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Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies

  • Author Footnotes
    1 Romain Collet and Mel Major made equal contributions to this manuscript.
    Romain Collet
    Footnotes
    1 Romain Collet and Mel Major made equal contributions to this manuscript.
    Affiliations
    Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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  • Author Footnotes
    1 Romain Collet and Mel Major made equal contributions to this manuscript.
    Mel Major
    Footnotes
    1 Romain Collet and Mel Major made equal contributions to this manuscript.
    Affiliations
    Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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  • Maarten van Egmond
    Affiliations
    Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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  • Marike van der Leeden
    Affiliations
    Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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  • Rhea Maccow
    Affiliations
    Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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  • Anne Eskes
    Affiliations
    Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands

    Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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  • Martijn Stuiver
    Correspondence
    Corresponding author. Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
    Affiliations
    Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    Center for Quality of Life and Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • Author Footnotes
    1 Romain Collet and Mel Major made equal contributions to this manuscript.
Open AccessPublished:August 30, 2022DOI:https://doi.org/10.1016/j.ejon.2022.102198

      Highlights

      • Delivering supportive cancer care requires enhanced interpersonal aptitudes.
      • Person-centered interaction positively influences patient satisfaction.
      • Recent studies report patients' negative interaction experiences with professionals.

      Abstract

      Purpose

      This study investigates patients’ experiences of interaction with their healthcare professionals (HCPs) during cancer treatment and identifies elements that HCPs can utilize to improve cancer care provision.

      Methods

      PubMed, CINAHL, PsycINFO, SCOPUS, and Embase were systematically searched for relevant studies published from January 2010 until February 2022. Qualitative studies investigating adult patients’ perspectives on their interaction with HCPs during cancer treatment were included. Studies conducted during the diagnosis or end-of-life treatment phase were excluded. Duplicate removal, screening, and quality appraisal were independently performed by four reviewers using Covidence.org. We performed a thematic meta-synthesis of qualitative data extracted from studies meeting the quality criteria in three stages: excerpts coding, codes categorization, and theme identification by merging similar categories.

      Results

      Eighty-eight studies were included for quality appraisal, of which 50 papers met the quality inclusion criteria. Three themes were identified as essential to positively perceived patient-HCP interaction: “Support, respect and agency”, “Quantity, timing, and clarity of information”, and “Confidence, honesty, and expertise”. Overall, patients experienced positive interaction with HCPs when the approach was person-centered and when HCPs possessed strong interpersonal skills. However, patients expressed negative experiences when their preferences regarding communication and the type of personal support needed were ignored.

      Conclusions

      This meta-synthesis emphasizes the importance for HCPs to recognize all patients’ needs, including communication and personal support preferences, to provide high-quality care. Consequently, healthcare professionals should continuously train their verbal and non-verbal communication, empathy, active listening, and collaboration skills during their undergraduate and continuing education.

      Keywords

      1. Introduction

      Every stage in the cancer continuum is accompanied by symptoms such as pain, fatigue, weight loss, and psychological distress, and the importance of supportive care for patients diagnosed with cancer is increasingly being acknowledged (
      • Berman R.
      • Davies A.
      • Cooksley T.
      • Gralla R.
      • Carter L.
      • Darlington E.
      • Scotté F.
      • Higham C.
      Supportive care: an indispensable component of modern oncology.
      ;
      • Hui D.
      • Hannon B.L.
      • Zimmermann C.
      • Bruera E.
      Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care.
      ;
      • Jordan K.
      • Aapro M.
      • Kaasa S.
      • Ripamonti C.
      • Scotté F.
      • Strasser F.
      • Young A.
      • Bruera E.
      • Herrstedt J.
      • Keefe D.
      European Society for Medical Oncology (ESMO) position paper on supportive and palliative care.
      ). Supportive care in cancer is defined as the prevention and management of the adverse effects of cancer and its treatment, from diagnosis through treatment to post-treatment care, in a person-centered manner (
      • Jordan K.
      • Aapro M.
      • Kaasa S.
      • Ripamonti C.
      • Scotté F.
      • Strasser F.
      • Young A.
      • Bruera E.
      • Herrstedt J.
      • Keefe D.
      European Society for Medical Oncology (ESMO) position paper on supportive and palliative care.
      ;
      What is supportive care?
      MASCC. Multinational Association of Supportive Care in Cancer.
      ). Supportive care includes basic care, i.e., information provision and symptom management, as well as more specialized interventions such as nutritional support, exercise therapy, music therapy, counseling, meditation, and comprehensive palliative care (
      • NCI Dictionary of Cancer terms
      National Cancer Institute.
      ).
      In general, different healthcare professionals, including physicians, nurses, dieticians, occupational therapists, physiotherapists, psychologists, spiritual caregivers and social workers, play a role in delivering supportive care (
      • Holmes A.
      • Kelly B.D.
      • Perera M.
      • Eapen R.S.
      • Bolton D.M.
      • Lawrentschuk N.
      A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer.
      ;
      • Selby P.
      • Popescu R.
      • Lawler M.
      • Butcher H.
      • Costa A.
      The value and future developments of multidisciplinary team cancer care.
      ). These professionals usually collaborate as part of a multidisciplinary team to provide timely and effective treatment of physical and psychological impairments resulting from the disease or its treatment, thus optimizing patients’ quality of life (
      • Hui D.
      • Hannon B.L.
      • Zimmermann C.
      • Bruera E.
      Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care.
      ;
      • Silver J.K.
      • Baima J.
      • Mayer R.S.
      Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship.
      ,
      • Silver J.K.
      • Raj V.S.
      • Fu J.B.
      • Wisotzky E.M.
      • Smith S.R.
      • Kirch R.A.
      Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.
      ).
      Delivering supportive care for patients who have cancer requires enhanced skills and knowledge of the healthcare professionals involved, including interpersonal and communication aptitudes, to create adequate patient-professional interaction – as laid down in professional competency profiles and frameworks by several international professional bodies (
      • Fitch M.
      , Fitch,
      • Fitch M.
      Supportive care framework.
      ;
      • Fitch M.
      ;
      • Cancer nursing education framework
      EONS - The European Oncology Nursing Society.
      ; ).
      In the literature, communication and interaction are often used interchangeably or synonymously (
      • Fleischer S.
      • Berg A.
      • Zimmermann M.
      • Wüste K.
      • Behrens J.
      Nurse-patient interaction and communication: a systematic literature review.
      ). Interaction, however, encompasses more than only effective communication. Casu et al. associates interaction with person-centeredness and, therefore, with aspects such as informational and support needs, respect, the interest of the professional in the patient, and the ability to actively listen to and involve the patient in the care choices (
      • Casu G.
      • Gremigni P.
      • Sommaruga M.
      The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective.
      ). Such aspects have also been noted as essential to delivering high-quality cancer care (Institute of Medicine Committee on Quality of Health Care in, 2001), and person-centered interaction has been shown to positively influence patient satisfaction (
      • Baker T.A.
      • O'Connor M.L.
      • Roker R.
      • Krok J.L.
      Satisfaction with pain treatment in older cancer patients: identifying variants of discrimination, trust, communication, and self-efficacy.
      ;
      • Lee S.
      • Gross S.E.
      • Pfaff H.
      • Dresen A.
      Waiting time, communication quality, and patient satisfaction: an analysis of moderating influences on the relationship between perceived waiting time and the satisfaction of breast cancer patients during their inpatient stay.
      ;
      • Moore A.D.
      • Hamilton J.B.
      • Knafl G.J.
      • Godley P.A.
      • Carpenter W.R.
      • Bensen J.T.
      • Mohler J.L.
      • Mishel M.
      Patient satisfaction influenced by interpersonal treatment and communication for african American men: the North Carolina-Louisiana prostate cancer project (PCaP).
      ;
      • Moreno P.I.
      • Ramirez A.G.
      • San Miguel-Majors S.L.
      • Castillo L.
      • Fox R.S.
      • Gallion K.J.
      • Munoz E.
      • Estabrook R.
      • Perez A.
      • Lad T.
      • Hollowell C.
      • Penedo F.J.
      Unmet supportive care needs in Hispanic/Latino cancer survivors: prevalence and associations with patient-provider communication, satisfaction with cancer care, and symptom burden.
      ), potentially leading to better health outcomes (
      • Forbes C.C.
      • Swan F.
      • Greenley S.L.
      • Lind M.
      • Johnson M.J.
      Physical activity and nutrition interventions for older adults with cancer: a systematic review.
      ;
      • Hoffman R.M.
      • Hunt W.C.
      • Gilliland F.D.
      • Stephenson R.A.
      • Potosky A.L.
      Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study.
      ;
      • Umihara J.
      • Nishikitani M.
      • Kubota K.
      Rapport between cancer patients and their physicians is critical for patient satisfaction with treatment decisions.
      ;
      • Wright S.
      Patient satisfaction in the context of cancer care.
      ). While the benefits of effective patient-professional interaction in cancer care are known, patients’ expectations and preferences regarding their healthcare professionals should be clarified.
      In the last decade, an abundance of qualitative studies investigating patients' needs and experiences related to interaction with healthcare professionals during their cancer treatment has been published. Conducting a systematic overview and qualitative meta-synthesis of these publications may provide insights into the existing body of evidence and establish the level of saturation on these topics (
      • Goodman S.
      The generalizability of discursive research.
      ;
      • Howitt D.
      Introduction to Qualitative Research Methods in Psychology: Putting Theory into Practice.
      ).
      Therefore, this study aimed to identify and appraise the current body of evidence investigating patients' experiences of interaction with healthcare professionals while receiving cancer treatment, provide an overarching thematic synthesis of high-quality study results, and provide recommendations for crucial interpersonal and communication skills expected from healthcare professionals working with patients with cancer.

      2. Methods

      The systematic review of the literature took place between July 2019 and April 2022. The review protocol was prospectively submitted for registration in the International Prospective Register of Systematic Reviews under the identification number: CRD42019139427.

      2.1 Data sources and searches

      Qualitative studies, using either semi-structured interviews or focus groups as data collection methods, were eligible for review. Multiple electronic searches in PubMed.gov, Embase, SCOPUS, CINAHL, and PsycInfo databases, respectively, were conducted between August 2019 and February 2022. Additionally, reference lists of included papers were hand searched for potentially eligible papers.
      The search strategy used several combinations of four groups of index terms and respective keywords: Neoplasm (cancer, tumor, malignancy, etc.); Patient satisfaction (patient's perspective, patient's view, patient's desire, etc.); Qualitative research (focus groups, interviews, needs assessment, etc.); Professional-patient (Physician-patient relations, Nurse-patient relations, therapeutic alliance, etc.). The search strings were executed in the corresponding databases by an experienced medical information specialist (exact search strings: see supplementary material).

      2.2 Study selection

      Qualitative studies investigating adult patients' experiences with interaction with all healthcare professionals (i.e., physicians, nursing professionals, allied health professionals) during cancer treatment were included. Studies were eligible for appraisal if they: 1) applied well-described qualitative data collection methods such as focus groups or semi-structured interviews, 2) included patient populations, and 3) were published after 2010. Studies investigating the interaction experience from the healthcare professionals’ perspective were excluded, as were studies on patients in the diagnosis or end-of-life stage of cancer care. Retrieved records were imported and organized in Covidence.org. After duplicate removal title and abstract of remaining records were screened for eligibility by one reviewer (RC, MM, ME, RM). Consensus meetings were held to resolve disagreements between reviewers.

      2.3 Quality assessment and data extraction

      Three researchers conducted the critical appraisal (RC, MM, and RM), and each article was independently assessed by at least two reviewers, using the Critical Appraisal Skills Programme checklist for qualitative research (

      CASP, C.A.S.P., CASP Checklist: 10 Questionsto Help You Make Sense of a Qualitative Research.

      ). The Critical Appraisal Skills Programme checklist consists of 10 items assessing qualitative studies' methodological rigor and validity and has been widely used in qualitative meta-syntheses (
      • Butler A.
      • Hall H.
      • Copnell B.
      A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care.
      ). The Critical Appraisal Skills Programme checklist qualitative checklist is divided into three sections. Section A (6 questions) evaluates the internal validity or methodological rigor of the study, section B (3 questions) evaluates the results of the study, and section C (1 question) evaluates the external validity and implications of the study results (

      CASP, C.A.S.P., CASP Checklist: 10 Questionsto Help You Make Sense of a Qualitative Research.

