Communicating with Patients with Cancer Ayman Mansour RN, PhD Faculty 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 said Facing 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 approval Rejecting Disapproving Advising Challenging Defending

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 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).