Researchers interviewed nurses and patients about the challenges related to communication after the patients undergo surgery for head and neck cancer.
People who have undergone surgery for head and neck cancer may often experience difficulties with very basic things such as chewing, swallowing or speaking.
Surgery may also change their appearance, and they may experience emotional effects in addition to physical problems.
The Danish Health Authority therefore recommends that people with head and neck cancer be invited to rehabilitation consultations, in which their needs are assessed and they may be supported by such professionals as psychologists, speech therapists or speech-language pathologists.
In a new study, researchers identified the challenges that can arise during the typical interaction between nurses and patients after the patients undergo surgery for head and neck cancer. Although the consultations aim to help patients, the process does not always run smoothly.
“After surgery, a patient’s physical, functional, mental and existential challenges and problems should be assessed. In Denmark, this is done through three consultations after surgery, and my colleagues and I investigated what happens in these consultations. We carried out this qualitative study to get a better understanding of the challenges that may occur and how both patients and nurses think about this interaction,” explains a researcher behind the study, Annelise Mortensen, nurse and PhD, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen.
The research has been published in the European Journal of Oncology Nursing.
Fifteen nurse–patient interactions analysed
Annelise Mortensen observed 15 interactions between patients and four nurses.
The patients had all undergone surgery for head and neck cancer and were offered three consultations after surgery: before discharge; 7–10 days after surgery; and 2 months after surgery.
Annelise Mortensen and colleagues also interviewed individual patients to explore their perspectives and interviewed nurses in a focus group to explore their perspectives on the consultations.
“I asked what the patients thought about the consultations and whether they actually experienced being involved actively in the consultation. I also asked the nurses about their experiences,” says Annelise Mortensen.
Consultations without any predetermined expectations
The results show that the nurse–patient interactions are often not as smooth as hoped for.
The initial problems comprised differences in expectations because the nurses entered the consultation with an idea of what to say, what to ask and what to suggest to the patients.
“The patients may not be nearly as prepared and do not have the same expectations. They do not know what they are getting into and what to expect. Some think that this is just fine, whereas others think that the nurse’s questions are basically invading their privacy,” explains Annelise Mortensen.
Establishing good interaction is complex
Another finding is that nurses may feel challenged in building rapport with patients.
The nurses are responsible for building rapport, and they must create a framework of trust and confidentiality so that the patients feel secure about answering difficult questions.
“Many nurses find this challenging. They admit that they do not explain frequently enough why they are asking the various questions. The questions may be obvious to the nurses but may not be to the patients. This presents a challenge in the consultations,” says Annelise Mortensen.
Difficult to identify and discuss sexual problems
Annelise Mortensen also found that nurses often experienced barriers to asking the difficult questions.
The nurses may feel barriers to asking questions about the patients’ mental health or sexual problems. This can also apply to existential challenges.
“The nurses may find this challenging. Asking questions about physical needs such as voice training or difficulty swallowing are clearly easiest for them. This is by the book. We can see it in the records and can do something about it. Asking about the less obvious things that can still be challenging for the patients is considerably more difficult,” explains Annelise Mortensen.
Difficulty discussing smoking
Finally, the nurses also often had difficulty asking patients about their diet, smoking, alcohol consumption and physical activity.
Denmark’s health authorities require that nurses ask about these topics in consultations with patients.
Questions on diet are relatively easy because these are often related to patients’ problems with chewing and swallowing food.
Smoking and alcohol consumption are more difficult. Smoking and excessive alcohol consumption are risk factors for head and neck cancer, and the nurses think that they have to be careful in asking questions about these habits, since smoking and alcohol do not cause all cases of head and neck cancer.
“So the nurses tiptoe round the subject before they ask these questions. However, the patients did not remember at all that the nurse asked these questions. This is a clear challenge in the consultations,” says Annelise Mortensen.
However, Annelise Mortensen also says that even though both nurses and patients identify problems in the consultations, they generally work out really well, and the patients think that they are useful.
“One of the patients said that he thought the whole consultation was based on the terms of the healthcare system, yet he thought that was okay, because he did not know what to ask anyway,” explains Annelise Mortensen.
Difficult questions may need to be taken up during separate interviews
Annelise Mortensen explains that the perspectives in the study are that some sort of assessment instruments may have to be used more extensively to better equip the nurses to conduct the interviews and ask the difficult questions.
One possibility is using a computer programme to ask the questions.
Another option is to have a more relaxed approach to the discussions at the three official consultations.
“The research also showed that patients may experience information overload. One idea is to decide together with the patients which information they want and when they would like it in relation to their surgery. These are some of the things we consider doing,” concludes Annelise Mortensen.