Table 3 Summary of challenges and variability in PCC for DCIS
PCC domain | Approaches | Challenges 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 |