Communicating with older cancer patients: impact on information recall

Abstract

The central aim of this thesis was to unravel the relationship between patient characteristics, communication between patient and clinician, and subsequent patient information recall in the context of medical consultations with older cancer patients. Chapter 2 reviewed the literature to explore age differences in cancer patients’ need for information and support surrounding cancer treatment. The results indicated that older patients prefer to receive information about the most important aspects of their illness and treatment, but are relatively less interested in all the details. Furthermore, older patients have less prominent needs for psychosocial support than younger patients. In Chapter 3, we assessed to what extent age influences communication between cancer patients and their oncologist and determined the influence of chronological age, other age-related factors and communication on patients’ recall. The results showed that recall decreased with age, but only when the total amount of information presented and the consultation length were taken into account. Recall was also influenced by prognosis in two ways. Firstly, patients with a poorer prognosis recalled proportionally less. Secondly, the more information that was provided about prognosis, the less information patients proportionally recalled, regardless of their actual prognosis. In Chapter 4 we developed a questionnaire to measure older cancer patients’ recall of information after a patient education session, conducted by nurses preceding chemotherapy. Since our study was the first to investigate recall of this type of consultation, no existing questionnaire was available that suited our aims. The results showed that older cancer patients were confronted with a large amount of detailed information and recommendations (on average 82 items) and had marked difficulties actively recalling the information (23% for open-ended questions), whereas recognition memory was relatively good (80% for multiple-choice questions). Sensitive responses to cancer patients’ emotions and needs for information (‘cues’) have been associated with improved outcomes such as reduced distress. We looked at these responses in relation to recall in Chapter 5. We found that the expression of neither emotional cues nor informational cues influenced recall. The way in which nurses responded to informational cues did not influence recall either. In contrast, recall was affected by responses to emotional cues. When nurses used minimal encouragements, such as ‘Hmmm’ or ‘Go on’, in response to an emotional cue, patients recalled more. Distancing responses, such as ignoring the cue, resulted in lower recall scores. Older cancer patients are more commonly accompanied to the consultation. These companions may enhance communication thereby increasing the patients’ recall. Furthermore, companions may remember different information. In Chapter 6 we investigated recall of information in unaccompanied and accompanied older cancer patients and their companions. The results revealed that pooled recall in patient and companion couples was higher than their separate recall scores, indicating that the older cancer patient and their companion supplement each other. Combined recall in the patient-companion dyad was also significantly higher than recall in unaccompanied patients for absolute scores but not for proportion of information recalled. Nurses discussed more information when companions were present and accompanied consultations were longer in duration.