The Who and the How: Redressing the Imperative Need for Science Characterizing the Cancer Nurse-Patient Relationship

Let us make the invisible visible—how do people being treated for cancer receive treatment and supportive care? No matter the specifics, the answer always includes a who—nurses—and a how—interaction between nurses and patients, the people they care for and about.

Today’s cancer nurse is more knowledgeable and skilled than ever. Within complex healthcare systems, we nurses appear in myriad places throughout the cancer journey. The list of distinct cancer nursing roles, defined in relation to treatment modality, patient needs, and care setting, grows longer each year. No matter their specialty, cancer nurses provide care by shaping knowledge to meet needs through the human interaction of communication. Thus, they foster relationships that frequently endure over time. Those interactions and resultant relationships become central to patients’ own knowledge and their self-care capacity, influencing patient-reported and clinical outcomes.

Public awareness of our profession’s essential value is greater than ever, yet cancer nursing research fails to fill a notable void. Nursing science around the larger nursing workforce research is among the best known and publicized, our relatively less robust knowledge specific to the cancer nursing workforce notwithstanding. Yet, overemphasis on workforce research plays to popular conceptions that nurses are simply interchangeable workers, bringing a definable skill set but negligible comportment to healthcare delivery. Moreover, an unbalanced focus on workforce research risks coloring nursing as simply a labor, and not a professional, workforce.

Trials of behavioral and other nonpharmacological interventions are increasingly visible, gaining widespread attention within healthcare and public press. However, protocols for investigating the effects of these interventions commonly lack specificity about those who deliver the intervention including preparation beyond training for the study intervention. Our proposition that professional cancer nurses leverage communication to tailor knowledge to the needs of the patient is undermined when, in clinical trials, the nature of the nurse remains undefined and interaction with the person receiving the intervention is unspecified.

A consequential void lies between the visible domains of workforce and intervention science, that of relationship science. The nurse is a distinctive professional whose mien enables therapeutic interaction with the patient and with their support. Modern cancer care relies on interaction between the professional nurse and the patient. A connection both personal and frequently emotional for each person involved, the nurse-patient relationship is the fundamental conduit for cancer care. Nonetheless, the cancer nurse-patient relationship is nearly unseeable scientifically, increasingly unacknowledged educationally, and imprecisely charted clinically. Amidst the complexity of today’s cancer care, evidence of the specific nature, character, and mechanisms of the relationship are too vague to optimally guide practice. Instead, healthcare system emphases on technical and transactional aspects of cancer care drive institutional policy and national practice standards. Where technical skill and transactional success thrive, relational understanding pales and relationship excellence becomes happenstance.

Only sporadic contemporary research contributes knowledge of the nurse-patient relationship. This small body of research tends to leverage cross-sectional designs, limiting relevance to cancer care as a longitudinal experience. Methodological reliance on qualitative traditions offers merit, given foci of interaction and relationship, but is incomplete without analytic scale and balance gained in quantitative approaches. The science of the cancer nurse-patient relationship lags well behind need engendered as we seek to effectively deploy the relatively scarce resource of the cancer nurse workforce where and when they are needed to create effective relationships with patients.

The fractal increase in cancer nursing specialties, emerging from the multiplicity of treatment modalities, supportive care options, and care settings across many societies in recent decades, generates an immense but generally undocumented need. Scant evidence quantifies and qualifies effects on the nurse, role fulfillment, the nurse-patient relationship, and, critically, the patient. We then lack discrete knowledge and transferrable substantive understandings about the nature, character, and mechanisms of the cancer nurse-patient relationship. The nurse-patient relationship void in our research detracts from the broad utility of our science and limits our capacity to influence quality care.

Meeting public expectations by ensuring safe, quality delivery of treatment and supportive therapeutics mandates knowing better how cancer care is provided and received. Merit in workforce and intervention research well acknowledged, our true power to shape quality cancer care lies idle if we do not improve our comprehension of the who and the how—the nurse and the nurse-patient relationship—of the processes and outcomes we generate with our patients. Let us move forward investigating what we need to know in the domain of cancer nurse relationship science, deploying better perspective and stronger methods.

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