The nurse-patient communication process: Cancer pain and pain management

Abstract

Purpose. Explore how nurses and patients talk about cancer pain management during an oncology clinic visit. Describe the elements of these interactions and the patient-researcher discussions in order to evaluate the communication process used to report pain and to plan pain management. Design. Exploratory design of nurse-patient oncology clinic interactions and patient-researcher discussions. Methods. Nurse participants completed (1) a questionnaire about clinic time spent with patients and (2) Ward's Barrier Questionnaire (BQ) which concerns beliefs about the use of analgesics. Patient participants also completed a questionnaire about pain and Ward's BQ. Nurse-patient clinical interactions were audio-taped and analyzed by means of narrative analysis. Post-questionnaire patient-researcher discussions were analyzed also by narrative analysis. Quantitative data analysis was conducted on data from the questionnaires. Findings. Audio-taped nurse-patient interactions were divided by theme grouping into four summary examples: (1) Beginning to want to put it all together (56%), Communicating personal uniqueness (22%), (2) Active patient participation (13%), and (3) Learning about tests for future treatment (9%). Analysis revealed that while over 60% of the participants reported to be presently in pain, pain and pain management were rarely mentioned during the interactions. Patients did talk about pain extensively during the post-questionnaire discussions. Conclusions. Narrative analysis of nurse-patient interactions can provide health care professionals with examples of the quality and extent of information that cancer patients need regarding pain management. Not enough attention is given to patients' pain reports in the planning of pain management. Without systematic study of patients' pain reports and patients' comments on the effectiveness of analgesics, oncology clinic pain management will continue to remain inadequate.