Achieve Equity in Patient Communication With These Evidence-Based Approaches

The research team, which included ONS members and nurse scientists Timiya S. Nolan, PhD, APRN-CNP, ANP-BC, and Rachel Hirschey, PhD, RN, conducted a systematic literature review (https://doi.org/10.1188/22.ONF.509-524) to assimilate the evidence for factors that affect interpersonal nurse-patient communication. A total of 24 published articles met the study’s inclusion criteria: (a) sample population with a cancer diagnosis of any kind, (b) information for Black or African American participants, and (c) information on patient-clinician communication.

Factors That Promote Positive Patient-Provider Communication

It's About Building Relationships, Not Just Communicating: All of the studies in the researchers’ literature review identified the patient-provider relationship as a key component of communication (https://doi.org/10.1188/22.ONF.509-524) and many of them indicated a need for improvement.

Relationships Are Built on Mutual Trust: Trust is the foundation for positive and effective communication. The studies demonstrated (https://doi.org/10.1188/22.ONF.509-524) that when Black patients with cancer trust clinicians, they are more active in conversations and seek additional information. However, several studies reported a lack of trust between clinicians and Black patients in their patient populations.

Apply That Trust to Shared Decision-Making: Multiple studies found that (https://doi.org/10.1188/22.ONF.509-524) most patients rely on their clinicians to provide them with information for effective decision-making, yet Black patients consistently receive less information compared to White patients.

Don’t Underestimate the Influence of Social Determinants of Health: Low literacy levels, low economic status, cultural perceptions of cancer, and a provider’s own race or ethnicity all affected the patient-provider relationship (https://doi.org/10.1188/22.ONF.509-524) in the studies included in the literature review.

Actively Approach Patient Communication With These Strategies

“For a multitude of reasons, nurses are ideally positioned to work for equitable outcomes among all patients with cancer,” the researchers said (https://doi.org/10.1188/22.ONF.509-524). They advised beginning by actively addressing the patient-reported topics of concern they discovered (https://doi.org/10.1188/22.ONF.509-524) during their literature review:

• Psychosocial needs: Black patients with cancer need more psychosocial support from their clinicians, particularly when they are actively seeking to understand their cancer situation.
• Diagnosis, treatment options, and side effects: Black patients with cancer desire more information about their prescribed treatments, treatment and disease side effects, and long-term care coordination. They also want to understand what caused their cancer, including genetic factors (https://www.ons.org/learning-libraries/precision-oncology).
• Health behaviors: Black patients lack clinician-provided information about improving their diet and physical activity (https://www.ons.org/courses/incorporating-physical-activity-cancer-care) and follow-up care to prevent cardiovascular complications.
• End-of-life care: Black patients require more information about hospice and advance care planning, and they prefer that their providers initiate those conversations.
• Family and community: Black patients perceive the cancer experience through the lens of prior cancers in family and friends, and they rely heavily on their community for health information. Religious and spiritual beliefs also shape their cancer perspective.

“As the most trusted profession, nurses can lead the way in rebuilding the healthcare system to be trustworthy,” the researchers wrote (https://doi.org/10.1188/22.ONF.509-524). “These efforts will take time and dedication from nurses and should include empathetic curiosity, learning focused on the injustices patients face, engagement with communities, self-reflection, and cultural humility.”

They added that (https://doi.org/10.1188/22.ONF.509-524) their findings “point to the need for a person-centered approach, which can be guided by transcultural nursing theory, highlighting the understanding and respect of a patient’s culture as foundational to meeting a patient’s needs.” They recommended that nurses consider using the Transcultural Assessment Model (https://doi.org/10.1188/22.ONF.509-524), which includes assessments for:

• Communication (e.g., between the patient or family, language, body language, vernacular language, slang)
• Space (e.g., nonverbal communication)
• Social organization (e.g., how the patient or family views themselves within the culture of religion, values)
• Time (e.g., the patient’s or family’s view of time)
• Disease environment control (e.g., whether the disease was placed by a deity, whether they can use an environmental cure)
• Biologic variations (e.g., genetic variations that may affect a specific cultural group)

The researchers concluded by (https://doi.org/10.1188/22.ONF.509-524) calling for increased nursing advocacy and additional studies to “identify and test multilevel strategies that oncology nurses can use to promote health equity for all patients through individual, interpersonal, and systems-level change.”