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Factors Influencing Communication Between the Patients with Cancer and their
Nurses in Oncology Wards

Article  in  Indian Journal of Palliative Care · March 2014

DOI: 10.4103/0973-1075.125549 · Source: PubMed

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Original Article

Factors Influencing Communication Between the Patients

with Cancer and their Nurses in Oncology Wards
Vahid Zamanzadeh, Maryam Rassouli1, Abbas Abbaszadeh2,
Alireza Nikanfar3, Hamid Alavi‑Majd4, Akram Ghahramanian2
Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, 1 Nursing and Midwifery School,
Shahid Beheshti University of Medical Sciences, Tehran, 2 Nursing and Midwifery School, Kerman University of
Medical Sciences, Kerman, 3Hematology and Oncology Research Center, Tabriz University of Medical Sciences,
Tabriz, 4Para Medicine School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Address for correspondence: Dr. Akram Ghahramanian; E‑mail: [email protected]

ABSTRACT

Aims: The purpose of this study was to demonstrate the factors influencing nurse‑patient communication in
cancer care in Iran.
Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in
oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi‑structured deep
interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness
of data analysis was evaluated by the participants and external control.
Results: The main theme of the research emerged as “three‑factor effects” that demonstrates all the factors
related to the patient, nurse, and the organization and includes three categories of “Patient as the center of
communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two
sub‑categories of “Imposed changes by the disease” and “the patient’s particular characteristics”. The second
category includes sub‑categories of “sense of vulnerability” and “perception of professional self: Pre‑requisite
of patient‑centered communication”. The third category consists of the sub‑categories of “workload and time
imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”.
Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the
communication.
Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of
the care environment are essential. Nurses must receive proper trainings which meet their needs and which
focus on holistic and patient‑centered approach.

Key words: Cancer, Effective factors, Nurse‑patient communication, Oncology

INTRODUCTION providing quality nursing care. Researches on nursing

care often complain about poor relationship,[1‑5] and
Relationship with the patient is the major component patients often feel health care personnel do not meet all
of nursing care. In fact, along with other organizational their communicative needs. According to the Research
factors, it would help to build a positive relationship Center for Quality Care, 10.8% of patients believe that
between nurse and patient. Furthermore, it helps in caregivers sometimes or never listened to them carefully,
do not explain things clearly, they do not respect what
Access this article online patients say, and do not spend enough time with them.[6]
Quick Response Code: Because of asking questions or expressing their concerns,
Website:
www.jpalliativecare.com
some patients have to face with inappropriate behavioral
reactions of caregivers. Gaps in communication between
caregivers and patients result in decreased quality of
DOI:
10.4103/0973-1075.125549 care, poor outcomes, and dissatisfaction with health
care system.[7]
12 Indian Journal of Palliative Care / Jan-Apr 2014 / Vol-20 / Issue-1
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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

