Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses

Although high quality professional-patient communication is recognized as fundamental to effective cancer care, less attention has been paid to developing an evidence basis for communications surrounding the stage of the cancer journey when primary cancer treatment concludes, management responsibilities shift from oncology specialist services into the generalist care domain, and the patient transitions beyond patienthood and into survivorship. Using applied qualitative methodology, we analyzed a database of multiple interviews with 14 Canadian cancer patients from a larger study of changing communication needs and preferences across the cancer trajectory. Through constant comparative analysis, we generated a thematic summary of interpretive understandings from the patient perspective of communication patterns across the transition from active treatment to survivorship. The accounts illuminate the complexities of the communication environment in which the transition to survivorship occurs. Communication gaps and misinterpretations by clinicians contributed to the confusion, insecurity, vulnerability, loss, and abandonment associated with this transition when they failed to accurately and sensitively respond to individual conditions. Despite increasing recognition of the importance of this transition, communication gaps occur in relation to attending to cues, giving prior warning, avoiding avoidance, sensitivity to context, managing relationships, surfacing anxieties, and clarifying roles and responsibilities. These findings expand upon previous reports to explain mechanisms whereby interactions between clinicians and patients may significantly shape the transitional experience and set the stage for survivorship. From the perspective of cancer survivors, the transition beyond initial treatment warrants well-informed anticipatory and supportive healthcare communications.