Cue-responding behaviours of oncology nurses in video-simulated interviews.
OBJECTIVE
This paper is a report of a study to describe nurse-patient interactions, i.e. nurses' cue-responding behaviour in encounters with actors playing the role of patients.


BACKGROUND
Patients with cancer seldom express their concerns directly but express cues instead. Few studies empirically investigated nurses' cue-responding behaviour and the subsequent influence of disclosure of cues and concerns.


METHODS
In this descriptive observational study, conducted from April to June 2004, five oncology nurses interviewed an actor playing the role of a patient with cancer. Each nurse performed seven different interviews (n = 35); these were videotaped and subsequently rated for cue-responding using the Medical Interview Aural Rating Scale. Mixed model analysis was used to investigate the relation between cues and cue-responding.


RESULTS
Half of the patients' cues were responded to with distancing behaviours. The other half of the cues were either explored (33%) or acknowledged (17%). In 16% of these responses, nurses used open directive questions. One out of four open directive questions were used as a distancing response, suggesting that open directive questions are not used to explore or acknowledge cues of patients. Cue-responding influenced subsequent expression of concerns and emotions, i.e. disclosure of a concern is two times higher after exploration or acknowledging of a preceding cue than after a distancing response.


CONCLUSIONS
Cue-responding is a valuable concept which can contribute to our understanding of optimal ways of communicating. Cue-responding behaviour facilitates the disclosure of worries and concerns of patients. Further research is needed to assess the clinical relevancy of cue-responding.
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Ruud
R
Uitterhoeve
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jacqueline
J
De Leeuw
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jozien
J
Bensing
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Cathy
C
Heaven
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
George
G
Borm
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Pieter
P
DeMulder
Ruud Uitterhoeve MScN RN Researcher Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJacqueline de Leeuw MScN RN Researcher Neurosensoric Cluster, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsJozien Bensing PhD Professor of Clinical and Health Psychology Department of Health Psychology, Utrecht University and Netherlands Institute for Health Services Research, Utrecht, The NetherlandsCathy Heaven PhD RN Researcher and Communication Skills Tutor Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UKGeorge Borm PhD Associate Professor in Statistics Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsPieter deMulder (deceased) MD PhD Professor Medical Oncology Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsTheo van Achterberg PhD RN Professor Nursing Science Centre for Quality of Care Research, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Theo
T
Van Achterberg
D000328:Adult; D001519:Behavior; D003463:Cues; D030881:Disclosure; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009426:Netherlands; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009859:Oncology Nursing; D016544:Patient Simulation