Professor Phyllis Butow
Optimising Health Professionals’ Skills when
Communicating and Interacting with Patients
The University of Sydney
School of Psychology
Communication in nursing care
Phyllis Butow
Centre for Medical Psychology
an...
The University of Sydney
School of Psychology
Why is nurse communication
so important?
• Nurses often first people to beco...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
The University of Sydney
School of Psychology
Communication: Good clinical practice
Optimal health care
Technical care:
Ph...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
• Communication reduces...
The University of Sydney
School of Psychology
Communication reduces distress
and aids recovery
A review of 34 controlled t...
The University of Sydney
School of Psychology
Communication reduces distress
and aids recovery
• Effective communication l...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
• Communication can inf...
The University of Sydney
School of Psychology
Burnout in Australian nurses
• 243 oncology/haematology nurses working in 11...
The University of Sydney
School of Psychology
Communication a major factor in stress
• Feeling unhappy with communication ...
The University of Sydney
School of Psychology
Reducing stress and burnout
• Guidelines for the recognition, prevention, an...
The University of Sydney
School of Psychology
Reducing stress and burn-out
• Set personal limits both for time and for ene...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
• Communication can inf...
The University of Sydney
School of Psychology
Nurses find communication challenging
• Lubbers and Roy reported that
• 37% ...
The University of Sydney
School of Psychology
What do nurses find challenging?
• Survey of 350 oncology nurses in a major ...
The University of Sydney
School of Psychology
What’s hard?
1. Handling requests for euthanasia or
assisted suicide
2. Conf...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
• Communication can inf...
The University of Sydney
School of Psychology
Audiotape studies show deficits
• Nurses have been found to block patients’ ...
The University of Sydney
School of Psychology
Barriers to effective communication
• Lack of time
• Insufficient training
•...
The University of Sydney
School of Psychology
Why focus on communication?
• Good clinical practice
• Communication can inf...
The University of Sydney
School of Psychology
Communication skills training
• Recent review identified 14 studies evaluati...
The University of Sydney
School of Psychology
Impact on patients?
• Only 3 studies have looked at impact on patients
• In ...
The University of Sydney
School of Psychology
Communication skills training
• 24 nurses randomised to intervention or stan...
The University of Sydney
School of Psychology
What is effective communication
in nursing practice?
• 25 cancer patients, 6...
The University of Sydney
School of Psychology
Patient Centred Care
• Understanding the patient as a unique human being
• U...
The University of Sydney
School of Psychology
Model of ideal nursing care
Pt characteristics
• Age
• Gender
• Education le...
The University of Sydney
School of Psychology
Our work
• Reviewing the chemotherapy education session for two aspects of p...
The University of Sydney
School of Psychology
Coding
• Emotion focused coding
• Information focused coding
• Coders traine...
The University of Sydney
School of Psychology
Emotion-focused coding
• The Verona Coding of
Emotional Sequences
for Cues a...
The University of Sydney
School of Psychology
Emotion focused coding:
Cues and Concerns
 Cue: “a verbal/non-verbal emotio...
The University of Sydney
School of Psychology
Emotion focused coding:
Providing and reducing space
• Providing space
– Ack...
The University of Sydney
School of Psychology
Research Questions
 Do nurse responses to patient-cues influence patients’
...
The University of Sydney
School of Psychology
Nurse demographics (n=19)
Characteristics n (%)
Age: mean (range) 35 yrs (24...
The University of Sydney
School of Psychology
Participant demographics (n=67)
Characteristics N (%)
Age: mean (range) 55 y...
The University of Sydney
School of Psychology
Patient disease characteristics
Cancer Primary Site
30%
12%
22%
8%
2%
10%
2%...
The University of Sydney
School of Psychology
Cancer treatment details
N (%)
Chemotherapy intent
first line
adjuvant
neoad...
The University of Sydney
School of Psychology
Results
• Mean duration of chemotherapy education sessions:
33.5 min (7.5 - ...
The University of Sydney
School of Psychology
Result: predictors of cues
Simultaneous regression analysis, predictors of a...
The University of Sydney
School of Psychology
Result: Emotional wellbeing
Simultaneous regression analysis, predictors of ...
The University of Sydney
School of Psychology
Discussion: predictors of cues (1)
 More distressed ≠ more cues
- Consisten...
The University of Sydney
School of Psychology
Discussion: predictors of cues (2)
 “More space provided”  less cues
 Not...