      ). Each question contains several hints to assist in scoring and is marked either “yes”, “no”, or “can't tell”. Scoring guidelines (yes: 1 point, can't tell: 0.5 points and no: 0 points) as proposed by
      • Butler A.
      • Hall H.
      • Copnell B.
      A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care.
      were applied by two reviewers, and the final appraisal score (maximum 10 points) was determined through a consensus meeting.
      As
      • Butler A.
      • Hall H.
      • Copnell B.
      A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care.
      suggest, articles were excluded for further review when receiving a score of <1 on item 7: “Have ethical issues been taken into consideration?” on the Critical Appraisal Skills Programme checklist. Additionally, we chose to exclude articles from the meta-synthesis when items 5: "Was the data collected in a way that addressed the research issue?", or 8, "Was the data analysis sufficiently rigorous?" received a score of 0, since low scores on these items pose a serious threat to the methodological rigor (
      • Charmaz K.
      Constructing Grounded Theory: A Practical Guide through Qualitative Analysis.
      ;
      • Howitt D.
      Introduction to Qualitative Research Methods in Psychology: Putting Theory into Practice.
      ;
      • Mays N.
      • Pope C.
      Qualitative research in health care. Assessing quality in qualitative research.
      ).
      Articles with a total score >5.5 were included for the meta-synthesis. Papers were categorized into high-quality papers (score 9.0–10), moderate-quality (score 7.5–9.0), and low-quality (score 5.5–7.5). (Table 1).
      Table 1Quality appraisal.
      First authorYearCritical Appraisal Skills Programme itemsTotalCategoryReason(s) for exclusion
      12345678910
      Aagaard201811100.50.510.50.517Low-quality paper
      Abt Sacks2016111111111110High-quality paper
      Albrecht20191100.50.50110.516.5Low-quality paper
      Alpert2018110110110.517.5Moderate-quality paper
      Anderson20201100.50.5011117Low-quality paper
      Appleton2018110.50.50.5111118.5Moderate-quality paper
      Asiedu20180.510.50.50.5010116ExcludeData analysis
      Back20140.510.510.50.510.50.506Low-quality paper
      Bergin2017110.510.50.510117.5ExcludeData analysis
      Best201411111010.5118.5Moderate-quality paper
      Bittencourt Romeiro2016110.5000100.50.54.5Exclude<6 score, data analysis and collection
      Blakely2017110.5110.510.500.57Low-quality paper
      Boons20181110.50.50100.505.5Exclude<6 score, data analysis
      Brincat20211110.510.510.5118.5Moderate-quality paper
      Brom2017111100.510117.5ExcludeData collection, data analysis
      Burrows Walters201711110.50100.517ExcludeData analysis
      Candela2020110.50.51110.5118.5Moderate-quality paper
      Chen201911010.5010.500.55.5Exclude<6 score
      Couchman201901011110.5117.5Moderate-quality paper
      Daem20191110.50.50.51110.58Moderate-quality paper
      Dance2021110010100.50.55Exclude<6 score, data analysis
      Den Herder-van der Eerden201711111011119High-quality paper
      Dencker2018110010100.515.5Exclude<6 score, data analysis
      Devitt20201110.50.5010.5117.5Moderate-quality paper
      Donachie20201100.51010.5117Low-quality paper
      Evans20120.510.510.500.500.50.55Exclude<6 score, data analysis
      Farias20171100.51010.50.516.5Low-quality paper
      Furber201511100.501000.55Exclude<6 score, data analysis
      Furber2013110.510.50.510117.5ExcludeData analysis
      Gruss201911110.50100.517ExcludeData analysis
      Halkett2010110.5110100.50.56.5ExcludeData analysis
      Herrmann2021110.510.50.510.510.57.5Moderate-quality paper
      Hess202111011011118Moderate-quality paper
      Hillen2012110.5110.5110.518.5Moderate-quality paper
      Hogberg20131110.50.50100.516.5ExcludeData analysis
      Hopmans2015110.50.50.5010.50.50.56Low-quality paper
      Hull20200.510.50.50.50.510116.5ExcludeData analysis
      Jacobsen201511111011119High-quality paper
      Janssens20211100.5101010.56ExcludeData analysis
      Jones20131110.50.5010.5005.5Exclude<6 score
      Jordan202211011111119High-quality paper
      Kamradt20151100.50.50.5100.50.55.5Exclude<6 score, data analysis
      Kobleder201711010011117ExcludeData collection
      Kumar20201110.50.500.5110.57Low quality paper
      Kvale201011110.5010.50.50.57Low-quality paper
      Lawhon202011111010.5118.5Moderate-quality paper
      Lelorain20191100.5111110.58Moderate-quality paper
      Lowe202111100.5010.510.56.5Low-quality paper
      Martinsson201611010.5010.50.50.56Low-quality paper
      Masel2016111111111110High-quality paper
      Mazor20131100.50.5010.50.50.55.5Exclude<6 score
      McCarthy201411110.50100.50.56.5ExcludeData analysis
      McKenzie2015110.50.50.50100.516ExcludeData analysis
      McNair20161100.50.50110.516.5Low-quality paper
      Melhem20171100.50.5010015Exclude<6 score, data analysis
      Myers202110.500.50010.510.55Exclude<6 score, data collection
      Myren20211100.510.511118Moderate-quality paper
      Nababan20200.510.500.50.510.510.56Low-quality paper
      Niranjan2020110.500.5010.510.56Low-quality paper
      Noteboom2021111110.511119.5High-quality paper
      Pedersen2013110.50.50.5010.50.516.5Low-quality paper
      Prip2022110.511011118.5Moderate-quality paper
      Retrouvey2019111110.511119.5High-quality paper
      Rocque2019110.5110.510.50.518Moderate-quality paper
      Salmon201111010.50.5110.517.5Moderate-quality paper
      Sattar201811011110.5118.5Moderate-quality paper
      Schildmann20131100.50.5010.50.516Low-quality paper
      Sheppard20110.51000.50100.50.54Exclude<6 score, data analysis
      Slavova-Azmanova20181110.50.50.5100.50.56.5ExcludeData analysis
      Smith20171110.510100.517ExcludeData analysis
      Step201111011010.50.517Low-quality paper
      Tamirisa20170.510.500.50100.50.54.5Exclude<6 score, data analysis
      Tanay20140.51100.5010.50.516Low-quality paper
      Thorne2013110000100.50.54Exclude<6 score, data collection, data analysis
      Tomlinson20121100.50.51100.516.5ExcludeData analysis
      Twibell202011011111119High-quality paper
      Van Bruinessen2013110.510.50110.50.57Low-quality paper
      Van Egmond201911011010.50.517Low-quality paper
      Vaughan20210.51000.50.510.5116Low-quality paper
      Villalobos20180.510.500.50100.515Exclude<6 score, data analysis
      Waelli20211100.50.5010.50.50.55.5Exclude<6 score
      Wagland2019110.50.50.5010.510.56.5Low-quality paper
      Wong201111011010.50.517Low-quality paper
      Wood2013110.510.5110118ExcludeData analysis
      Ziebland2015110.500.50100.515.5Exclude<6 score, data analysis
      Legend
      Included studiesHard exclusion criteria (data collection/data analysis/ethical considerations)
      The following data were extracted from the studies meeting the quality criteria: the country where the study was conducted, population data (demographics, type of cancer, treatment received), methods (data collection methods, topics investigated), and the results (first-order constructs, i.e., participant's quotes and second-order constructs, i.e., interpretations).

