Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Practical strategies for starting a conversation about fear of cancer recurrence: Findings from direct observation of gynae-oncology outpatient consultations (#109)

Darcy Malady-Meek 1 , Stuart Ekberg 2 , Bronwyn Jennings 3 , Nisha Jagasia 3 , Ben Smith 4 5 , Elizabeth (Lizzy) Johnston 6 7 8
  1. School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  2. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  3. Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, Queensland, Australia
  4. The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, New South Wales, Australia
  5. South West Sydney Clinical Campuses, Faculty of Medicine & Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
  6. School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
  7. Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
  8. Cancer Council Queensland, Fortitude Valley, QLD, Australia

Aims: Fear of cancer recurrence is a significant concern for gynaecological cancer patients and a highly ranked unmet need for support. This study aimed to identify communication practices that clinicians can use to initiate conversation about fear of cancer recurrence during outpatient consultations after treatment for gynaecological cancer.

Methods: A corpus of 30 audio-recorded outpatient consultations, involving 4 gynae-oncologists, 30 women who had completed treatment for endometrial or ovarian cancer, and 11 family members/friends, were analysed to identify instances where fear of cancer recurrence was discussed. Instances were transcribed and analysed using conversation analysis, a leading approach for studying real-world communication in healthcare settings.

Results: Six consultations included conversations about fear of cancer recurrence initiated by the same gynae-oncologist. Two recurrent practices were used to initiate these conversations: (i) universal claims, and (ii) general claims. Universal claims involved the use of a full-inclusivity device (e.g., “always”), allowing the gynae-oncologist to frame fear of cancer recurrence as a routine part of follow-up consultations raised with all gynaecological cancer survivors. Conversely, general claims involved the use of a partial-inclusivity device (e.g., “some”, “a lot of”) with a generic third-person reference (e.g., “people”) to indirectly suggest that the patient may be experiencing fear of cancer recurrence. General claims provided opportunity for the patient to expand on their own experience of fear of cancer recurrence, if relevant to them, and for the gynae-oncologist and patient to discuss available support.

Conclusions: Fear of cancer recurrence was not regularly discussed in the consultations analysed. Findings from direct observation show how gynae-oncologists can use universal and general claims to create space for these conversations, including patients’ experiences of fear of cancer recurrence. These strategies provide practical guidance for clinicians to start a conversation about fear of cancer recurrence and available support with cancer survivors.