The University of Sydney
School of Psychology
Discussion (3): Emotional wellbeing
 “More space provided” ≠ better emotion...
The University of Sydney
School of Psychology
Information coding
Preliminary Results
(n=67 patients)
The University of Sydney
School of Psychology
Information Sources
n (%)
Sources of Information*
Nurse
Doctor
Friends
Famil...
The University of Sydney
School of Psychology
Information discussed – Mean totals
67
12
23
34
0
10
20
30
40
50
60
70
80
To...
The University of Sydney
School of Psychology
Information discussed - side-effects
0.0
1.0
2.0
3.0
4.0
5.0
6.0
B
one
M
arr...
The University of Sydney
School of Psychology
Recommendations discussed
0
1
2
3
4
5
6
7
8
9
Report
SE
M
outh
Bone
M
arrow
...
The University of Sydney
School of Psychology
Australia vs Netherlands - demographics
Australia
N = 67
Netherlands
N = 69
...
The University of Sydney
School of Psychology
Australia vs. Netherlands
0
10
20
30
40
50
60
70
80
90
Total Background & Si...
The University of Sydney
School of Psychology
Information recalled – (Australia)
13
1
0
11
0
2
4
6
8
10
12
14
Total Recall...
The University of Sydney
School of Psychology
Australia vs. Netherlands
information recalled
0
2
4
6
8
10
12
14
16
18
Tota...
The University of Sydney
School of Psychology
Information given
• Wide range of information items discussed
• More discuss...
The University of Sydney
School of Psychology
Limitations & Future research
 Limitations:
- A relatively small sample  g...
The University of Sydney
School of Psychology
In the future…
• No-one has explored nurse communication in the highly
charg...
The University of Sydney
School of Psychology
Communication – So important, and a
lot more to learn!
Upcoming SlideShare
Loading in...5
×

Too often we underestimate the power of a touch, a smile, a kind ...

652

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
652
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Too often we underestimate the power of a touch, a smile, a kind ...

  1. 1. Professor Phyllis Butow Optimising Health Professionals’ Skills when Communicating and Interacting with Patients
  2. 2. The University of Sydney School of Psychology Communication in nursing care Phyllis Butow Centre for Medical Psychology and Evidence-based Decision-making (CeMPED) University of Sydney
  3. 3. The University of Sydney School of Psychology Why is nurse communication so important? • Nurses often first people to become aware of important issues affecting patient care; otherwise unaddressed – pain, treatment side effects, new symptoms, patient uncertainties, questions about procedures, emergence of depression and anxiety • Pt education usually by nurses, where communication vital • 90% of all observed communication with the health care team initiated and concluded by a nurse! Close A. Patient education: a literature review. J Adv Nurs. 1988;13:203-213. Gott M. Speak to me nurse. Nursing Mirror. 1982; 154(1): ii-vi.
  4. 4. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice
  5. 5. The University of Sydney School of Psychology Communication: Good clinical practice Optimal health care Technical care: Physical diagnosis, Treatment Psychosocial care: Interactional skills / Gathering / Transferring information Donabedian, 1988
  6. 6. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice • Communication reduces distress and improves other patient outcomes
  7. 7. The University of Sydney School of Psychology Communication reduces distress and aids recovery A review of 34 controlled trials showed information and emotional support led to: – faster recovery amongst patients (average two days reduction in hospitalisation) – greater cooperation with treatment – fewer post-hospital complications & events Mumford et al, 1982
  8. 8. The University of Sydney School of Psychology Communication reduces distress and aids recovery • Effective communication leads to better patient: – understanding – coping – satisfaction – Improved psychological wellbeing Psychosocial Clinical Practice Guidelines for Adults with Cancer NBOCC / NHMRC 2003 e.g. Women who felt poorly informed twice as likely to be depressed at 12 months (Fallowfield et al, 1990)
  9. 9. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice • Communication can influence distress and other patient outcomes • Communication can influence health professional outcomes
  10. 10. The University of Sydney School of Psychology Burnout in Australian nurses • 243 oncology/haematology nurses working in 11 Queensland health care facilities • Over 70% experienced moderate to high levels of emotional exhaustion • Over 48% of the sample could not commit to remaining in the specialty for a further 12 months Barrett L. Yates P. Australian Health Review. 25(3):109-21, 2002.