      2.4 Data synthesis and analysis

      We used thematic synthesis to analyze the data (
      • Thomas J.
      • Harden A.
      Methods for the thematic synthesis of qualitative research in systematic reviews.
      ). This systematic method consists of coding data excerpts from the included studies to yield descriptive and analytical themes (
      • Nicholson E.
      • Murphy T.
      • Larkin P.
      • Normand C.
      • Guerin S.
      Protocol for a thematic synthesis to identify key themes and messages from a palliative care research network.
      ). A new dataset was formed from the extracted individual study results. Analysis was conducted as follows: First, all text fragments relevant to this study's purpose were coded (RC). Text blocks were considered pertinent to our study if they depicted interaction with healthcare professionals from the patient's viewpoint. Next, a code list was generated, after which codes were re-read and grouped into meaningful categories. These results were discussed in reflexivity meetings, after which - as the last analysis step - themes were generated from the categories (
      • Charmaz K.
      Constructing Grounded Theory: A Practical Guide through Qualitative Analysis.
      ;
      • Thomas J.
      • Harden A.
      Methods for the thematic synthesis of qualitative research in systematic reviews.
      ). Analysis was conducted in MAXQDA 2022 (
      • VERBI Software
      ). Throughout the different stages of analysis, several reflexivity meetings with the research team were held to reduce researcher bias and increase the richness of the findings (
      • Creswell J.W.
      • Creswell J.D.
      Research Design: Qualitative, Quantitative, and Mixed Methods Approaches.
      ). Lastly, a sensitivity analysis was conducted through which the identified themes were verified against individual study results, population characteristics, and study settings (Fig. 2).

      3. Results

      After duplicate removal title and abstract of remaining records (n = 10332) were screened for eligibility, leaving 406 studies meeting the inclusion criteria (Fig. 1: PRISMA flowchart). Eighty-eight articles were appraised, after which 37 studies were excluded due to threats to methodological rigor. One additional study was excluded after quality appraisal as the focus of that study was retrospectively found irrelevant to this study's aim (
      • Rohde G.
      • Soderhamn U.
      • Vistad I.
      Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study.
      ). A total of 50 articles are included in this meta-synthesis (Table 2). All these studies were conducted to either investigate patients' interaction preferences with healthcare professionals or evaluate interventions adjacent to innovative care projects aimed at improving patient-professional interaction.
      Fig. 1
      Fig. 1PRISMA Flowchart: selection process for qualitative meta-synthesis.
      Fig. 2
      Fig. 2Sensitivity analysis. Shown are the number of studies per country including Stage I-III and Stage IV patients (top) and finding each of the respective themes (bottom), AUS: Australia, AUT: Austria, BE: Belgium, CA: Canada, DK: Denmark, FR: France, GER: Germany, IT: Italy, MT: Malta, NL: Netherlands, NOR: Norway, SP: Spain, SWE: Sweden, UK: United Kingdom, USA: United States of America, COMB: Combined.
      Table 2Study characteristics.
      First authorReference numberYearCountryType of cancerNGender

      M/F
      Mean age [range]Treatment(s) receivedProfessionals mentioned by patientsTopics investigated
      Aagaard12018DenmarkBreast, GI136/7Breast: 63.75 [N/A]

      GI: 70.7 [N/A]
      SurgeryNPPatients experience of being prepared for general anesthesia and their interaction with RNAs
      Abt Sacks22016SpainBreast411/40N/A [32–69]Chemotherapy, radiotherapy, hormone therapy or combinationsPhysicians, NP, mammography operatorsPerception of information and assessed oncologic care received
      Albrecht32019USALeukemia74/332 [25–36]Induction chemotherapyPhysicians, NPExperiences of treatment, support, information, and communication
      Alpert42018USABreast, hematologic, GI, GU, lung, sarcoma, skin, gynecologic3514/2154 [N/A]N/APhysiciansPerception of portal communication, risk information communication via a portal, patient-oncologist relationship changes through portal use
      Anderson52021USABreast280/2864 [N/A]Adjuvant endocrine therapyPhysicians, NP, unspecified healthcare providersPatient perceptions of and possible race-based differences in patient-provider communication
      Appleton62018UKLung, GI, head/neck3018/12N/A [52–88]Radiotherapy, chemotherapy or combinationPhysicians, NP, unspecified medical staffIdentify components of care important to patients and meeting their needs. To explore how cancer services promote and support patient's wellbeing throughout cancer treatment
      Back72014USAGI3715/2258 [31–84]Surgery, chemotherapy, radiotherapyPhysiciansTo identify communication practices that clinicians could use as entry points into conversations about goals of care.
      Best82014AustraliaGI, lung, GU, breast, gynecologic, adenocarcinoma155/1070 [41–87]Palliative, not further specifiedPhysicians, spiritual advisorsSpiritual support of patients with advanced cancer and preferences regarding the role of doctors in helping them cope with a terminal illness
      Blakely92017CanadaGI20N/AN/ASurgery, disease surveillancePhysiciansCommunication experiences of patients treated surgically for pancreatic cancer, identify perceived enablers and barriers to effective communication
      Brincat102021MaltaGI122/1062 [38–78]Antineoplastic medicines, not further specifiedPhysicians, NP, unspecified HCPExperiences on initiation of treatment with antineoplastic medicines for colorectal cancer.
      Candela112020ItalyN/A3217/15N/A [41–80]N/ANPExperiences with dependence on care of patients with advanced cancer
      Couchman122019UKGU, GI, breast, gynecologic, lung, atrial sarcoma156/874 [N/A]N/APhysiciansExperiences of family physician's role in providing palliative care and facilitators and barriers to the family physician's ability to fulfil this perceived role.
      Daem132019BelgiumBreast, Hematologic, Lung, GI13N/AN/AN/ANP, psychologists, physicians, social workersWhen patients with cancer experience quality psychosocial care
      den Herder-van der Eerden142017Belgium, Germany, Hungary, Netherlands, UKN/A96N/A68 [N/A]Palliative (Not further specified)Physicians, NP, physiotherapists, hospice professionalsExperience of relational, informational and management continuity of care in patients with advanced cancer, COPD or CHF
      Devitt152020AustraliaBreast, GI, hematologic, GU, lung94/5N/A [36–74]N/APhysicians and health professionals, not further specifiedAttitudes of patients toward multidisciplinary cancer meetings
      Donachie162020The NetherlandsGU1717/067 [54–76]Active surveillancePhysicians, NPPsychosocial support needs of prostate cancer patients during active surveillance
      Farias172017USABreast220/22N/AAdjuvant endocrine therapyPhysiciansPhysicians' communication about all aspects of AET treatment from patients' perspective
      Herrmann182021Germany, AustraliaLeukemia, lymphoma, multiple myeloma, myelofibrosis207/1356 [N/A]N/APhysiciansPreferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation
      Hess192021GermanyBreast, GU, GI29N/A58.4 [N/A]N/APhysicians, psychologists, unspecified medical staffPsychosocial needs in cancer patients at the beginning of inpatient rehabilitation
      Hillen202012NetherlandsGI, Breast, GU, Gynecologic, Muscle, Bone, Brain2913/16N/ACurative treatment, palliative treatment, not further specifiedPhysiciansTo elucidate cancer patients' trust in their oncologist
      Hopmans212015NetherlandsLung115/6N/ASurgery, stereotactic ablative radiotherapyPhysiciansPatients experience of treatment decision-making process
      Jacobsen222015CanadaLymphoma, Leukemia, sarcoma, breast, GI, multiple myeloma, GU137/6N/A [18–39]N/ANP, unspecified healthcare providersTo explore how young adults with cancer experience being known by their healthcare team
      Jordan232022USAGU77/075 [N/A]N/APhysiciansPreferences of older patients with advanced bladder cancer related to their communication with providers and navigation of care planning.
      Kvale242010NorwayN/A2010/10N/ACurative treatment, not further specifiedNPTo gain insight into the patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.
      Kumar252020USAGI, Lung3215/1766 [45–80]N/APhysicians, NP, physician assistantsPatients' perceptions of a serious illness conversation with an outpatient oncology clinician
      Lawhon262020USABreast33N/AN/ARadiationPhysiciansShared decision-making and patient preferences
      Lelorain272019FranceN/A21N/AN/AN/APhysicians, NPRelational, organizational, and informational issues
      Lowe282021DenmarkGU1313/0N/A [60–89]Androgen deprivation, chemotherapyPhysicians, NPAttitude of patients to involvement in treatment decisions and how physicians' and nurses' approaches to patient involvement were expressed through attitude and action.
      Martinsson292016SwedenGI, breast156/9N/A [ 41–71]Palliative chemotherapyPhysicians, NPPerspectives on the information received from physicians during palliative chemotherapy regarding cancer diagnosis, treatments, prognosis and future planning
      Masel302016AustriaBreast, lung, brain, GI, sarcoma, GU, skin207/13N/A [42–85]Palliative care, not further specifiedPhysicians, psychologists, dietitians, voluntary workersUnderstanding of patients about their upcoming palliative care, expectations and needs when being admitted for palliative care, what is a good palliative care physician
      McNair312016UKEsophageal3124/767 [55–79]Chemotherapy, pre-surgeryPhysiciansExplore verbal information provision by surgeons during preoperative consultations, and patients' preferences about esophageal cancer surgery
      Myren322021The NetherlandsGynecological80/8N/A [44–80]SurgeryPhysicians, NP, case managersPractical constraints and experiences from the perspective of patients with regard to morbidity and mortality meetings.
      Nababan332020AustraliaLung4724/23N/ASurgery, chemotherapy, radiation therapy, palliative carePhysiciansPatients' experience of GP involvement following lung cancer diagnosis, and patients' view on communication between hospital cancer specialists and GPs.
      Niranjan342020USABreast200/2053 [N/A]N/APhysiciansSupportive care needs of Western Australian women experiencing gynecological cancer
      Noteboom352021The NetherlandsSkin, breast, GI, GU, lung, gynecological206/1469 [54–81]N/APhysiciansTreatment decision-making process and added value of GP involvement
      Pedersen362013DenmarkGI, breast, GU, head/neck, lung, gynecological94/555 [38–74]Chemotherapy, radiation therapy or a combinationNP, unspecified medical staffExplore experiences of how side effects from chemo and radiotherapy impact everyday life as well as information needs in coping with these side effects
      Prip372022DenmarkGynecological, skin, GU189/9N/A [30–80]Chemotherapy, immunotherapyPhysicians, NP, unspecified HCPPatients' experiences of communication with HCP during their course of treatment in an oncology outpatient clinic to elucidate how their needs for support are met
      Retrouvey382019CanadaBreast280/2849 [N/A]Surgery, chemotherapy, radiation therapyPhysiciansBreast cancer patients' acceptability of breast reconstruction
      Rocque392019USABreast200/20N/AChemotherapy, radiotherapy, surgery or a combinationPhysiciansIdentify factors influencing decision making in treatment selection for patients with metastatic breast cancer and oncologists treating MBC
      Salmon402011UKBreast200/20N/A [39–86]SurgeryPhysicians, NPHow to define authentic, caring, clinical relationships? how do patients and surgeons perceive their relationships
      Sattar412018CanadaBreast, GU, GI, lung2012/8[66–78]Chemotherapy and/or radiation therapyPhysiciansTo explore cancer treatment decision making in older adults
      Schildmann422013GermanyGI126/664.6 [40–76]Chemotherapy, radiation, surgeryPhysiciansPerceptions and preferences on information and treatment decision-making
      Step432011USABreast, head/neck, lung, GI gynecologic300/3063 [42–84]N/APhysiciansPerceptions and experiences related to the discussion of prognosis with oncologists when initially diagnosed and when cancer recurred
      Tanay442014UKN/A128/455.6 [36–70]Chemotherapy, palliative care, surgery, radiotherapy or combinationsNP, unspecified health professionalsUse of humor during patient-nursing interactions in an adult cancer ward
      Twibell452020USABreast, leukemia, GI, lung, GU, lymphoma, metastatic/multiple sites, Oral/larynx, skin, adrenal, bone, thyroid30N/A65.4 [26–92]N/ANP, physiciansPerspectives of hospitalized adults with cancer regarding engagement in fall prevention plans
      Van Bruinessen462013NetherlandsLymphoma2812/1659 [39–81]N/APhysiciansTo identify communication barriers and facilitators at all stages after diagnosis
      Van Egmond472019NetherlandsSkin4225/17N/A [60–77]N/APhysiciansCare needs and preferences of patients with basal cell carcinoma and squamous cell carcinoma
      Vaughan482021AustraliaMesothelioma, myeloid leukemia, nasal, breast, lung, GU, GI, peritoneal carcinoma126/6N/A [56–86]N/APhysicians, physiotherapist, dietitians, and NPEvaluation of a Multidisciplinary Cachexia and Nutrition Support Service
      Wagland492019UKGU9797/065.5 [48–87]Radiotherapy, surgery, androgen deprivation therapy, or combinationPhysiciansExperiences of treatment decision making
      Wong502011CanadaBreast160/16N/A [70–84]RadiationPhysiciansInformation needs of older women with early-stage breast cancer in relation to adjuvant treatment post lumpectomy
      Legend, AET: Adjuvant endocrine therapy, COPD: Chronic obstructive pulmonary disease, CHF: Chronic heart failure, GI: Gastro-intestinal, GP: General practitioner, GU: Genitourinary, MBC: Metastatic breast cancer, N/A: Non-available, NP: Nursing professionals.

