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Table 3 Summary of challenges and variability in PCC for DCIS

From: Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians

PCC domainApproachesChallenges or Variability
Fostering Healing Relationships• Exhibit patience
• Affirm they are listening
• Exchange pleasantries
• Sit at same level
• Make eye contact
Exchanging information• Distinguish DCIS from invasive cancer• Clinicians differed in whether they believed DCIS was cancer; as a result, terms used to describe DCIS also differed: ‘abnormal cells’ versus ‘early stage breast cancer’
• Avoid using the word ‘cancer’
• Spend time explaining DCIS, sometimes over multiple appointments• Frustrating when patients remain confused about DCIS despite their efforts to explain it
• Difficult to justify treatment while also assuring women of a good prognosis; this was frustrating because they knew it further confused women
• Use self-drawn notes or diagrams in additional to verbal information
• Internet information of poor quality; unaware of good quality Internet information on DCIS
• Refer women to web sites for supplemental information
Addressing Emotions• Alleviate concerns by emphasizing a good prognosis• Recognize that women with DCIS experience anxiety and concerns but do not directly address emotions
• Refer women to patient navigators, social workers for information and emotional support
• Lack access to patient navigators or social workers
Managing Uncertainty• Uncertainty not defined or explained in brief, vague terms (i.e. unlikely)
• None shared statistics or scientific evidence
Making Decisions• Describe options but recommend one
• Describe and recommend only one option
Enabling Self-Management• Self-care advice or support specific to invasive breast cancer
• Unaware of DCIS-specific self-management resources