Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer

BMC Palliative Care, vol. 20, pp. 142

Abstract

BACKGROUND: There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists' and patients' views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy. METHODS: Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software. RESULTS: Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients' unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more. CONCLUSIONS: Integrating oncologists' and patients' views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate - tailored - information-provision, leading ultimately to patient-centered care lying at the heart of medicine.

Authors 7

1. Liesbeth Mirjam van Vliet corresponding Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University Leiden Institute for Brain and Cognition

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands. l.m.van.vliet@fsw.leidenuniv.nl

   Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands. l.m.van.vliet@fsw.leidenuniv.nl

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

2. Maartje C. Meijers Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

3. Sandra van Dulmen

   Radboud University Nijmegen · University of South-Eastern Norway · Radboud University Medical Center · Netherlands Institute for Health Services Research · Radboud Institute for Health Sciences

   Affiliation as printed

   Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands

   Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway

   Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands

4. Elsken van der Wall

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

5. Nicole Plum

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

6. Jacqueline M. Stouthard

   The Netherlands Cancer Institute

   Affiliation as printed

   Netherlands Cancer Institute, Amsterdam, the Netherlands

7. Anneke L. Francke

   Netherlands Institute for Health Services Research · Amsterdam Public Health · Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands

   Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands