Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-19T00:50:29.383Z Has data issue: false hasContentIssue false
  • English
  • Français

What symptoms tell us: A multiple case study of oncology consultations

Published online by Cambridge University Press:  11 September 2020

Céline Bourquin Open the ORCID record for Céline Bourquin [Opens in a new window]  and
Friedrich Stiefel
Céline Bourquin*
Affiliation:
Psychiatric Liaison Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
Friedrich Stiefel
Affiliation:
Psychiatric Liaison Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
*
Author for correspondence: Céline Bourquin, Service de Psychiatrie de liaison, Ave de Beaumont 23, Centre hospitalier universitaire vaudois, 1011Lausanne, Switzerland. E-mail: celine.bourquin@chuv.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

While patients’ symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach.

Methods

Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature.

Results

Patients’ symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential.

Significance of results

Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.

Keywords

CancerMultiple case studyPalliative patientQualitative researchSymptoms
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 4 , August 2021 , pp. 421 - 436
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akin, S, Can, G, Aydiner, A, et al. (2010) Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy. European Journal of Oncology Nursing 14(5), 400–409.CrossRefGoogle ScholarPubMed
Armstrong, TS (2003) Symptoms experience: A concept analysis. Oncology Nursing Forum 30(4), 601–606. doi:10.1188/03.ONF.601-606CrossRefGoogle ScholarPubMed
Barras, V and Louis-Courvoisier, M (Eds.) (2001) La Médecine des Lumières: Tout autour de Tissot. Geneva: Bibliothèque d'histoire des sciences, Georg.Google Scholar
Beach, WA, Easter, DW, Good, JS, et al. (2005) Disclosing and responding to cancer “fears” during oncology interviews. Social Science & Medicine 60(4), 893–910. doi:10.1016/j.socscimed.2004.06.031CrossRefGoogle ScholarPubMed
Bell, K (2009) ‘If it almost kills you that means it's working!’ Cultural models of chemotherapy expressed in a cancer support group. Social Science & Medicine 68(1), 169–176. doi:10.1016/j.socscimed.2008.10.023CrossRefGoogle Scholar
Ben-Arye, E, Bar-Sela, G, Frenkel, M, et al. (2006) Is a biopsychosocial–spiritual approach relevant to cancer treatment? A study of patients and oncology staff members on issues of complementary medicine and spirituality. Supportive Care in Cancer 14(2), 147–152. doi:10.1007/s00520-005-0866-8CrossRefGoogle ScholarPubMed
Bombeke, K, Symons, L, Vermeire, E, et al. (2012) Patient-centredness from education to practice: The ‘lived' impact of communication skills training. Medical Teacher 34(5), e338–e348.CrossRefGoogle ScholarPubMed
Bowen, G (2006) Grounded theory and sensitising concepts. International Journal of Qualitative Methods 5, 12–23.CrossRefGoogle Scholar
Bruera, E, Kuehn, N, Miller, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care 7(2), 6–9.CrossRefGoogle ScholarPubMed
Clark, D (1999) Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Social Science & Medicine 49(6), 727–736.CrossRefGoogle Scholar
Crowe, S, Cresswell, K, Robertson, A, et al. (2011) The case study approach. BMC Medical Research Methodology 11(1), 100.CrossRefGoogle ScholarPubMed
De Vries, AMM, Gholamrezaee, MM, Verdonck-de Leeuw, IM, et al. (2017) Patient satisfaction and alliance as a function of the physician's self-regulation, the physician's stress, and the content of consultation in cancer care: Patient outcome: Physician's defense mechanisms and stress. Psycho-oncology 26(7), 927–934. doi:10.1002/pon.4233CrossRefGoogle Scholar
Doumit, MA, Huijer, HAS and Kelley, JH (2007) The lived experience of Lebanese oncology patients receiving palliative care. European Journal of Oncology Nursing 11(4), 309–319.CrossRefGoogle ScholarPubMed
Engel, GL (1977) The need for a new medical model: A challenge for biomedicine. Science 196(4286), 129–136.CrossRefGoogle ScholarPubMed