Nurses play a major role in cancer care, because cancer nursing care. Moreover, increasing level of education,
nursing not only focuses on the biological and medical patient’s expectations, and more familiarity with his/her
aspects of care, but also on the emotional aspects. Therefore, rights causes the patients to demand more authority and
such care requires a comprehensive understanding of the effectiveness in their communications with the caregivers.
patient.[8] As cancer care is affected by factors related to Communication gap is one of the reasons for the
the patient and organizational factors,[9] this leads to many dissatisfaction of patients in the country.[17]
communicative problems experienced by nurses that
consequently leads to excluding patients from sharing To improve health care and reduce patients’ dissatisfaction,
their concerns with them.[10] In other words, the roles the factors that affect communication between nurses and
of patients and caregivers in influencing communication patients must be identified and taken into account, also
processes are equally important.[11] Moreover, factors response to all communication needs of patients should be
such as the competence of nurses in communication provided.[18] Therefore, this study was conducted with the
skills, training programs to improve the nurse‑patient aim of exploring the factors influencing the communication
relationship, task‑oriented view, insufficient skills in between cancer patients and their nurses.
providing psychological aspects of care for patients who are
living in difficult emotional situations, seeking information
by patients and having a role in caring themselves and that MATERIALS AND METHODS
they do not want to talk about the disease and their feelings
in such cases have been mentioned.[12] In this study, in order to explore participants’ experiences
of factors influencing communication, qualitative content
Studies show that nurses often fear from situations when analysis approach was used. Participants (nine patients,
patients express emotions that they are unable to manage. three family members, and five nurses) were chosen based
Therefore, through changing discussions, they prevent on purposive sampling and saturation principles using the
patients from expressing their concerns. In most cases, the following inclusion criteria for patients: 1) They should be
emotional issues are not being selected as the main topic; at least 20 years old, and 2) they should not be suffering
instead, they tend to provide information and practical from mental disorders according to their records. The
care. In fact, these barriers lead to inadequate emotional inclusion criteria for family members were: 1) They should
support for patients.[5,12,13] Fakhr‑Movahedi et al. studied be at least 20 years old, and 2) they should have experience
the nurse ‑ patient relationship in Iran and showed that of accompanying patient during hospitalization; the criteria
factors such as organizational factors, culture and tradition, for nurses were: 1) At least one year of nursing experience
expectations from nurses, and heavy workloads can limit in oncology unit, and 2) a minimum of a bachelor’s degree
the time allocated to communicate with patients and reduce in nursing. This study was conducted in two main oncology
the effectiveness of communication.[4] centers in Tabriz that include Ali‑Nasab Hospital and
Shahid Ayatollah Qazi Tabatabaee hospital.
In addition, although nurses’ communication behavior,
including friendly personality, kindness, quick response, and The data were collected during the months of  May to
timely attending to the needs of patients, allocating sufficient December 2012 using semi‑structured and in‑depth
time to provide care could improve communication with individual interviews. All interviews were audiotape‑recorded.
the patient, heavy workload and shortage of nurses, are In‑depth individual interviews were performed in an isolated
common problems that are prevalent in the training room for the participants’ comfort. The interviews that
hospitals of Iran, which could potentially affect this lasted between one and two hours started with general
behavior.[14] On one hand, it should be noted that facilities questions but progressively, questions became more detailed
for palliative care in cancer in Iran are currently limited to pertinent to the study. For example, “What experience do
only a few centers in major cities, and as a result, referring you have in communication with cancer patients? What
patients with a variety of needs and concerns increases are your experiences of nurses’ communication with you?
the workload in oncology units.[15] On the other hand, How nurses act for you?” In case of need, the researcher,
the number of nurses in the country has not reached the with follow‑up questions, asked participants to express
standard that it can influence the quality of nursing care experiences, memories, and more description of their
and effectiveness of communication with patients.[16] understandings of what they say. Natural behaviors and
Cancer care system is based on the biomedical model patient‑nurse interactions were observed in the environment,
and the unwillingness to allocate authority to the patient and field notes were prepared in the same environment as
for clinical decision making affects the patients, share in well. It means that notes recorded interaction of nurses

Indian Journal of Palliative Care / Jan-Apr 2014 / Vol-20 / Issue-1 13

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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

with patients during nursing care, chemotherapy, or bone patient and the caregiver, always this kind of communication
marrow biopsy. was being affected strongly by three factors that were related
to the condition of patient, the nurse, and the organization.
The researcher transcribed the interviews and field notes In this theme, the three categories which emerged affect
verbatim and read them all several times to obtain full communicative performance of nurses were: Patient as the
understanding of the data. Whole interviews and field center of communication, nurse as a human factor, and
notes were contemplated as units of analysis. Words, organizational structures [Table 1]. These categories explain
sentences, and paragraphs considered as the meaning units the underlying psychosocial and cultural factors influencing
were condensed according to their content and context. nurse–patient communication in oncology care environment.
The condensed meaning units were abstracted and labeled
with codes. Codes were sorted into subcategories and The patient as the center of the communication
categories based on comparisons regarding their similarities
This category refers to the particular characteristics of the
and differences. Finally, a theme was formulated as the
patient and the changes that the disease and its long‑term
expression of the latent content of the text.[19]
treatment impose on the patient and his/her family. These
changes made communication with patients particularly
The Research Council and Ethics Committee affiliated
important.
to Kerman University of Medical Sciences approved the
study proposal (with No K.91.125). The aims of the study Changes imposed by the disease
were explained in detail to the participants. The following
Cancer and treatments such as mastectomy and chemotherapy
information was given to the participants: The voluntary
cause severe appearance changes in patients. In addition,
nature of the participation, their right to privacy, anonymity,
change of patients’ self‑image has more effect on mood in
and confidentiality as well as right to withdraw from the
young patients, particularly females. In such circumstances,
study at any time without any penalty. The participants
it is essential that nurses consider gender differences, needs,
then signed an informed consent form. During observation
and problems of patients in communication. These changes
sessions, informed consent was obtained dynamically and
cause the patient to be deprived of the support of his/her
continuously from both nurse and patient.
family or his/her spouse.
To increase the validity of the data, the codes were compared,
“Participant 2 (nurse): Females have different problems; we
and the differences were discussed and re‑evaluated in group
saw that when their appearances change, their husbands
research, until shared codes and categories were created. avoid them….they do not contact easily, they become
In addition, parts of two interviews that converted to text apathetic to our recommendations….”
had been sent to two expert researchers in the qualitative
research on cancer. The agreement between the external The change in appearance was much stressful for patients,
coders with codes of researchers was measured using Holsti which caused an increase in their emotional needs. In other
method,[20] which was an average of 78%. words, preparing the patients by the nurse before the onset
of these changes would be helpful.
RESULTS “Participant 4 (patient): The first time of chemotherapy,
I had a great fear, the mouth sores, hair shedding,… the
All the nurses participating in the study had a bachelor
degree, and their work experiences in oncology unit ranged
from a year and half to 29 years. There was just one male. Table 1: Categories and sub‑categories in
Two of them were head nurses. The patients’ age ranged theme of three‑factor effects
Theme Category Sub‑category
between 20 and 59 years, and there were three females.
Three‑factor Patient as the center of Imposed changes by the disease
The patients were diagnosed with and were being treated effects communication Particular characteristics of patient
for leukemia, breast cancer, colon, lymphoma, sarcoma, Nurse as a human Perception of professional self:
stomach, and liver cancer. factor Pre‑requisite of patient‑centered
communication
Sense of vulnerability
Data analysis resulted in the emergence of the “three‑factor Organizational Workload and time imbalance
effects” theme. This theme suggests that despite the desire structures Impose duties in context of
of nurses and patients to establish a patient‑centered neglecting nurse and patient needs