      3.1 Population characteristics

      A total of 1245 patients under active cancer treatment were included across the 50 studies, of whom 45% (n = 558) was female, 36% (n = 444) was male, and 19% (n = 243) was unspecified. Across all study samples, age ranged from 18 to 92 years. Patients were diagnosed with 21 different types of cancer, the majority being gastrointestinal (34 studies), breast (25 studies), genitourinary (20 studies) and lung cancer (16 studies). Cancer treatments received at time of study were chemotherapy, radiotherapy, surgery, hormone therapy, endocrine therapy, and disease surveillance (Table 2).

      3.2 Quality appraisal results

      Eight studies (references 2, 14, 22, 23, 30, 35, 38, 45 in Table 2) were considered of high-quality (score 9.0–10), 18 studies (references 4, 6, 8, 10–13, 15, 18–20, 26, 27, 32, 37, 39–41 in Table 2) of moderate quality (score 7.5–9.0) and 24 studies (references 1, 3, 5, 7, 9, 16, 17, 21, 24, 25, 28, 29, 31, 33, 34, 36, 42–44, 46–50 in Table 2) of low-quality (score 5.5–7.5). Generally, the low-quality papers lacked in reporting of methodological rigor with regards to specification of the analysis approach (i.e., phenomenological, grounded theory, content analysis), data collection methods (i.e., no interview guide presented) and/or researcher reflexivity. Also, information on the relationship between researcher and participants and methods applied for triangulation and validation of data were often unavailable in studies of lower quality, while these items are deemed essential in qualitative study reporting (
      • Creswell J.W.
      • Creswell J.D.
      Research Design: Qualitative, Quantitative, and Mixed Methods Approaches.
      ;
      • Mays N.
      • Pope C.
      Qualitative research in health care. Assessing quality in qualitative research.
      ). (Table 1).

      3.3 Data synthesis

      The main concept describing positively perceived interaction, emerging from data analysis, was “person-centered care”, incorporating the following themes: “Support, respect, and agency”, “Quantity, timing and clarity of information”, “Confidence, honesty and expertise”.

      3.3.1 Theme 1: support, respect and agency

      A total of 45 studies (8 high, 17 moderate and 20 low-quality papers) (Table 3) reported that the experience of support, respect, and personalized care enhanced a positive perceived patient-professional relationship. The following four subcategories were identified:
      Table 3Example quotes.
      Theme 1: Support, respect, and agency