  11. 11. The University of Sydney School of Psychology Communication a major factor in stress • Feeling unhappy with communication has been linked to stress and burnout in health professionals 1. Escot C, Artero S, Gandubert C, Boulenger JP, Ritchie K. Stress levels in nursing staff working in oncology. Stress Health. 2001;17(5):273Y279. 2. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996;347(9003):724Y728.
  12. 12. The University of Sydney School of Psychology Reducing stress and burnout • Guidelines for the recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer: • Report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Spinetta et al. Medical & Pediatric Oncology. 35(2):122-5, 2000
  13. 13. The University of Sydney School of Psychology Reducing stress and burn-out • Set personal limits both for time and for energy • Engage in staff socials at work when feasible • Where possible, help achieve closure by attending funerals or post-death meetings with family • Keep communication lines open with colleagues and patch up minor differences as they occur • Attend communication skills workshops
  14. 14. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice • Communication can influence distress and other patient outcomes • Communication can influence health professional outcomes • Health professionals express a need
  15. 15. The University of Sydney School of Psychology Nurses find communication challenging • Lubbers and Roy reported that • 37% of nurses felt inadequately trained in communication skills while in nursing school. • 55% of nurses reported there were few continuing education opportunities available for skill development in any type of communication Lubbers CA, Roy SJ Communication skills for continuing education in nursing. The J Continuing Educ Nurs.1990; 21(3): 109-112.
  16. 16. The University of Sydney School of Psychology What do nurses find challenging? • Survey of 350 oncology nurses in a major cancer center in Texas. Given 33 items and asked to rate difficulty. Sivesind D, Parker PA, Cohen L, et al. Communicating with Patients in Cancer Care; What Areas Do Nurses Find Most Challenging? J Cancer Educ 2003;18(4): 202-209.
  17. 17. The University of Sydney School of Psychology What’s hard? 1. Handling requests for euthanasia or assisted suicide 2. Confronting a colleague about undesirable behaviour 3. Having several dying patients in your practice at once 4. Managing clinical situations that pose ethical dilemmas 5. Dealing with families who are in conflict about treatment decisions 6. Setting limits with patients who demand too much time 7. Managing overprotective families 8. Intervening with family members who are angry 9. Intervening with patients in denial 10. Setting boundaries when families have unrealistic expectations 11. Intervening with a patient who is angry 12. Intervening with family members in denial 13. Managing your own stress level (balancing home and work life) 14. Handling the sudden unexpected death of a patient 15. Dealing with the economic impact cancer has on patient and family 16. Intervening when a co-worker shows signs of depletion and depression. 17. Addressing sexual concerns 18. Discussing DNR (do not resuscitate)
  18. 18. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice • Communication can influence distress and other patient outcomes • Communication can influence health professional outcomes • Health professionals express a need • Audits show deficits
  19. 19. The University of Sydney School of Psychology Audiotape studies show deficits • Nurses have been found to block patients’ expression of emotional distress and to make use of distancing techniques to avoid emotionally difficult communication with patients Booth K, Maguire PM, Butterworth T, Hillier VF. Perceived professional support and the use of blocking behaviours by hospice nurses. J Adv Nurs. 1996;24(3):522-527. Wilkinson S. Factors which influence how nurses communicate with cancer patients. J Adv Nurs. 1991;16(6): 677-688.
  20. 20. The University of Sydney School of Psychology Barriers to effective communication • Lack of time • Insufficient training • Fear of “opening the pandora’s box” • Fear of causing damage
  21. 21. The University of Sydney School of Psychology Why focus on communication? • Good clinical practice • Communication can influence distress and other patient outcomes • Communication can influence health professional outcomes • Health professionals express a need • Audits show deficits • Communication skills training may help
  22. 22. The University of Sydney School of Psychology Communication skills training • Recent review identified 14 studies evaluating communication skills training for cancer nurses. • Training associated with increased: – nurse control in the interview – use of emotional words – use of open directive questions – coverage of patients’ problems – empathy – confidence in communication skills Kruijver IP, Kerkstra A, Francke AL, Bensing JM, van de Wiel HB. Evaluation of communication training programs in nursing care: a review of the literature. Patient Educ Couns. 2000;39(1):129-145. And decreased stress!
