A qualitative multiple case study investigating information exchange at lung cancer consultations

Abstract

Background: Effective information exchange is an asset to effective lung cancer care. Although a considerable body of evidence informs the approaches to ‘diagnostic bad news delivery’, the exchange of information that takes place between patients with cancer and professionals with whom they interact thereafter is less well documented. Information exchange has an influential role throughout the lung cancer care continuum, providing patients and professionals with details relative to the cancer diagnosis and the subsequent choices to be made in its management. Information on disease extent, treatment and related side-effects, rehabilitation and prognosis are judged by patients as the most prominent for them. Despite awareness of the specific categories relevant to information exchange needs, there is little evidence available exploring the information exchange process, per se, within cancer generally and even less within the lung cancer context.

Aim: To investigate information exchange processes during lung cancer consultations, specifically exploring information content which is both exchanged and not exchanged.

Design: Qualitative, multiple case study design.

Methods: A case centred on a patient with lung cancer. Within the case were the patients, the health professionals they consulted with and accompanying companions. Seven cases were recruited, which included 12 companions. Data were collected in outpatient clinics between 2010 and 2011. Data were digital recordings of consultations; debrief interviews immediately post-consultation and later in-depth patient interviews. All interviews were transcribed and analysed for pattern matching and coding.

Findings: Analysis of categorical data indicated cases were typical of the Scottish lung cancer population across all demographic domains, accept age and performance status. The preliminary analysis showed across cases, almost universal satisfaction with the level and content of information exchange for the main a priori categories of diagnosis, treatment and treatment outcome. Substantive analysis revealed that information content across the a priori categories was influenced by the presence of the accompanying companion. Within the clinical consultation, companion influence on information exchange was shown to be mediating, moderating or neutral. A key finding which emerged showed companion accompaniment to be a negotiated process, with three identifying levels of accompaniment. Non-negotiated companion presence at the clinic was associated with influential and expert companions who significantly moderated the content, direction and flow of information exchange, using the constructs of companion control, companion agenda and companion as expert. Persuasive influences further shaped non-negotiated accompaniment and were identified as demographic characteristics and relationship alliances. Patient and professional perspective regarding companion accompaniment was shown to be discordant.

Conclusions: The level of negotiated companion presence at lung cancer clinics has direct implications for clinical care. There needs to be greater understanding among professionals of ways in which information exchange can be influenced by companions.