Nurses’ responses to older cancer patients’ cues.

Jansen, J., Weert, J. van, Dulmen, S. van, Heeren, T., Bensing, J.M. Nurses’ responses to older cancer patients’ cues. Psycho-Oncology: 2007, 16(9, suppl.), p. S2. Abstract. 9th World Congress International Psycho-Oncology Society, Londen, 16-20 september 2007
PURPOSE: Fulfilling cancer patients informational and emotional needs is a key factor in reducing stress and assisting recovery, and might be even more important in an aging population. The current study investigates how older cancer
patients attempt to gain informational and emotional support by using verbal cues and how oncology nurses respond to these cues. In addition, it investigates the relationship between patients’ cues and providers’ responses on the one hand and sociodemographic factors and consultation length on the other hand. METHODS: We have analysed
the actual communication between nurses and patients aged 65 years and older with heterogeneous cancer in 100 videotaped educational sessions in preparation of chemotherapy treatment. Independent observers used an adaptation of the Medical Interview Aural Rating Scale (MIARS) to rate the number of informational cues (medical, practical or lifestyle questions) and emotional cues (rated on a level from 1 to 3). Providers’ responses to cues were categorized as facilitating-, neutraland inhibiting behaviours. RESULTS: Preliminary results of 33 video-observations showed that older
cancer patients gave an average of 16.1 information cues per consultation and only 3.5 emotional cues. Nurses responded adequately to the majority of the informational cues (70%), but almost 25% of the responses were rated as inadequate (e.g. inappropriate or too little information). Around a quarter (23%) of the emotional cues were followed
by an inhibiting response. Nurses responded to one third (32%) of the emotional cues by giving a minimal response such as back channelling (mmm, yeah) or showing short agreement. Cues were often acknowledged (32%) but nurses rarely explored cues (7%) or showed other more explicit facilitative responses. Data analysis is still in progress, but will be finished at the time of the conference. CONCLUSIONS: The findings will provide knowledge about older patients’ emotional and informational cues during education about chemotherapy treatment and how this relates to nurses’ communication styles and patient characteristics. RESEARCH IMPLICATIONS: This is one of the first studies that investigates how older cancer patients express their emotional and informational needs through the use of cues and how nurses respond to these needs. The results indicate that the sequential observations as defined in the observation
scale are appropriate to establish providers’ specific styles of responding. Further exploration of this method is commended. Additional research is also recommended to determine the effectiveness of responses types in terms of outcome measures. CLINICAL IMPLICATIONS: Training nurses to recognise and respond appropriately to older
patients’ needs is an important task to improve (the outcomes of) communication for both nurses and patients. The findings of this study provide a sound basis to teach the essential skills of good communication with older cancer patients, i.e. adequate responses to cues and concerns. The practical implications will be discussed during the
presentation. (aut. ref.)