  23. 23. The University of Sydney School of Psychology Impact on patients? • Only 3 studies have looked at impact on patients • In two studies, small effects on patient anxiety and satisfaction with care were found • A recent study (Rask et al, 2009) evaluated training • Two 2-day sessions over 8 weeks • Covered: – psychological reactions to somatic disease – building and structuring an encounter – basic communications skills – encouraging disclosure of patients’ concerns – breaking bad news – engaging in other difficult conversations • Roleplays, theoretical presentations, video demos, group discussions. feedback on videotaped patient consultation
  24. 24. The University of Sydney School of Psychology Communication skills training • 24 nurses randomised to intervention or standard care • 413 patients pre and post training • No training effect on patient perception of nurse empathy and attentiveness • No training effect on patients’ anxious/depressed, angry, or positive mood, or cancer-related self-efficacy. • Conclusions? Training needs to better target what patients need and expect from nurses, and the specific communication interactions nurses have with patients. Rask MT, Jensen ML, Andersen J, Zachariae R. Effects of an Intervention Aimed at Improving Nurse-Patient Communication. Cancer Nursing, Vol. 32, No. 1, 2009
  25. 25. The University of Sydney School of Psychology What is effective communication in nursing practice? • 25 cancer patients, 6 advocates and 20 cancer nurses interviewed about their lived experiences of receiving and providing quality nursing care. • 6 attributes of quality nursing care identified: – being valued – being respected – being cared for by communicative and supportive nurses – being confirmed – being cared for religiously and spiritually – belonging Charalambous A. Papadopoulos IR. Beadsmoore A. Towards a theory of quality nursing care for patients with cancer through hermeneutic phenomenology. European Journal of Oncology Nursing. 13(5):350-60, 2009
  26. 26. The University of Sydney School of Psychology Patient Centred Care • Understanding the patient as a unique human being • Using the patient's knowledge and preferences to guide the interaction • Viewing the patient's illness through the patient's own eyes • The Picker/Commonwealth Program for Patient Centered Care identified 7 dimensions: – Respecting patients' values, preferences, and expressed needs – Coordinating and integrating care – Effectively providing information, communication, and education – Ensuring patient is physically comfortable – Providing emotional support and alleviation of fear and anxiety – Involving family and friends – Ensuring effective transition and continuity of care • Later addition: – Ensuring access to reliable care NRC/Picker : Our philosophy–eight dimensions. Available at: http://www.nrcpicker.com/Measurement/Understanding%20PCC/Pages/default.aspx
  27. 27. The University of Sydney School of Psychology Model of ideal nursing care Pt characteristics • Age • Gender • Education level Patient-centred nursing • Responsiveness • Individualization • Co-ordination • Proficiency Nursing focused health care system characteristics • Nurse-physician collaboration • Nurse control over nursing practice • Patient advocacy • Nursing expertise • Nurse time per patient Patient state characteristics • Acuity • Illness severity •Desired Desired health outcomes • Trust in nurses • Sense of well-being • Authentic self-representation • Optimism and fortitude Radwin LE. Cabral HJ. Wilkes G. Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system. Research in Nursing & Health. 32(1):4-17, 2009
  28. 28. The University of Sydney School of Psychology Our work • Reviewing the chemotherapy education session for two aspects of patient centred care: Information provision and Responsiveness to emotion • H Dhillon, J Janson, M Oguchi, RM Devine, J Jacquet, K Cox, B Colagiuri, Tan J, Butow P. • Chemo education sessions in two hospitals audio-recorded, transcribed and coded in various ways • Any patient, any stage, first-time chemo • Patients complete questionnaires before and 2-6 weeks after the session – Demographics – QLQ-30 (quality of life – physical and emotional) – Recall of information
  29. 29. The University of Sydney School of Psychology Coding • Emotion focused coding • Information focused coding • Coders trained by expert collaborator from Holland • Inter-rater reliability high
  30. 30. The University of Sydney School of Psychology Emotion-focused coding • The Verona Coding of Emotional Sequences for Cues and Concerns (Verona-CoDES-CC) and health care providers’ responses (VERONA-CoDES-P) Figure 1: Categorisation of nurses’ response to cue/concerns (based on VERONA-CoDES-P) PS RS Del Piccolo Let al. Coding of health provider talk related to cues and concerns (VERONA-CoDES-P). 2009. (Accessed at http://www.each.nl) Del Piccolo L et al. Verona coding definitions of emotional sequences (VR-CODES): Cue and concern manaual. 2009. (
  31. 31. The University of Sydney School of Psychology Emotion focused coding: Cues and Concerns  Cue: “a verbal/non-verbal emotional hint which suggests an underlying unpleasant emotion and would need a clarification from the HP” - e.g. “I don’t have a very long attention span these days” - “My head is full”  Concern: “a clear and unambiguous expression of an unpleasant current or recent emotion where the emotion is explicitly verbalized..” - e.g. “That’s what I worry about, I’m not very good with vomiting”
  32. 32. The University of Sydney School of Psychology Emotion focused coding: Providing and reducing space • Providing space – Acknowledge – Empathise – Explore – Be silent • Reducing space – Ignore – Block – Postpone – Focus on information giving
  33. 33. The University of Sydney School of Psychology Research Questions  Do nurse responses to patient-cues influence patients’ QoL (emotional wellbeing)?  What influences patients’ (family) cue expressions? - e.g. type of response, patients’ emotional state etc..  More specifically: - More distressed  more cues? - More space given for cues  more cues? - More space given for cues  better emotional wellbeing?