communication regarding a particular condition of the Lack of supervision

14 Indian Journal of Palliative Care / Jan-Apr 2014 / Vol-20 / Issue-1

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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

nurse who had given me drugs talked to keep me calm, but “Participant 9 (nurse): In the active phase, patient tries to
I was still afraid of serum in the foil.” communicate with the nurse, he/she always asks questions
and requires information, but when they get discouraged
Sometimes patients showed reactions such as anger and of the treatment, they seek less information than before.
aggression in communication with nurses. In this phase, they should be supported emotionally more.”

“Participant 10 (nurse): When a number of periods pass Difference in languages is another effective characteristic
and they see there is no improvement, they become that plays a preventive role in communication. In such
depressed, which makes it hard to communicate with them. cases, using a third person who is familiar with the language
Because he/she thought that whatever had been done by of the patient and of the nurse was the only possible
you or the doctor was useless…” solution to break the language barrier in nurse ‑ patient
communication.
This condition caused nurses to limit verbal communication
with them and just to leave them alone in their world not “Participant 6 (relative): Well, my mother speaks Kurdish.
to be met with negative reactions of patients. Moreover, she is illiterate. Therefore, nurses cannot explain
to her what they mean. When I am here, I translate what
“Participant 13 (nurse): In some patients, because they were not nurses say to her into Kurdish.”
in the mood, we tried to make the least verbal communication
with them…when insisting on communication, they turned In terms of participants, another effective characteristic
aggressive.” was gender differences. In fact, male participants mention
it as a major barrier in communication. Our study showed
Emotional need of families of end‑stage patients substantially that unmarried young female nurses have difficulty in
increased, that they showed severe psychological reactions. communicating in a friendly manner with male patients.
Nurses tried to support them spiritually and emotionally to
prepare them for the upcoming eventuality. “Participant 11 (unmarried female nurse) in this regard
stated that: There have been times when I communicate
“Participant 13 (nurse): When a patient is ill or close to comfortably with a male patient and it brings problems.
death, his/her family showed violent reactions… cried, To me, communication is for facilitating curing, but the
made noise, I let them express their feelings. I consoled patient thinks something else. I try to limit contact with
them to trust in God…” young males.”
The particular characteristics of the patient Nurse as a human factor
Patients with higher education level asked more questions.
In addition, with increased awareness, adherence to This category deals with the personal, cognitive, emotional,
self‑care recommendations became more. and professional characteristics processed by nurses, which
affect the nurse‑patient communication.
“Participant 11 (nurse): Patients are not the same in terms
of awareness and knowledge. Even for patients with high Perception of professional self: Pre‑requisite of patient-centered
levels of education, they don’t get convinced with our communication
trainings and take the Internet to search for information. We To work and communicate effectively with patients
consider these situations to give appropriate trainings. For in oncology, nurses should have three characteristics
those with low‑level education, we try to provide them with as follows: Self‑confidence, holistic view, and expert
simple information about the disease and its complications.” knowledge. In fact, the presence of these characteristics
leads to the “perception of professional self ” in nurse that
Another particular characteristic is the stage of the disease. is effective in nurse‑patient communication.
Patients after passing the denial stage are more active in
terms of communication with nurses. However, when they Self‑confidence in nurses shows extent to which they
reach close to end stages, they often become depressed. are familiar with their roles and its influence in the
According to a number of participants, in the beginning consequences of cancer and its treatment. Some nurses in
stage, when patients became aware of the diagnosis and the present study had the view that doctors have towards
in the end stages as well, they had greater need for nurses caring. In other words, they measure the effectiveness of
and for their support. the work of a nurse by an increase in the patient’s longevity;

