1. Communicating with Patients with Cancer
Ayman Mansour RN, PhD
Faculty of Nursing
University of Jordan

2. Outline Communication and therapeutic skills
Psychosocial aspect of illness
Communicating with cancer patient

3. 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

4. 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

5. 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?

6. 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?

7. 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.

8. How can I become a good communicator?
Appropriateness:
The message fit the circumstances
A; how are you?
B: fine.

9. 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”

10. 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”

11. 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

12. 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.”

13. 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.”

14. 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?”

15. 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….”

16. 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.”

17. 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?”

18. Non-therapeutic techniques
Reassuring
Giving approval
Rejecting
Disapproving
Advising
Challenging
Defending

19. 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

20. 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

21. 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

22. 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

23. important for building trust relationship
help patient to disclose information and concerns related to their confrontation with a life threatening disease. )

24. 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

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

26. 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)

27. 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).