Investigating interactions: how do doctors and patients experience the disclosure of significant information in the advanced cancer setting and how do these experiences enhance practice?

Furber, Lynn (2010) Investigating interactions: how do doctors and patients experience the disclosure of significant information in the advanced cancer setting and how do these experiences enhance practice? PhD thesis, University of Nottingham.

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Abstract

This thesis focuses specifically on the transmission of bad news from doctors to patients and their families in the context of a hospital oncology department. It uses awareness context theory as a basis for exploring communication between patients and health care professionals, particularly when the information to be disclosed is sensitive and will have a significant bearing on how people perceive their future. In order to enhance clinical practice, senior health care professionals in particular, have in the past been encouraged through government policy and professional legislation to attend communication skills courses to develop the way they communicate and interact with patients. Yet, in spite of these interventions evidence suggests that doctors and other health care professionals still find it difficult to negotiate sensitive and emotionally challenging discussions, and frequently question whether or not patients are aware and understand the information disclosed to them and whether or not information provided meets the needs and expectations of patients.

The premise of this research is that more attention needs to be given to how other more reflective and experiential professional development approaches and techniques might help doctors communicate better with their patients when disclosing sensitive information and bad news. In order to do this however, a better understanding is needed about what is going on in consultations and how each of the individuals involved experience and make sense of these interactions. It is proposed that in order to understand ‘resulting interactions’ more fully it is necessary to explore and compare the multiple perspectives of doctors, patients and others; including relatives and nurses. This thesis seeks to do this in an innovative way by reporting research, which involved observing and recording consultations between doctors and patients and their relatives and then conducting in-depth interviews with such people in order to explore their own insights into this process. In total, 115 episodes of data were collected and analysed from 16 patients and 16 doctors.

The insights gained from this study are presented in relation to two main analytic themes; Doctors and Patients Acting their Parts, and Sharing Uncomfortable News. The data analysis highlighted a number of approaches used by patients and doctors to manage and control their interactions within the medical consultation. The implications of the study findings are discussed in relation to both wider theoretical perspectives and ideas for how doctors working in such settings could be assisted to consider alternative strategies for these aspects of their work.

Item Type:Thesis (PhD)
Supervisors:Cox, K.
Murphy, R.J.L.
Faculties/Schools:UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
ID Code:1641
Deposited By:Dr Lynn Furber
Deposited On:01 Mar 2011 14:46
Last Modified:01 Mar 2011 14:46

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