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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

they believed that because their work could not be effective it makes the nurse to limit his/her communication with
in curing the disease, then it doesn’t matter how they the patient.”
communicate with the patient. Lack of confidence caused
them to make technical aspects important and ignore the Nurses suffer from a sense of grief that afflicts them
effectiveness of nurse‑patient communication in improving following the death of patients. Long‑term relationships
the patient’s conditions. with their patients have brought up friendship and
familiarity, while the death of patient cuts friendship
“Participant 9 (nurse): I believe that whether the nurse between the patient and the nurse. Because of the fear
sympathizes with the patient or not, is kind or not, and so of being in a situation like this, nurses limit friendly and
on, he/she would get chemotherapy and eventually will die. intimate relationship with patients.
I could not postpone the patient’s death …”
“Participant 9 (nurse): Due to prolonged hospitalization
Holistic approach as a professional characteristic in nurses of patients when he/she died, it was hard for you to take
demands that they consider comprehensive roles for him/her out of your mind.… When a patient died, it was
themselves. In the present study, nurses mostly focus on just like that a friend has been dead. Because of this, some
care roles regardless the intellectual and emotional context nurses try not to be involved with patients emotionally.”
which care is provide.
Organizational structures
“Participant 6 (relative): Well, nurses emphasize more on
routine works; most of them just gave medications, check These factors in organizational context lead to reduction
blood pressure. Even during chemotherapy, they did not in quantity and quality of nurse‑patient communication
say anything or ask any questions…” and include the three sub‑categories.

Expert knowledge of nurses is essential to identify, to solve Workload and time imbalance
problems, and to enable patients through information. In The large number of patients, the unstable condition of
fact, the knowledge processed by a nurse leads the patient the patients as well as shortage of nurses would lead to
to develop trust in the nurse. imbalance between the workload and time for nurses that
caused extreme stress to the nurses and minimized the time
“Participant 11 (nurse): For effective communication with of interacting with patients and supporting them emotionally.
the patient, we should have more information. When a
patient sees that I have rich information and I answer “Participant 10 (nurse): Workload of oncology is horrible.
whatever he/she asks, then he/she feels can trust me. ” Due to the high workload, communications with patient
become less, often routine care is a priority, and there isn’t
Sense of vulnerability an opportunity to support the patient.”
Nurses described this characteristic as the feeling of
exposure to physical and psychological harm during Impose duties in context of neglecting nurse and patient needs
care and communication with patients with cancer. This Nurses participating in the study felt they were imposed
feeling stems from three beliefs including the impalpable in oncology and had to tolerate conditions that result
effects of chemotherapy drugs on the health of nurses, from organizational culture and lack of attention to the
transmission of depressed mood, and grief after death of personal and professional needs of them. However, nurse
patient. In light of this sense, their relationship was more managers acknowledge the hard work in oncology, but
of a superficial and non‑intimate communication, in which in conditions of overcrowding of patients, they impose
emotional issues were not being exchanged between the additional shifts to nurses. In this situation, there is a
nurse and the patient. reduction in the quality of care and communication with
patients, and the conflict between work and personal life
Nurses think that preparing chemotherapy drugs, close increases job dissatisfaction.
contact with people undergoing chemotherapy could affect
them with drug complications in future. “Participant 2 (nurse): Irritated behavior with patients,
especially in nurses who had been given forced extra shifts,
“Participant 9 (nurse): In the oncology unit, nurses is more common… Concern for her child… problems with
are much afraid of the side‑effects of chemotherapy, her husband… she is dissatisfied with her job… working
which in turn increases job dissatisfaction. In addition, with cancer patient has been regular for her/his…”