  34. 34. The University of Sydney School of Psychology Nurse demographics (n=19) Characteristics n (%) Age: mean (range) 35 yrs (24-60) Female 15 (70) Born in Australia 11 (55) English-primary language 15 (75) Education University/College Post-graduate 13 (65) 6 (30) Oncology certificated 7 (35) Months in working oncology: mean (range) 69 (9-340) Months in current role: mean (range) 15 (2-48)
  35. 35. The University of Sydney School of Psychology Participant demographics (n=67) Characteristics N (%) Age: mean (range) 55 yrs (38-69) Female 46 (69) Married 47 (70) Children 54 (81) Education < Grade 12 Grade 12 University/College Post-graduate 19 (28) 16 (246) 27 (50) 4 (6) Time since diagnosis: mean (range) 17 months (1-264)
  36. 36. The University of Sydney School of Psychology Patient disease characteristics Cancer Primary Site 30% 12% 22% 8% 2% 10% 2% 14% Breast Colorectal Lung Prostate Upper GI Gynaecological Haematological Other
  37. 37. The University of Sydney School of Psychology Cancer treatment details N (%) Chemotherapy intent first line adjuvant neoadjuvant 22 (33) 35 (52) 4 (6) Prior surgery 45 (67) Prior radiotherapy 6 (9) Prior endocrine therapy 1 (2)
  38. 38. The University of Sydney School of Psychology Results • Mean duration of chemotherapy education sessions: 33.5 min (7.5 - 88.3) SD: 17.4  Family or friends present in 67% of consultations
  39. 39. The University of Sydney School of Psychology Result: predictors of cues Simultaneous regression analysis, predictors of average patient cues/concerns expressed Average patient cue b SE  p Family attendance -3.136 1.011 -.386 .004** Duration (mins) .045 .035 .169 .208 Colorectal vs Other^ 4.817 1.384 .440 .001** Baseline EF .004 .018 .025 .835 Proportion of PS responses -3.303 1.619 -.258 .049* Note. SE indicates standard error; b baseline EF ** Significant at p<.01; * significant at p<.05 ^ Dummy coded with breast cancer as the reference group i.e. More distressed ≠ more cues More space provided  less cue
  40. 40. The University of Sydney School of Psychology Result: Emotional wellbeing Simultaneous regression analysis, predictors of follow-up EF score Average follow-up EF b SE  p Baseline EF .510 .122 .627 .000** Proportion of PS responses .480 10.535 .007 .964 Note. SE indicates standard error; b baseline EF ** Significant at p<.001 i.e. More PS responses ≠ better emotional wellbeing
  41. 41. The University of Sydney School of Psychology Discussion: predictors of cues (1)  More distressed ≠ more cues - Consistent with a study of genetic counseling for breast cancer (Duric et al., 2003), but not previous studies in primary care (Del Piccolo et al., 2000; 2005; 2007)  Possible explanations: - Cancer patients tend to perceive distress as unavoidable (Maguire,1985; Labrecque et al.,1991) less likely to seek help? - Feel not appropriate to discuss “emotions” in education sessions?  Implication: - Can’t rely on patients to raise emotional concerns, need to directly ask
  42. 42. The University of Sydney School of Psychology Discussion: predictors of cues (2)  “More space provided”  less cues  Not in line with previous findings: - more exploration/acknowledgement  more cues (Duric et al., 2003; Uitterhoeve et al., 2007)  Possible explanations: - Again, patients feeling emotion not appropriate in education session? - Feel heard so less cues?  Implication: - NOT a reason for ignoring emotions - Perhaps patients need to be explicitly given permission to discuss concerns in this setting?
