Ethical perspectives in communication in cancer care: An interpretative phenomenological study

Oncology residents' experiences of decision-making in a clinical learning environment: a phenomenological study

Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility.

Lack of Awareness, Body Confidence and Connotations of Sex: An Interpretative Phenomenological Analysis of Barriers Affecting the Decision to Attend Initial Cervical Cancer Screening

This study sought to understand how cervical cancer screening (CCS) awareness, sexual connotations and body image influenced the likelihood of CCS uptake in women yet to attend. Eleven females, aged 23–24, yet to attend CCS, were purposefully sampled. Interview transcripts were analysed using interpretative phenomenological analysis, generating three superordinate themes: (1) building screening expectations, (2) confronting sexual connotations and (3) growing pains. Findings demonstrated how a lack of awareness of CCS and the sexual connotations implicit in CCS acted as a barrier to attendance, exacerbated by negative body image comparisons between oneself and online or social media-based images. The perceived sexual connotations of CCS, and the resulting embarrassment, bolsters the case for self-screening, removing the need to attend clinic screening appointments. Reconceptualising screening using a theoretical model of the relationship between body image disturbances and body-focused screening behaviours among women, could lead to the development of pro-screening social media interventions.

Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members

BACKGROUND

Oncology healthcare professionals (HCPs), particularly nurses, experience moral distress. However, little is known about the impact of moral distress on oncology teams.

OBJECTIVES

The purpose of this study was to describe moral distress as it is experienced by oncology teams in practice.

METHODS

32 oncology team members participated in eight focus groups. Content analysis was used to identify key themes. Two investigators collaboratively analyzed the data, and findings were independently reviewed by two additional investigators.

FINDINGS

The following six themes emerged.

The Importance of Spirituality for Women Facing Breast Cancer Diagnosis: A Qualitative Study

Breast cancer remains significantly distressing and produces profound changes in women’s lives. Spirituality is an important resource at the time of diagnosis and treatment decisions. This qualitative study aimed to explore the spiritual experience of women diagnosed with breast cancer and the considerations of spirituality in health care using the existential phenomenology approach. The sampling procedure was intentional, based on the study’s exclusion and inclusion criteria. Forty women participated in individual interviews. The research was conducted in the outpatient clinic of a reference federal university hospital in South-Eastern Brazil. Throughout the research process, ethical principles were carefully followed. Five themes were identified: (1) meaning of spirituality–source of spiritual strength, (2) well-being in the relationship with God, (3) well-being in religious fellowship, (4) values and purpose of life–meaning in life, and (5) spirituality as a foundation to continue. Respect for patient’s spiritual values was recognised as a fundamental principle in health care. Spirituality was revealed as a source of support during the complex process of being diagnosed with breast cancer. Thus, health care professionals that value and encourage spirituality are needed, favouring better patient response to the diagnosis.

Discussing Prognosis with Empathy to Cancer Patients

PURPOSE OF REVIEW

Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy.

RECENT FINDINGS

First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.