Communicating with Patients with Cancer

Ayman Mansour RN, PhDFaculty of Nursing

University of Jordan

Outline

Communication and therapeutic skills

Psychosocial aspect of illness Communicating with cancer

patient

Definition

“all modes of behavior that one individual employs, conscious or unconscious, to affect another not only the spoken and written word, but also gestures, body movements, somatic signs and symbolism in arts”

Ruesch 1972

Types of Communication

Verbal - written & spoken messages exchanged in the form of words as the element of language

Nonverbal - messages that do not involve spoken/written word and are conveyed by behavior or through any of the five senses

90% of communication is thought to be nonverbal

Nonverbal cues should have congruence with the verbal message

Assessment of Communication

Includes analysis of how verbal and nonverbal modes are used to structure communication

What are the messages conveyed by each?

Are the messages congruent?

To what extent are stereotypes about the self/others conveyed by the structure of the client’s communication?

How does the structure of the client’s communication contribute to the problem (s) for which help is sought?

How can I become a good communicator? Feedback: e.g., the patient is telling the nurse about his

pain, the nurse replied“if I understand you correctly, you have pain in

your lower abdomen every time you move you left leg”

* Then the patient can agree or correct the patient.

How can I become a good communicator?

Appropriateness:

The message fit the circumstances

A; how are you?

B: fine.

How can I become a good communicator?

Efficiency:

Simple clear words

Nurse to patient “tomorrow you will have a procedure where a balloon is threaded into an artery and inflated to open up the vessels so more blood can flow through”

How can I become a good communicator?

Flexibility:

Making communication based on immediate situation rather than perceived expectations

The nurse enter the patient’s room to give him a medication and teach him about the side effect. The nurse found the patient crying.

“ the nurse to be flexible to deal with the patient feeling rather than what she came for”

Therapeutic Communication

Occurs between the nurse and the client but it is client focused

It is a learned skill involving both verbal and nonverbal communication

The purpose is to promote client growth Involves the disclosure of personal

information by the client

Therapeutic Techniques

Introducing self– Enables client to meet nurse

Offering self– The nurse offers his or her presence, interest,

and desire to understand without making any demands on the patient.“We can sit here quietly; there’s no need to

talk unless you want to.”

Therapeutic Techniques

Active Listening– Utilizing both verbal and nonverbal skills

that show the client that the nurse is attentive to what is being saidFacing client; maintaining eye contact;

“Go on, I hear what you are saying.”

Therapeutic Techniques

Stating Observations– Nurse offers a view of what is seen

or heard to increase verbalization“I see you are quite anxious.”“You keep rubbing you forehead;

are you in discomfort?”

Therapeutic Techniques

Summarizing– A concise review of the main ideas

that have been discussed– Allows clients to sense whether the

nurse understood their message“From what you describe, your

family seems….”

Therapeutic Techniques

Focusing– Focuses on a subject until the important

points come into clear view for both the client and the nurse“You touched on his drinking. Tell me

more about that.”

Therapeutic Techniques

Role Playing– The nurse plays the part of a person the client needs to say

something to “Let’s go over what you want to say to her.”

Confronting– The nurse supports the client but directly challenges

inaction on the part of the client “You keep telling me that you want to quit drinking, but what

actions have you taken thus far to aid with your sobriety?”

Non-therapeutic techniques

Reassuring Giving approvalRejectingDisapprovingAdvisingChallengingDefending

Dysfunctional Communication

Acting on assumptions without validation Assuming that…..

others share your perception

your perceptions won’t change

your perceptions are complete

others know how you think or feel Decision-making by power Stereotyped phrases Sending mixed messages

What is special about CANCER

life threatening situation Clients diagnosed with cancer experience

distress Nurses are there 24/7 Communication is The Most important

aspect of nursing care

Two types of communication

1. Instrumental behavior: informing patient about the disease and treatment and providing care such as:

Orientation and instruction about the unit, hospital

asking for clarification, understanding and opinions

nursing and medical topics Expressions about lifestyles

Two types of communication

2. Affective behaviors: showing respect, giving comfort and trust, showing understanding such as:

Personal and social conversation (jokes, laughs, approval, compliments)

Showing concern and empathy Reassurance/ encouragement Showing agreement and understanding

important for building trust relationship

help patient to disclose information and concerns related to their confrontation with a life threatening disease. )

Negatives

Overwhelming patient with information about the disease and medications.

Not establishing what patient understands about his illness.

Overwhelming patient with physical care and treatment problems

Using close questions not being able to assess problems of concern to patient

Not being able to get patient disclose feelings

Negatives leads to imbalance in nurse communication ------leading to ----- patient dissatisfaction and view nurse as unsupportive especially if no attention paid to emotional problems

What studies found about nurse cancer patient relationship

Nurse exhibit more negative features than positive The cancer patient is willing to explore concerns if

the nurse is willing to listen and explore these concerns

The more the nurse show empathy the more the patient disclose concerns

Patient discloser is strongly inhibited by nurse’s avoidance behaviors (abrupt and change subjects, ignoring the patient)

Why?

Because discussing emotional issues is difficult

Unease experience especially with cancer patient in terminal stages

Nurse tend to use distancing tactics (afraid of loosing control over the situation if they became close to patient).