Factors impacting on patient-centered communication skills and their opportunities to be involved in decision-making from the perspective of patients with cancer, informal caregivers, and/or healthcare professionals : a systematic review

Abstract

Background : Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients’ communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical. Objective : To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals. Methods : A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results. Results : Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients’ lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals’ knowledge, communication skills, and patient relationships. Conclusions : Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication. Implication for Practice : The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture’s impact on communication effectiveness and decision-making participation.