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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

One of the impositions was compulsory education, and it the complexity of communication in end‑stage patients.
was inconsistent with the nurses’ need. Nurses believed that Perhaps, so the literature indicates, in this stage of cancer,
the trainings provided do not prepare them to communicate patients are faced with unpleasant feelings and thoughts of
with the patients with cancer. death, and focus of health care providers must be shifted
to the relief of emotional distress.[9,21,23,24] Moreover, our
“Participant 9 (nurse): Here, managers hold courses about results showed that the appearance changes resulting from
communication with patient, but is communication really the disease and its treatment lead to weakening the patient’s
the same in oncology and general units?” mood, which make it difficult to communicate with them.
Understanding these changes and preparation of patient
The dominant culture among oncology nurses is routine- and family for dealing with these changes could reduce
oriented; it means that nurses due to the high workload, the severity of the patient’s emotional distress. In patients
limited time, and incomplete understanding of their with cancer, return to previous life is a dream, but when
professional roles, provide task‑oriented care rather than they realize that this would not happen, they are depressed.
holistic care. This situation could disrupt interactions with caregivers.[9]

“Participant 1 (relative): High workload does not justify Characteristics of the patients seemed to be an important
neglect of patients… They can communicate with patient influential factor on the communication, and the results
and listen to him/her during care… His spirit is more of the present research showed that information‑seeking
important than his/her body, but they just take care of differed from patient to patient depending on their
his/her body.” educational level and the disease stage and patients with
different conditions in terms of education level and stage
Lack of supervision of the disease demand different information and nurses
Patients expect the system have not supervision over work can provide appropriate information consistent with the
and communication of nurses. Surprisingly, nurses believed patient preferences and perception to gain the trust. Owen
that the system does not demand them to increase their and Jeffrey pointed out that the need and demand for
ability in communication with patients. In fact, it demands information differs in patients and depends on the patient’s
them to pass their shifts and to do their tasks that caused understanding of the issues and of his/her health literacy.[9]
nurses to be inclined to do dictated tasks that were ordered Fakhr‑ Movahedi et al. showed that information provision
by doctors. to patient influences on the nurse‑patient communication
and leads to building confidence in patients.[4]
“Participant 1 (relative): The system should provide more
supervision on the nurse’s behavior with the patients. In our study, more female patients mentioned different
The system should ask the nurse to strengthen his/her emotional needs than male patients. Moreover, the need for
communication with the patients…” emotional support was more expressed by young females.
The study of Wessels et al. also showed that among the
factors related to patient, gender is the most influential
DISCUSSION factor on patients’ preferences.[25] Studies showed that
females more than males prefer to receive psychosocial
This study aims to explore the factors affecting the support during communication.[26‑28] This is not restricted
communication between patients with cancer and nurses. to only patients, but family members are also affected by
This study indicates that the triangle of patient, nurse, and the disease. The need to support family members especially
organization can play a decisive role in the effectiveness of increases in the end stages of the disease, and if the family
this communication. Problems related to these three factors members were not supported in this situation, negative
have been stated in various studies.[1,4,5,10,12,21,22] psychological reactions of relatives such as stress, tension,
and worry will be transferred to the patient. This finding is
Our participants explain that the impacts of the disease on not consistent with results of Fakhr‑Movahedi et al., to be
the body, mind, and social life bring difficulties for them. precise; they mentioned that presence of family members in
In fact, paying comprehensive attention to these problems the wards prevents nurse‑patient communication.[4] Perhaps,
by nurses would facilitate communication process. The this difference is related to the setting of their study, which
result of McCabe’s study showed that considering the was restricted to medical‑surgical wards, where emotional
needs and problems of patients is a fundamental key in support to patients was not as important as it is in oncology
patient‑centered communication.[5] The findings indicated wards. In contrast, Park and Song found that for nurses,
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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

