Effective Communication for Preventing and Responding to Oncology Adverse Events

Cancer patients often experience problems in their care, many of which are caused by
communication breakdowns. Some communication breakdowns lead to adverse events and even
harmful errors. Deficiencies in provider-patient communication can compound patients'
distress, lower the quality of care, and disrupt patient-provider relationships. There is
little research on patients' and providers' experiences of the communication breakdowns that
precipitate adverse events and errors, or on effective responses to these events. Because of
this, cancer providers are unsure how to communicate with patients in these difficult
situations. The goal of the proposed study is to improve patient-centered communication
around adverse events and errors in cancer care. Our specific aims are: 1) To describe
patients' experiences with communication around adverse events and errors in cancer care, 2)
To describe providers' experiences and practices with communication around adverse events
and errors in cancer care, 3) To develop practical recommendations, provider training
materials and patient educational materials for improving communication around adverse
events and errors in cancer care, 4) To disseminate the recommendations and materials
through three health plans, and 5) To conduct a preliminary evaluation of the perceived
usefulness and impact of the materials. The investigators will first conduct interviews with
breast and colorectal cancer patients who have experienced adverse events or errors at 3
Cancer Research Network (CRN) health plans (Atlanta, Georgia; Seattle, Washington and
Worcester, Massachusetts). The interviews will focus on instances where patients believe
that better communication might have prevented an adverse event or error, or mitigated the
event's impact. Next the investigators will conduct focus groups to understand providers'
attitudes and experiences with these communication dilemmas, and use simulations to describe
providers' communication practices. Finally, the investigators will interview health plan
leaders to identify the systems factors that influence communication with patients around
adverse events and errors. These perspectives will be synthesized to create patient and
provider educational material for improving communication. Three advisory panels: a Patient
Advisory Panel, a Health Plan Advisory Panel and a Dissemination Advisory Panel (including
all 14 CRN health plans) will help create and disseminate these educational interventions.
Dissemination will occur at the three core clinical sites. The investigators use patient
and provider surveys to evaluate the educational materials' impact. This evaluation will
provide the evidence-base to refine the study products before widespread dissemination
throughout the CRN and beyond. The project will have the advantage of the CRN
infrastructure, the CRN Clinical Communication Research Center, and is led by nationally
recognized communication researchers.