Learning through difficult disclosures of cancer progression: experiences of physicians and nurses in training

TL;DR

This paper explores how medical and nursing trainees in Switzerland experience and learn from disclosing cancer progression to patients, emphasizing the emotional and communication challenges involved.

Contribution

The study provides new insights into the experiences of trainees in delivering difficult cancer progression news, highlighting the role of experiential learning and supportive environments.

Findings

Trainees rely on experience, supervision, and peer support to develop communication skills for disclosing cancer progression.

Emotional burden and variability in patient reactions influence trainees' decision-making and communication strategies.

Formal training and protocols offer limited guidance, emphasizing the need for flexible and relationally attuned approaches.

Abstract

Breaking the news of cancer progression is a complex task that requires a balance between clinical accuracy and relational sensitivity. Although research has examined the perspectives of experienced healthcare professionals, little is known about how trainees navigate these consultations. This study aims to explore the experiences of medical and nursing trainees in disclosing disease progression, focusing on communication strategies, emotional impacts, and professional development.

Eighteen semi-structured interviews were conducted with trainees in Swiss hospitals (11 oncologists and 7 nurses). The data were analyzed via thematic analysis.

Trainees described disclosure as a carefully prepared, emotionally demanding process requiring clarity, empathy, and teamwork. Five themes emerged, with particular emphasis on experiential learning and the emotional burden of disclosure. Formal training and protocols provided limited guidance, while experience, supervision, and peer support were crucial in developing communication skills. Variability in patient and family reactions influenced decision-making and underscored the need for flexible, relationally attuned communication.

Disclosing cancer progression is a demanding experience for trainees, who described the need to adapt their communication, manage emotional responses, and rely on interprofessional collaboration. Their accounts highlight the central role of experience, supervision, and supportive environments in shaping how they navigate these challenging consultations.