Communicating With Families of Patients With Advanced Cancer
After pain management, poor communication with health professionals creates the most distress for families of patients with cancer. Difficulties communicating with families also have been identified as potentially stressful for nurses. This is particularly the case for nurses working in acute care settings. However, little research has been undertaken to examine the specific problems and challenges confronting nurses who endeavor to communicate with families of patients with cancer in a hospital setting. The purpose of this study was to describe nurses' perceptions of communication issues, potential barriers, and strategies associated with nurse-family interactions in an acute cancer hospital setting. Focus groups were conducted with nurses from two cancer wards at an Australia hospital. Four distinct themes emerged. First, all nurses described communication difficulties they encountered when interacting with families. Second, team factors appeared to be a central determinant of the quality of nurse-family communication. Third, nurses described difficulties associated with the delivery of bad news and treatment plans that are not clearly defined for the patient. Finally, the effects of poor communication on nurses were notably and vividly described. In this report, recommendations for clinical practice and subsequent research are offered.



I think we don't have the time to spend with them. You've hit the nail on the head. You go from being acute to dead and kind of nothing in between. We don't have the time for families to grieve or our patients to grieve or us to grieve.



Caring for dying patients in an acute hospital ward may be particularly stressful for nursing staff because of the blend of care required in an acute care setting. This includes providing care for patients undergoing treatment, for those with recurrence and hopes for remission, and for those requiring end-stage care. Attention to the communication needs of patients with advanced cancer and their families may be difficult to achieve amid the demands of a busy active treatment ward. Communication in the acute care setting is extremely important to ensure that the treatment plan is clearly understood and approaches to management are sensitive and coordinated.

A review of the empirical literature shows difficulties associated with the provision of quality care for patients with advanced cancer in acute hospitals. During the past decade, hospitals have demonstrated improvements in symptom management of patients with advanced cancer, but there are still deficits in the attention paid to the psychosocial needs of the patient and family. Family members have reported dissatisfaction with the hospital staff 's communication skills. Hospital staff members are more likely to be regarded by family members as busy, and the hospital atmosphere as less family-like.

The extent to which families in acute care settings are able to communicate effectively with staff has not been well described. In one of the earliest studies conducted in this area, Wright and Dyck reported that in their study, 49% (n = 45) of the family members of patients with cancer had difficulty obtaining adequate information from professionals. Among the specific concerns mentioned were difficulties obtaining concrete answers from doctors, problems associated with contacting doctors, and dissatisfaction with receiving information by telephone or finding out about the patient's daily progress from nurses. Bond reported that an unfamiliar physician usually imparted information to family members, and that one third of the family members he surveyed were not satisfied with the information exchange. In a second study conducted by Bond, 75% (n = 107) of family members reported having no contact with nurses and indicated that they had to initiate communication. Nurses were described as hesitant to disclose information, and one half of the families were not satisfied with these communication exchanges.

According to Northouse and Northouse, a major obstacle to information access is the limited contact that families have with health professionals because of the timing of hospital visits and the family's lack of confidence in initiating communication. These researchers report that in most instances the onus is on the family to seek information, and that some family members feel awkward about approaching a busy doctor for information that may already have been given to the patient. Because of these difficulties in accessing staff, family members rely on second-hand information obtained from the patient or other members of the family. This makes it difficult for them to seek clarification, entertain correct assumptions, or develop rapport with health professionals.

Although nurses identify honest communication as an important factor in the effective provision of family-centered palliative care in a hospital, little research has been undertaken to articulate the components of this communication. Most research so far has been conducted with North American populations. The extent to which these communication issues apply within an Australian cancer care context is uncertain.

Little work has been done to provide a detailed examination of difficulties acute care nurses have in communicating with families of patients who have advanced cancer. Therefore, this study aimed to articulate communication issues, potential barriers, and possible strategies associated with nurse-family interactions in an Australian advanced cancer care setting.