in these series are also portrayed as characters with social communication difficulties who struggle to communicate effectively with patients and their relatives. It has been observed that in TV series, this communication gap is overcome thanks to the professional competence of the doctors. The portrayal in these series carries the risk of further exacerbating communication problems between doctors, patients, and their families. While professional success is crucial in a physician’s medical career, it cannot be viewed as a substitute for addressing communication gaps. In today’s world, where social media and media outlets significantly influence communication between physicians, patients, and their families, it is essential for physicians to be knowledgeable and sensitive in this regard in order to foster healthy communication.

Suggestions for Resolving Communication Problems
A study evaluated the effectiveness of communication enhancement programs administered to healthcare professionals working in oncology.[26] A total of 21 studies were reviewed, and in most of these studies, the programs were administered to experienced clinicians. Of the 21 studies evaluated, 19 found that these programs were effective in improving communication and building trust. In a randomized study conducted by Delvaux et al.,[27] the impact of workshop programs administered to physicians on their communication with patients and their families was investigated. In the study, physicians participated in six workshops, each lasting three hours. The analysis revealed that these training programs had a positive impact on communication between physicians and their patients and their families. In a randomized controlled trial conducted by Fujimori et al.,[28] the effectiveness of communication skills training programs for oncologists was evaluated. Of the 30 oncologists who agreed to participate in the study, 15 were enrolled in the program. The results of the study showed that communication enhancement programs have a positive impact on patient-oncologist communication in the areas of emotional support, information-sharing skills, and creating a supportive environment. Additionally, the self-confidence scores of physicians who participated in the program were found to be higher than those of physicians who did not participate. It has been recommended that oncologists take advantage of these programs to improve their communication skills. Today, various training programs including those involving patient participation or simulation-based approaches are being implemented in medical schools to strengthen communication between physicians and patients and their families.[29,30] When the studies are evaluated, it is noteworthy that many of the training programs are applied to experienced clinicians. It is clear that communication improvement programs benefit physicians regardless of their experience level. It should not be forgotten that communication is a skill that can be improved through training.

In today’s world, where the survival rates and duration of home care for cancer patients are increasing, it is clear that communication between patients’ relatives and physicians is of critical importance. In our country, the fact that many patients’ relatives request that the cancer diagnosis not be shared with the patient is another factor that underscores this importance. Communication problems between a physician and a patient’s family member may stem from the physician, but they can also be caused by the family member’s level of education and unrealistic expectations, as well as media and online content, or the healthcare system itself. From this perspective, it is appropriate to view communication issues between physicians and patients’ relatives as multifactorial. Communication training programs should be expanded, and physician participation in these programs should be increased. Physicians should be open to communication, patient-centered, patient-centered, and patient-centered, and should be patient when responding to questions from patients’ families, recognizing that different family members may have different questions. In this era, when the internet is used as a source of information by a very large segment of society, healthcare providers should be prepared to address questions from patients’ families regarding information they have obtained online. It is important to remember that the most important expectations patients’ families have of their doctors are trust and knowledge. Patients’ families should be educated to have realistic expectations regarding the treatment process. They should be warned to be cautious about information of unknown origin that they may come across on the internet and in the media. It is very important for family members to share their concerns about the accuracy of this information with the treating physician and for the physician to address these concerns with patience; knowing that they can ask the physician any questions that come to mind is a factor that strengthens communication. In addition to factors related to the physician and the patient’s family member, structuring the healthcare system and hospital conditions to be more patient-family-centered is also a key consideration in addressing communication issues between physicians and patients’ family members.

Introduction

Conclusion

With the increasing survival rates and home confinement periods for oncology patients, it is clear that communication between patient relatives and physicians is crucial. Communication problems between physicians and patient relatives need to be addressed from a multifactorial perspective. In addition to training programs for physicians, awareness programs for patient relatives and improvements in the healthcare system can be effective in resolving these communication issues.

Conclusion