Associate Professor Dr. Laura Nimmon is the lead author of an article published in the Lancet Oncology, one of the world’s leading journals in clinical oncology. The article examines the complex dynamic of power between patients and clinicians when people are accessing health services for cancer treatment.
‘Broadening our view of power in clinician–patient relationships in oncology’ is an invited perspective paper, where the journal contacted Dr. Nimmon and her co-authors to seek their expertise on the topic. Her paper is published in the Lancet Oncology‘s 25th anniversary issue and was selected as an editor’s pick.
Dr. Nimmon’s central argument is that the influence of culture and social practices are complex and may be overlooked in the power dynamic between provider and patient, particularly in shared decision-making for cancer care.
Clinicians in oncology currently strive to equalize power by involving patients in shared decision-making. However, Dr. Nimmon and her team highlight the contextual factors that shape patients’ interactions with their care providers, and as a result, their understanding of a cancer diagnosis and prognosis, and the decisions they make regarding a treatment. These contextual factors can include access to information on the internet as well as the influences of immediate and extended family, culture and community, religious beliefs and religious authorities.
Although contextual factors are often acknowledged, they are seldom viewed as significant sources of influence that alter the balance of power in the clinician-patient relationship and silently skew the shared decision-making process.
Healthcare providers have legitimate power in the relationship through their expert knowledge and legal decision-making authority. However, it is the way in which patient experiences this power that will shape their perceived freedom to subsequently share their own values, beliefs, and preferences during shared decision making.
“Patients with cancer who feel heard, understood, and emotionally supported have higher rates of adherence to treatment and are proactive in their self-care and health habits.”
Dr. Nimmon’s paper calls for a deeper consideration of the many sources of influence that shape patients’ decision-making about cancer care, and proposes ways that clinicians can adapt their communications approach to the patient’s context and system of influence.
For example, clinicians can adopt a position of curiosity and cultivate “genuine influence”, and could be taught communication strategies to adapt information to each patient’s individual context, helping to “avoid the risk of cultural stereotyping that can stagnate clinicians’ communication practices”.
By creating communications models and a care system that considers contextual influences on provider-patient relationship, and in turn recognizing the power and self-determination that patients can also harness from those influences, the paper suggests we can reframe how we research and teach shared decision-making in patient care, advance compassionate cancer treatment, and improve patient experiences and outcomes.
“It is in the silent space of listening, where there is reverence and quiet, that clinicians can bear witness and be present and attentive to the authenticity of patients’ experiences.”
Learn more about Dr. Nimmon’s research
Dr. Nimmon’s primary site of research is the UBC Centre for Health Education Scholarship (CHES). The Centre’s research is founded on “working to understand how health care providers learn and how health professions educators teach.”