  43. 43. The University of Sydney School of Psychology Discussion (3): Emotional wellbeing  “More space provided” ≠ better emotional wellbeing  Differs from a previous study: - Higher empathetic response  lower levels of depression (Duric et al., 2003)  Possible explanations: - Insensitivity of measures? - Too long between education session and follow-up assessment (2-6 weeks)  Implication: - NOT a reason for ignoring emotion! - Overwhelmingly, literature supports empathy
  44. 44. The University of Sydney School of Psychology Information coding Preliminary Results (n=67 patients)
  45. 45. The University of Sydney School of Psychology Information Sources n (%) Sources of Information* Nurse Doctor Friends Family Internet Television Newspaper 46 (90) 45 (88) 33 (65) 22 (43) 15 (29) 6 (12) 4 (8) * Participants recorded all relevant options, there may be more than 1 response per participant
  46. 46. The University of Sydney School of Psychology Information discussed – Mean totals 67 12 23 34 0 10 20 30 40 50 60 70 80 Total Total. Background Total. Side Effects Total. Recommendations Information Category Number
  47. 47. The University of Sydney School of Psychology Information discussed - side-effects 0.0 1.0 2.0 3.0 4.0 5.0 6.0 B one M arrow S kin N ausea & V om it H air Loss G en W ell-being M outh S tools G eneral N erve/M uscle S afe H andling A ppetite & Taste S ex C ardiac Em otional B reathing Side effects Number
  48. 48. The University of Sydney School of Psychology Recommendations discussed 0 1 2 3 4 5 6 7 8 9 Report SE M outh Bone M arrow SafetyH air LossN auseaD rinking G en W ellBeing Skin Stool Eating Sex N erve/M uscle D ietEye/EarEm otion Appetite & Tast D aily LivingBreathing Category of recommendations Number
  49. 49. The University of Sydney School of Psychology Australia vs Netherlands - demographics Australia N = 67 Netherlands N = 69 Age: mean (range) 55 (38 - 69) 72 (65 - 85) Female 46 (69) 21 (30) Married 47 (70) 52 (75) Education Low Middle High 19 (28) 16 (24) 31 (46) 32 (46) 15 (22) 22 (32) Tumour Site Breast Lung Gastro-Intestinal Gynaecological Other 21 (31) 16 (24) 12 (18) 6 (10) 13 (29) 6 (9) 16 (23) 30 (44) 3 (4) 14 (20)
  50. 50. The University of Sydney School of Psychology Australia vs. Netherlands 0 10 20 30 40 50 60 70 80 90 Total Background & Side- effects Total Recommendations Information Discussed Number Australia n=63 Netherlands n=69
  51. 51. The University of Sydney School of Psychology Information recalled – (Australia) 13 1 0 11 0 2 4 6 8 10 12 14 Total Recall General Information Side Effects Recommendations Information Category Number 1/5 items recalled, primarily recommendations
  52. 52. The University of Sydney School of Psychology Australia vs. Netherlands information recalled 0 2 4 6 8 10 12 14 16 18 Total Recall General Information Side Effects Recommendations Information Recalled Number Australia Netherlands Similar proportion recalled
  53. 53. The University of Sydney School of Psychology Information given • Wide range of information items discussed • More discussion about the immediate, high impact physical side- effects and how to manage them • Less discussion about later, sexual, and psychological effects • We give less information than Dutch nurses, and our patients recall less, but they do recall more about management – more important?
  54. 54. The University of Sydney School of Psychology Limitations & Future research  Limitations: - A relatively small sample  generalisability? - Audio-recording  limited access to the non-verbal aspects  Ongoing work: - Recruitment continuing to achieve larger sample in more sites - Analyse information and emotional responses together to see how they interact - Explore whether what you say and the way you say it influences recall, trust in the nurse, satisfaction, and experience of side effects - Explore radiotherapy education
  55. 55. The University of Sydney School of Psychology In the future… • No-one has explored nurse communication in the highly charged situations they find most challenging: – Handling requests for euthanasia or assisted suicide – Confronting a colleague about undesirable behaviour – Having several dying patients in your practice at once – Managing clinical situations that pose ethical dilemmas – Dealing with families who are in conflict about treatment decisions
  56. 56. The University of Sydney School of Psychology Communication – So important, and a lot more to learn!
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×