Exploring Communication Difficulties in Pediatric Hematology: Oncology Nurses

  • Published : 2013.09.30


Background: Communication plays an important role for the well being of patients, families and also health care professionals in cancer care. Conversely, ineffective communication may cause depression, increased anxiety, hopelessness and decreased of quality life for patients, families and also nurses. Objective: This study aimed to explore communication difficulties of pediatric hematology/oncology nurses with patients and their families, as well as their suggestions about communication difficulties. Materials and Methods: It was conducted in a pediatric hematology/oncology hospital in Ankara, Turkey. Qualitative data were collected by focus groups, with 21 pediatric hematology/oncology nursing staff from three groups. Content analysis was used for data analysis. Results: Findings were grouped in three main categories. The first category concerned communication difficulties, assessing problems in responding to questions, ineffective communication and conflicts with the patient's families. The second was about the effects of communication difficulties on nurses and the last main category involved suggestions for empowering nurses with communication difficulties, the theme being related to institutional issues. Conclusions: Nurses experience communication difficulties with children and their families during long hospital stays. Communication difficulties particularly increase during crisis periods, like at the time of first diagnosis, relapse, the terminal stage or on days with special meaning such as holidays. The results obtained indicate that pediatric nurses and the child/family need to be supported, especially during crisis periods. Feeling of empowerment in communication will improve the quality of care by reducing the feelings of exhaustion and incompetence in nurses.


Communication difficulties;cancer communication;pediatric hematology/oncology nursing;empowerment


  1. Alacacioglu AC, Yavuzsen T, Dirioz M, Oztop I, Yilmaz U (2009). Burnout in nurses and physicians working at an oncology department. Psycho-oncology, 18, 543-58.
  2. Bjork M, Wiebe T, Hallstrom I (2009). An everyday struggle- swedish families' lived experiences during a child's cancer treatment. J Pediatr Nurs, 24, 423-32.
  3. Bressi C, Manenti S, Porcellana M, et al (2008). Haematooncology and burnout: an Italian survey. Brit J Cancer, 98, 1046-52.
  4. Dowling M (2008). The meaning of nurse-patient intimacy in oncology care settings: From the nurse and patient perspective. Eur J Oncol Nurs, 12, 319-28.
  5. Elo S, Kynga SH (2008). The qualitative content analysis process. J Adv Nurs, 62, 107-15.
  6. Fillion L, De Serres M, Lapointe-Goupil R, et al (2006). Implementing the role of patient-avigator nurse at a university hospital centre. Cancer Oncol Nurs J, 16, 11-7.
  7. Girgis A, Hansen VB, Goldstein D (2009). Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer, 45, 393-9.
  8. Hinds PS, Drew D (2005). What makes dying children different? Int J Palliat Nurs, 11, 264.
  9. Hinds PS, Oakes LL, Hicks J, Anghelescu DL (2005). End-of life care for children and adolescents. Semin Oncol, 21, 53-62.
  10. Kash KM, Holland JC, Breitbart W, et al (2000). Stress and burnout in oncology. Oncology, 14, 1621-33.
  11. Klassen A, Gulati S, Dix D (2012). Health care providers' perspectives about working. J Pediatr Oncol Nurs, 29, 92-7.
  12. Lambert S, Loiselle C, Mcdonald M (2009). An in-depth exploration of information-seeking behavior among individuals with cancer. Cancer Nurs, 32, 11-23.
  13. MacKenzie J, MacCallam J (2009). Preparing staff to provide bereavement support. Paediatr Nurs, 21, 22-4.
  14. McLennon S, Uhrich M, Lasiter S, Chamness A, Helft P (2013). Oncology nurses' narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients. Cancer Nurs, 36,114-21.
  15. Maguire, P, Faulkner A, Booth K, Elliott C, Hillier V (1995). Helping cancer patients disclose their concerns. Eur J Cancer, 32, 78-81.
  16. Malloy P, Virani R, Kelly K, Munevar C (2010). Beyond bad news-communication skills of nurses in palliative care. J Hosp Palliat Nurs, 12,166-74.
  17. Maskor NA, Krauss SE, Muhamad M, Nik Mahmood (2013). Communication competencies of oncology nurses in Malaysia. Asian Pac J Cancer Prev, 14, 153-8.
  18. Pai AL, Greenley RN, Lewandowski A, et al (2007). A metaanalytic review of the influence of pediatric cancer on parent and family functioning. J Fam Psychol, 21, 407-15.
  19. Palsson MB, Norberg A (1995). District nurses' stories of difficult care episodes narrated during systematic clinical supervision sessions. Scand J Caring, 9, 17-27.
  20. Parker PA, Aaron J, Baile WF (2009). Breast cancer: unique communication challenges and strategies to address them. Breast J, 15, 69-75.
  21. Sivesind D, Parker PA, Cohen L, et al (2003). Communicating with patients in cancer care; what areas do nurses find most challenging? J Cancer Educ, 18, 202-9.
  22. Tay LH, Ang E, Hegney D (2012). Nurses' perceptions of the barriers ineffective communication with inpatient cancer adults in Singapore. J Clin Nurs, 21, 2647-58.
  23. Usta YY, Demir Y, Yagmuroglu H (2012). Nurses' perspective on positive attitudes to cancer patients in Turkey: a qualitative study. Asian Pac J Cancer Prev, 13, 1225-9.
  24. Van Rooyen D, le Roux L, Kotze WJ (2008). The experiential world of the oncology nurse. Health SA Gesondheid, 13, 18-30.
  25. Wenzel J, Shaha M (2008). Experiencing cancer treatment decision-making in managed care. J Adv Nurs, 63, 455-64.
  26. Wilkinson S, Perry R, Blanchard K, Linsell L (2008). Effectiveness of a three-day communication skills course in changing nurses' communication skills with cancer/ palliative care patients: a randomised controlled trial. Palliat Med, 22, 365-75.

Cited by

  1. Experiences of Nursing Students in Caring for Pediatric Cancer Patients vol.15, pp.5, 2014,
  2. The Intelligent Clinical Laboratory as a Tool to Increase Cancer Care Management Productivity vol.15, pp.6, 2014,
  3. Developing a Scale for the Assessment of Fatigue in Pediatric Oncology Patients Aged 7-12 for Children and Parents vol.15, pp.23, 2015,
  4. Relation of Compassionate Competence to Burnout, Job Stress, Turnover Intention, Job Satisfaction and Organizational Commitment for Oncology Nurses in Korea vol.16, pp.13, 2015,
  5. Developing a Scale for Quality of Life in Pediatric Oncology Patients Aged 7-12 - Children and Parent Forms vol.16, pp.2, 2015,
  6. Nurses’ Perceptions of Diagnosis and Prognosis-Related Communication vol.39, pp.5, 2016,
  7. Communication in pediatric oncology: State of the field and research agenda vol.65, pp.1, 2017,
  8. Consult, Negotiate, and Involve: Evaluation of an Advanced Communication Skills Program for Health Care Professionals vol.35, pp.4, 2018,
  9. Education Milestones for Newly Diagnosed Pediatric, Adolescent, and Young Adult Cancer Patients: A Quality Improvement Initiative vol.36, pp.2, 2019,