Explicit prognostic information and reassurance about nonabandonment when entering palliative breast cancer care: findings from a scripted video-vignette study
Related Experiment Videos
Liesbeth M van Vliet1, Elsken van der Wall, Nicole M Plum
1Liesbeth M. van Vliet and Jozien M. Bensing, Netherlands Institute for Health Services Research (NIVEL); Elsken van der Wall, Nicole M. Plum, and Jozien M. Bensing, Utrecht University, Utrecht, the Netherlands.
Purpose:
When discussing the transition to palliative care for patients with breast cancer, oncologists have to find a balance between giving explicit information while not overwhelming patients and being realistic while remaining hopeful. It is unclear whether patients prefer more or less explicit prognostic information, and reassuring patients that they will not be abandoned may provide realistic hope. We assessed the effect of explicit prognostic information and reassurance about nonabandonment at the transition to palliative care.
Patients And Methods:
An experimental 2 × 2 study was used. Four scripted videos of a bad news conversation were created that differed only in the level of "explicitness of prognosis" and "reassurance about nonabandonment" (high v low). Patients with and survivors of breast cancer (n = 51) and healthy women (n = 53) watched the video-vignettes. The effects of the different communications on participants' anxiety, uncertainty, self-efficacy, and satisfaction were assessed by using multilevel analyses that explored the moderating influences of monitoring/blunting scores.
Results:
The highly explicit/highly reassuring video yielded the most positive outcomes, and the less explicit/less reassuring video, the most negative (P ≤ .05 for all outcome measures except anxiety). The main effects found were that explicitness and reassurance decreased participants' uncertainty (P < .001 and P = .002, respectively) and anxiety (only after reassurance; P = .001) while increasing self-efficacy (P = .004 and P < .001, respectively) and satisfaction (P < .001 and P < .001, respectively). High monitors seemed least positive, mainly following explicitness.
Conclusion:
Explicit prognostic information may lead to better outcomes than general information. In addition, reassurance about nonabandonment might provide realistic hope but should be lived up to. More research is needed to translate these findings into clinical care.
Related Concept Videos
01:21Cancer Survival Analysis
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's cancer...
01:15Techniques of therapeutic communication I: Active Listening, Sharing Observations, Validation, and Using Touch
Therapeutic communication is not the same as social interaction. Social interaction has no goal or purpose and consists of casual information sharing, whereas therapeutic communication has a plan or purpose for the conversation. Therapeutic...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
01:25Continuing Care
01:24Nursing Process for Patient and Caregiver Teaching I: Assessment and Diagnosis
It is critical to determine the patient's learning needs during the assessment. Determination of learning needs compounds data from the...