Epstein, RM and Street, RL (2011) The values and value of patient-centered care. Annals of Family Medicine 9(2), 100–103.CrossRefGoogle ScholarPubMed
Ernst, J, Kuhnt, S, Schwarzer, A, et al. (2011) The desire for shared decision making among patients with solid and hematological cancer. Psycho-oncology 20(2), 186–193.CrossRefGoogle ScholarPubMed
Estacio, CF, Butow, PN, Lovell, MR, et al. (2017) What is symptom meaning? A framework analysis of communication in palliative care consultations. Patient Education and Counseling 100(11), 2088–2094. doi:10.1016/j.pec.2017.05.006CrossRefGoogle ScholarPubMed
Estacio, CF, Butow, PN, Lovell, MR, et al. (2018) Exploring symptom meaning: Perspectives of palliative care physicians. Supportive Care in Cancer 26(8), 2769–2784. doi:10.1007/s00520-018-4126-0CrossRefGoogle ScholarPubMed
Ford, S, Fallowfield, L and Lewis, S (1996) Doctor-patient interactions in oncology. Social Science & Medicine 42(11), 1511–1519. doi:10.1016/0277-9536(95)00265-0CrossRefGoogle Scholar
Foucault, M (1973) The Birth of the Clinic: An Archaeology of Medical Perception. trans. AM Sheridan Smith, New York: Pantheon.Google Scholar
Gibbins, J, Bhatia, R, Forbes, K, et al. (2014) What do patients with advanced incurable cancer want from the management of their pain? A qualitative study. Palliative Medicine 28(1), 71–78. doi:10.1177/0269216313486310CrossRefGoogle ScholarPubMed
Gill, A, Chakraborty, A and Selby, D (2012) What is symptom burden: A aualitative exploration of patient definitions. Journal of Palliative Care 28(2), 83–89. doi:10.1177/082585971202800204CrossRefGoogle Scholar
Goldstein, K (1995) The Organism: A Holistic Approach to Biology Derived from Pathological Data in Man. New York: Zone Books.Google Scholar
Hall, AM, Ferreira, PH, Maher, CG, et al. (2010) The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy 90, 1099–1110.CrossRefGoogle ScholarPubMed
Hansen, HP (2007) Hair loss induced by chemotherapy: An anthropological study of women, cancer and rehabilitation. Anthropology & Medicine 14(1), 15–26. doi:10.1080/13648470601106335CrossRefGoogle ScholarPubMed
Harrington, CB, Hansen, JA, Moskowitz, M, et al. (2010) It's not over when it's over: Long-term symptoms in cancer survivors—a systematic review. International Journal of Psychiatry in Medicine 40(2), 163–181. doi:10.2190/PM.40.2.cCrossRefGoogle ScholarPubMed
Heidrich, SM, Egan, JJ, Hengudomsub, P, et al. (2006) Symptoms, symptom beliefs, and quality of life of older breast cancer survivors: A comparative study. Oncology Nursing Forum 33(2), 315–322. doi:10.1188/06.ONF.315-322CrossRefGoogle ScholarPubMed
Jewson, ND (1976) The disappearance of the sick-man from medical cosmology, 1770–1870. Sociology 10(2), 225–244.CrossRefGoogle Scholar
Jones, RA, Wiese, HJ, Moore, RW, et al. (1981) On the perceived meaning of symptoms. Medical Care 19(7), 710–717.CrossRefGoogle ScholarPubMed
Kirkova, J, Davis, MP, Walsh, D, et al. (2006) Cancer symptom assessment instruments: A systematic review. Journal of Clinical Oncology 24(9), 1459–1473.CrossRefGoogle ScholarPubMed
Kirmayer, LJ, Young, A and Robbins, JM (1994) Symptom attribution in cultural perspective. The Canadian Journal of Psychiatry 39(10), 584–595. doi:10.1177/070674379403901002CrossRefGoogle ScholarPubMed
Le Breton, D (2006) Anthropologie de la douleur, Vol. 12. Paris: Editions Métailié.Google Scholar
Lindley, C, McCune, JS, Thomason, TE, et al. (1999) Perception of chemotherapy side effects cancer versus noncancer patients. Cancer Practice 7(2), 59–65.CrossRefGoogle ScholarPubMed
Lindqvist, O, Widmark, A and Rasmussen, BH (2006) Reclaiming wellness-living with bodily problems, as narrated by men with advanced prostate cancer. Cancer Nursing 29(4), 327–337. doi:10.1097/00002820-200607000-00012CrossRefGoogle Scholar
Lobchuk, MM and Stymeist, D (1999) Symptoms as meaningful “family culture” symbols in palliative care. Journal of Palliative Care 15(4), 24–31. doi:10.1177/082585979901500405CrossRefGoogle ScholarPubMed