      45 studies (
      • Aagaard K.
      • Rasmussen B.S.
      • Sorensen E.E.
      • Laursen B.S.
      Patients scheduled for general anesthesia: betwixt and between worrying thoughts and keeping focus.
      ;
      • Abt Sacks A.
      • Perestelo-Perez L.
      • Rodriguez-Martin B.
      • Cuellar-Pompa L.
      • Algara Lopez M.
      • Gonzalez Hernandez N.
      • Serrano-Aguilar P.
      Breast cancer patients' narrative experiences about communication during the oncology care process: a qualitative study.
      ;
      • Albrecht T.A.
      • Keim-Malpass J.
      • Boyiadzis M.
      • Rosenzweig M.
      Psychosocial experiences of young adults diagnosed with acute leukemia during hospitalization for induction chemotherapy treatment.
      ;
      • Anderson J.N.
      • Graff J.C.
      • Krukowski R.A.
      • Schwartzberg L.
      • Vidal G.A.
      • Waters T.M.
      • Paladino A.J.
      • Jones T.N.
      • Blue R.
      • Kocak M.
      • Graetz I.
      Nobody will tell you. You've got to ask!": an examination of patient-provider communication needs and preferences among black and white women with early-stage breast cancer.
      ;
      • Appleton L.
      • Poole H.
      • Wall C.
      Being in safe hands: patients' perceptions of how cancer services may support psychological well-being.
      ;
      • Back A.L.
      • Trinidad S.B.
      • Hopley E.K.
      • Edwards K.A.
      Reframing the goals of care conversation: "we're in a different place.
      ;
      • Best M.
      • Butow P.
      • Olver I.
      Spiritual support of cancer patients and the role of the doctor.
      ;
      • Blakely K.
      • Karanicolas P.J.
      • Wright F.C.
      • Gotlib Conn L.
      Optimistic honesty: understanding surgeon and patient perspectives on hopeful communication in pancreatic cancer care.
      ;
      • Brincat A.
      • Vella Bonanno P.
      • Stewart D.
      • Weidmann A.E.
      Patients' experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study.
      ;
      • Candela M.L.
      • Piredda M.
      • Marchetti A.
      • Facchinetti G.
      • Iacorossi L.
      • Capuzzo M.T.
      • Mecugni D.
      • Rasero L.
      • Matarese M.
      • De Marinis M.G.
      Finding meaning in life: an exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them.
      ;
      • Couchman E.
      • Lempp H.
      • Naismith J.
      • White P.
      The family physician's role in palliative care: views and experiences of patients with cancer.
      ;
      • Daem M.
      • Verbrugghe M.
      • Schrauwen W.
      • Leroux S.
      • Van Hecke A.
      • Grypdonck M.
      How interdisciplinary teamwork contributes to psychosocial cancer support.
      ;
      • den Herder-van der Eerden M.
      • Hasselaar J.
      • Payne S.
      • Varey S.
      • Schwabe S.
      • Radbruch L.
      • Van Beek K.
      • Menten J.
      • Busa C.
      • Csikos A.
      • Vissers K.
      • Groot M.
      How continuity of care is experienced within the context of integrated palliative care: a qualitative study with patients and family caregivers in five European countries.
      ;
      • Devitt B.
      • Philip J.
      • Singh M.
      • McLachlan S.A.
      Understanding patients' attitudes toward cancer multidisciplinary meetings: a mixed methods study.
      ;
      • Donachie K.
      • Cornel E.
      • Adriaansen M.
      • Mennes R.
      • Oort I.
      • Bakker E.
      • Lechner L.
      Optimizing psychosocial support in prostate cancer patients during active surveillance.
      ;
      • Farias A.J.
      • Ornelas I.J.
      • Hohl S.D.
      • Zeliadt S.B.
      • Hansen R.N.
      • Li C.I.
      • Thompson B.
      Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis.
      ;
      • Herrmann A.
      • Holler E.
      • Edinger M.
      • Eickmann S.
      • Wolff D.
      A qualitative study on patients' and their support persons' preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation.
      ;
      • Hess V.
      • Meng K.
      • Schulte T.
      • Neuderth S.
      • Bengel J.
      • Jentschke E.
      • Zoll M.
      • Faller H.
      • Schuler M.
      Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation: a qualitative analysis.
      ;
      • Hillen M.A.
      • Onderwater A.T.
      • van Zwieten M.C.
      • de Haes H.C.
      • Smets E.M.
      Disentangling cancer patients' trust in their oncologist: a qualitative study.
      ;
      • Hopmans W.
      • Damman O.C.
      • Senan S.
      • Hartemink K.J.
      • Smit E.F.
      • Timmermans D.R.
      A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study.
      ;
      • Jacobsen S.K.
      • Bouchard G.M.
      • Emed J.
      • Lepage K.
      • Cook E.
      Experiences of "being known" by the healthcare team of young adult patients with cancer.
      ;
      • Jordan S.R.
      • Geiger C.L.
      • Fischer S.M.
      • Kessler E.R.
      Care planning priorities of older patients with advanced bladder cancer.
      ;
      • Kumar P.
      • Wixon-Genack J.
      • Kavanagh J.
      • Sanders J.J.
      • Paladino J.
      • O'Connor N.R.
      Serious illness conversations with outpatient oncology clinicians: understanding the patient experience.
      ;
      • Kvale K.
      • Bondevik M.
      Patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.
      ;
      • Lawhon V.M.
      • England R.E.
      • Wallace A.S.
      • Williams C.P.
      • Williams B.R.
      • Niranjan S.J.
      • Ingram S.A.
      • Rocque G.B.
      It's important to me": a qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer.
      ;
      • Lelorain S.
      • Moreaux C.
      • Christophe V.
      • Weingertner F.
      • Bricout H.
      Cancer care continuity: a qualitative study on the experiences of French healthcare professionals, patients and family caregivers.
      ;
      • Lowe M.M.
      • Osther P.J.S.
      • Ammentorp J.
      • Birkelund R.
      The balance of patient involvement: patients' and health professionals' perspectives on decision-making in the treatment of advanced prostate cancer.
      ;
      • Masel E.K.
      • Kitta A.
      • Huber P.
      • Rumpold T.
      • Unseld M.
      • Schur S.
      • Porpaczy E.
      • Watzke H.H.
      What makes a good palliative care physician? A qualitative study about the patient's expectations and needs when being admitted to a palliative care unit.
      ;
      • Myren B.J.
      • Hermens R.
      • Koksma J.J.
      • Bastiaans S.
      • de Hullu J.A.
      • Zusterzeel P.L.M.
      Openness to new perspectives created by patient participation at the morbidity and mortality meeting.
      ;
      • Nababan T.
      • Hoskins A.
      • Watters E.
      • Leong J.
      • Saunders C.
      • Slavova-Azmanova N.
      'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care.
      ;
      • Niranjan S.J.
      • Wallace A.
      • Williams B.R.
      • Turkman Y.
      • Williams C.P.
      • Bhatia S.
      • Knight S.
      • Rocque G.B.
      Trust but verify: exploring the role of treatment-related information and patient-physician trust in shared decision making among patients with metastatic breast cancer.
      ;
      • Noteboom E.A.
      • Vervoort S.
      • May A.M.
      • van Dorst E.B.L.
      • van Lindert A.S.R.
      • van Elst M.W.
      • Bijlsma R.M.
      • van der Wall E.
      • de Wit N.J.
      • Helsper C.W.
      Treatment decision-making and the added value of the general practitioner: a qualitative exploration of cancer patients' perspectives.
      ;
      • Pedersen B.
      • Koktved D.P.
      • Nielsen L.L.
      Living with side effects from cancer treatment--a challenge to target information.
      ;
      • Prip A.
      • Pii K.H.
      • Nielsen D.L.
      • Jarden M.
      Patients' experience of communication during their course of treatment in an oncology outpatient clinic: qualitative study.
      ;
      • Retrouvey H.
      • Zhong T.
      • Gagliardi A.R.
      • Baxter N.N.M.D.P.
      • Webster F.
      How patient acceptability affects access to breast reconstruction: a qualitative study.
      ;
      • Rocque G.B.
      • Rasool A.
      • Williams B.R.
      • Wallace A.S.
      • Niranjan S.J.
      • Halilova K.I.
      • Turkman Y.E.
      • Ingram S.A.
      • Williams C.P.
      • Forero-Torres A.
      • Smith T.
      • Bhatia S.
      • Knight S.J.
      What is important when making treatment decisions in metastatic breast cancer? A qualitative analysis of decision-making in patients and oncologists.
      ;
      • Salmon P.
      • Mendick N.
      • Young B.
      Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships.
      ;
      • Sattar S.
      • Alibhai S.M.H.
      • Fitch M.
      • Krzyzanowska M.
      • Leighl N.
      • Puts M.T.E.
      Chemotherapy and radiation treatment decision-making experiences of older adults with cancer: a qualitative study.
      ;
      • Schildmann J.
      • Ritter P.
      • Salloch S.
      • Uhl W.
      • Vollmann J.
      'One also needs a bit of trust in the doctor … ': a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.
      ;
      • Twibell K.R.
      • Siela D.
      • Delaney L.
      • Avila P.
      • Spradlin A.M.
      • Coers G.
      Perspectives of inpatients with cancer on engagement in fall prevention.
      ;
      • van Bruinessen I.R.
      • van Weel-Baumgarten E.M.
      • Gouw H.
      • Zijlstra J.M.
      • Albada A.
      • van Dulmen S.
      Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.
      ;
      • van Egmond S.
      • Wakkee M.
      • Droger M.
      • Bastiaens M.T.
      • van Rengen A.
      • de Roos K.P.
      • Nijsten T.
      • Lugtenberg M.
      Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study.
      ;
      • Vaughan V.C.
      • Harrison M.
      • Dowd A.
      • Eastman P.
      • Martin P.
      Evaluation of a multidisciplinary cachexia and nutrition support service- the patient and carers perspective.
      ;
      • Wagland R.
      • Nayoan J.
      • Matheson L.
      • Rivas C.
      • Brett J.
      • Downing A.
      • Wilding S.
      • Butcher H.
      • Gavin A.
      • Glaser A.W.
      • Watson E.
      'Very difficult for an ordinary guy': factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study.
      ;
      • Wong J.J.
      • D'Alimonte L.
      • Angus J.
      • Paszat L.
      • Soren B.
      • Szumacher E.
      What do older patients with early breast cancer want to know while undergoing adjuvant radiotherapy?.
      )
      Sub-categoryExample quotes (quality according to Critical Appraisal Skills Programme score)
      Experiencing emotional, spiritual, and social support“It makes you feel like she's not just giving you a treatment. She's [the physician] here and she cares about you.”(
      • Jacobsen S.K.
      • Bouchard G.M.
      • Emed J.
      • Lepage K.
      • Cook E.
      Experiences of "being known" by the healthcare team of young adult patients with cancer.
      ) (high-quality paper)
      “When one says, ‘I want to talk to a doctor,’ then there's someone available the whole week who explains everything to you. (…) Simply time. They take time and explain everything carefully” (P05b, female, aged 42 years, suffering from cancer of the small intestine).(
      • Masel E.K.
      • Kitta A.
      • Huber P.
      • Rumpold T.
      • Unseld M.
      • Schur S.
      • Porpaczy E.
      • Watzke H.H.
      What makes a good palliative care physician? A qualitative study about the patient's expectations and needs when being admitted to a palliative care unit.
      ) (high-quality paper)
      Feeling respected and treated as a person“When a clinician is very kind, that is 20% of your recovery. Only being nice. And when he is disrespectful, you decline with 20%”. F, 66y.(
      • Hopmans W.
      • Damman O.C.
      • Senan S.
      • Hartemink K.J.
      • Smit E.F.
      • Timmermans D.R.
      A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study.
      ) (low-quality paper)
      “He [oncologist] knew me by my name, my face. When I came in, it was like they treated you like you were a person and not just cattle coming through. He used to call me his most delicate patient.”(
      • Farias A.J.
      • Ornelas I.J.
      • Hohl S.D.
      • Zeliadt S.B.
      • Hansen R.N.
      • Li C.I.
      • Thompson B.
      Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis.
      ) (low-quality paper)
      Feeling safe, in a welcoming and familiar environment“Well, they get to know you by your first name and it is a very friendly atmosphere, even though it's quite a serious time in your life, they try and make you at ease, which was good” P27.(
      • Appleton L.
      • Poole H.
      • Wall C.
      Being in safe hands: patients' perceptions of how cancer services may support psychological well-being.
      ) (moderate-quality paper)
      “So maybe not directly in the consultation room but you sit down in a room where the atmosphere is a bit more “comfortable”. There you can have a water and a coffee for example. You just loosen it up a bit.” (Patient, female, 29 y, acute lymphoblastic leukemia) (
      • Herrmann A.
      • Holler E.
      • Edinger M.
      • Eickmann S.
      • Wolff D.
      A qualitative study on patients' and their support persons' preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation.
      ) (moderate-quality paper)
      Having agency“I think it's really good giving lots of information but then leaving some of the decision up to the patient, that feels like you're being, I suppose, more in control.”(
      • Best M.
      • Butow P.
      • Olver I.
      Spiritual support of cancer patients and the role of the doctor.
      ) (moderate-quality paper)
      “The problem is I've asked them [clinicians] about treatments and the best treatment and they haven't been able to give me an answer […] They say it's up to me to decide which treatment I want. Unfortunately, because I'm not qualified in that area I can't give an opinion on that, so I'm a bit in limbo [about] which is the best treatment […] I'm very, very depressed about it.” (67 years, stage I, AS: TDM2; DRS 30) (
      • Wagland R.
      • Nayoan J.
      • Matheson L.
      • Rivas C.
      • Brett J.
      • Downing A.
      • Wilding S.
      • Butcher H.
      • Gavin A.
      • Glaser A.W.
      • Watson E.
      'Very difficult for an ordinary guy': factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study.
      ) (low-quality paper)
      Theme 2: Quantity, clarity, and timing of communicated information