the absence of a family member as caregiver is the most patients in communication process. Systematic review of
important barrier in communication with patient.[29] Rchaidia et al. indicated according to the patients perception
that good nurses are characterized by professional and
The other characteristic influencing in our results was trained skills, specific nursing and non‑nursing knowledge,
language as the difference in language played a deterrent and support provision.[36] Such nurses increase confidence,
role in communication. A number of literatures,[1,4,29,30] hope, comfort, and safety in their patients.[36,37]
support our findings. In addition, gender differences
between patient and nurse prevents friendly relationship, For the nurses participating in the current study, psychological
which was expressed mostly by female nurses and male pressure of caring of patients who are suffering from cancer
patients participating in the research. In studies, patients’ was perceived as a factor influencing on the nurse‑patient
preference for receiving care from a nurse of the same communication. They mentioned the sense of vulnerability
gender was referred as a cultural issue. [1,4] From the as an effective factor on communication that could be
perspective of the people and health system managers, understood through a long‑term and friendly relationship
gender differences between patient and care providers is an with patient. Owen and Jeffrey believed that in long‑term
important cultural challenge in Iran because it’s a custom care of patients with cancer, nurses who share to patients’
in Iran that nurses are prohibited from touching or gazing distress in a close emotional connection with them, resulting
at patients of the opposite sex,[1] and the government has in the emotional involvement of nurses that is harmful
approved a plan to fit sex of health care providers with for them.[9] Rassouli et al. showed that fatigue in nurses
patients in 1998, but the shortage of nurses, especially working in oncology units is more related to emotional
male nurses has prevented its implementation.[31] Although factors.[38] Aycock and Boyle define this phenomenon as
in the current study, it was found that unmarried female compassion fatigue in oncology.[39] In addition, Anselm
nurses try to limit conversation with young male patients in et al. claim that under such psychological tension, caregivers
interactions with them, other studies have not mentioned are unable to communicate effectively.[40] According to the
about this finding that we found in religious background experiences of nurses participating in the study, traumatic
of Iran as a Muslim country. nature of work in oncology is related to death of patients
that occurs frequently. Other studies referred to the fear
Professional and psychological characteristics of the of death in oncology and its impact on communication
nurses were other influential factors on the nurse‑patient with patient.[9,10,12]
communication. According to our findings, the lack holistic
perspective among nurses inclined them towards doing Our research showed that in organizational dimension,
physician orders and physical care. Biomedical perspective factors such as time, workload, and imbalance between these
in nurses obstructs emotional support for the patient and two minimizes communication with patients. Furthermore,
holistic care in clinical situations. This perspective was Maguire et al. noted that crowded conditions increase
reflected in more attention of nurses to the technical pressure for caregivers and waiting time for patients. In
aspects of the caring and meeting physical needs of such situations, nurses do not have enough time to discover
patients. Study of Zamanzadeh et al. showed that patients concerns of patients.[41] This finding is consistent with other
with cancer and their nurses perceive physical aspects of studies that showed lack of time, heavy workload, work in
care more valuable than other aspects.[32] Sivesind et al. extra shifts, and fatigue in nurses hindered nurse–patient
study also indicated that nurses have less self‑confidence communication.[4,42] In contrast, the study of Chan et al.
in resolving non‑physical problems and responding to showed that nurses with integrating communication within
emotional needs of patients.[33] These results show that the routines that they tend to do, in practice prove that not
nurses have not yet moved toward a holistic view in practice only extra time is not needed to communicate with the
because a holistic nurse will be sensitive to the patient’s patients but also good communication is possible without
whole spectrum of needs.[34] Papathanasiou et al. mentioned wasting their time.[43]
that ineffective communication through health systems is
mostly derived from the biomedical view that has a negative According to the present research, imposed caring
effect on nursing care provision. This problem is rooted in duties in task‑oriented organizational context reduce the
the fact that the majority of nurses were graduated from communication with patients. Nurses participating in the
educational systems, which focus only on practical skills.[35] study believe that if their managers meet the need of nurses,
request them to do their all roles and monitor their work, all
In addition, our study showed that nurses who have needs of the patients will be attended by the nurses. Other
communication skills and knowledge gain the trust of studies have showed that task‑oriented approach results in

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Zamanzadeh, et al.: Factors influencing nurse‑patient communication in cancer care

regarding of many of the needs and problems of patients and professional problems. Furthermore, they must prevent
during communication.[1,5] Our findings demonstrated that burnout by balancing the workload and staffing. This
nurses’ tendency to perform dependent tasks, the shadow research was conducted based on the experiences of Iranian
of bio‑medical paradigm over care, and physician‑centered patients with cancer, their family members and the nurses,
system hindered patient‑centered communication. Study and according to a few studies in this area, it is necessary that
results indicated that nurses often focus on the physicians factors influencing nurse‑patient communication in other
orders instead of the patient’s needs and problems,[4,13] life‑threatening chronic conditions has to be researched.
and causes the patients to feel that the nurses’ duties and
physician orders have more importance than patients.
[5]
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