Loeser, JD and Treede, RD (2008) The Kyoto protocol of IASP Basic Pain Terminology. Pain 137(3), 473–477. doi:10.1016/j.pain.2008.04.025CrossRefGoogle ScholarPubMed
Mehta, A and Chan, LS (2008) Understanding of the concept of “total pain”: A prerequisite for pain control. Journal of Hospice & Palliative Nursing 10(1), 26–32.CrossRefGoogle Scholar
Molassiotis, A, Zheng, Y, Denton-Cardew, L, et al. (2010) Symptoms experienced by cancer patients during the first year from diagnosis: Patient and informal caregiver ratings and agreement. Palliative & Supportive Care 8(3), 313–324.CrossRefGoogle ScholarPubMed
Ream, E and Richardson, A (1996) Fatigue: A concept analysis. International Journal of Nursing Studies 33(5), 519–529. doi:10.1016/0020-7489(96)00004-1CrossRefGoogle ScholarPubMed
Richer, MC and Ezer, H (2000) Understanding beliefs and meanings in the experience of cancer: A concept analysis. Journal of Advanced Nursing 32(5), 1108–1115. doi:10.1046/j.1365-2648.2000.01581.xCrossRefGoogle ScholarPubMed
Ring, A, Dowrick, CF, Humphris, GM, et al. (2005) The somatising effect of clinical consultation: What patients and doctors say and do not say when patients present medically unexplained physical symptoms. Social Science & Medicine 61(7), 1505–1515.CrossRefGoogle Scholar
Rosman, S (2004) Cancer and stigma: Experience of patients with chemotherapy-induced alopecia. Patient Education and Counseling 52(3), 333–339.CrossRefGoogle ScholarPubMed
Salmon, P, Ring, A, Dowrick, CF, et al. (2005) What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized? Journal of Psychosomatic Research 59(4), 255–260.CrossRefGoogle ScholarPubMed
Shoja, MM, Tubbs, RS, Loukas, M, et al. (2008) Marie-François Xavier Bichat (1771–1802) and his contributions to the foundations of pathological anatomy and modern medicine. Annals of Anatomy 190(5), 413–420. doi:10.1016/j.aanat.2008.07.004CrossRefGoogle ScholarPubMed
Stiefel, F (1993) Psychosocial aspects of cancer pain. Supportive Care in Cancer 1(3), 130–134.CrossRefGoogle ScholarPubMed
Stiefel, F (Ed.) (2006) Communication in Cancer Care. Berlin: Springer.CrossRefGoogle Scholar
Stortenbeker, I, Stommel, W, van Dulmen, S, et al. (2020) Linguistic and interactional aspects that characterize consultations about medically unexplained symptoms: A systematic review. Journal of Psychosomatic Research 109994.CrossRefGoogle ScholarPubMed
Trajkovic-Vidakovic, M, de Graeff, A, Voest, EE, et al. (2012) Symptoms tell it all: A systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Critical Reviews in Oncology/Hematology 84(1), 130–148. doi:10.1016/j.critrevonc.2012.02.011CrossRefGoogle ScholarPubMed
Tranmer, JE, Heyland, D, Dudgeon, D, et al. (2003) Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. Journal of Pain and Symptom Management 25(5), 420–429.CrossRefGoogle ScholarPubMed
Tzartzas, K, Oberhauser, PN, Marion-Veyron, R, et al. (2019) General practitioners referring patients to specialists in tertiary healthcare: A qualitative study. BMC Family Practice 20(1), 165.CrossRefGoogle ScholarPubMed
van Ravenzwaaij, J, Olde Hartman, TC, Van Ravesteijn, H, et al. (2010) Explanatory models of medically unexplained symptoms: A qualitative analysis of the literature. Mental Health in Family Medicine 7(4), 223–231.Google ScholarPubMed
Weisman, AD and Sobel, HJ (1979) Coping with cancer through self-instruction: A hypothesis. Journal of Human Stress 5(1), 3–8. doi:10.1080/0097840X.1979.993499CrossRefGoogle ScholarPubMed
Wittkower, ED (1974) Historical perspective of contemporary psychosomatic medicine. International Journal of Psychiatry in Medicine 5(4), 309–319. doi:10.2190/3E22-QE77-PMDY-CWDDCrossRefGoogle ScholarPubMed
Wu, HS and Harden, JK (2015) Symptom burden and quality of life in survivorship: A review of the literature. Cancer Nursing 38(1), E29–E54. doi:10.1097/NCC.0000000000000135CrossRefGoogle ScholarPubMed
Zimmermann, C, Del Piccolo, L and Finset, A (2007) Cues and concerns by patients in medical consultations: A literature review. Psychological Bulletin 133(3), 438–463.CrossRefGoogle ScholarPubMed