      45 studies (
      • Aagaard K.
      • Rasmussen B.S.
      • Sorensen E.E.
      • Laursen B.S.
      Patients scheduled for general anesthesia: betwixt and between worrying thoughts and keeping focus.
      ;
      • Abt Sacks A.
      • Perestelo-Perez L.
      • Rodriguez-Martin B.
      • Cuellar-Pompa L.
      • Algara Lopez M.
      • Gonzalez Hernandez N.
      • Serrano-Aguilar P.
      Breast cancer patients' narrative experiences about communication during the oncology care process: a qualitative study.
      ;
      • Alpert J.M.
      • Morris B.B.
      • Thomson M.D.
      • Matin K.
      • Brown R.F.
      Identifying how patient portals impact communication in oncology.
      ;
      • Anderson J.N.
      • Graff J.C.
      • Krukowski R.A.
      • Schwartzberg L.
      • Vidal G.A.
      • Waters T.M.
      • Paladino A.J.
      • Jones T.N.
      • Blue R.
      • Kocak M.
      • Graetz I.
      Nobody will tell you. You've got to ask!": an examination of patient-provider communication needs and preferences among black and white women with early-stage breast cancer.
      ;
      • Appleton L.
      • Poole H.
      • Wall C.
      Being in safe hands: patients' perceptions of how cancer services may support psychological well-being.
      ;
      • Back A.L.
      • Trinidad S.B.
      • Hopley E.K.
      • Edwards K.A.
      Reframing the goals of care conversation: "we're in a different place.
      ;
      • Best M.
      • Butow P.
      • Olver I.
      Spiritual support of cancer patients and the role of the doctor.
      ;
      • Blakely K.
      • Karanicolas P.J.
      • Wright F.C.
      • Gotlib Conn L.
      Optimistic honesty: understanding surgeon and patient perspectives on hopeful communication in pancreatic cancer care.
      ;
      • Brincat A.
      • Vella Bonanno P.
      • Stewart D.
      • Weidmann A.E.
      Patients' experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study.
      ;
      • Candela M.L.
      • Piredda M.
      • Marchetti A.
      • Facchinetti G.
      • Iacorossi L.
      • Capuzzo M.T.
      • Mecugni D.
      • Rasero L.
      • Matarese M.
      • De Marinis M.G.
      Finding meaning in life: an exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them.
      ;
      • Couchman E.
      • Lempp H.
      • Naismith J.
      • White P.
      The family physician's role in palliative care: views and experiences of patients with cancer.
      ;
      • Daem M.
      • Verbrugghe M.
      • Schrauwen W.
      • Leroux S.
      • Van Hecke A.
      • Grypdonck M.
      How interdisciplinary teamwork contributes to psychosocial cancer support.
      ;
      • Devitt B.
      • Philip J.
      • Singh M.
      • McLachlan S.A.
      Understanding patients' attitudes toward cancer multidisciplinary meetings: a mixed methods study.
      ;
      • Donachie K.
      • Cornel E.
      • Adriaansen M.
      • Mennes R.
      • Oort I.
      • Bakker E.
      • Lechner L.
      Optimizing psychosocial support in prostate cancer patients during active surveillance.
      ;
      • Farias A.J.
      • Ornelas I.J.
      • Hohl S.D.
      • Zeliadt S.B.
      • Hansen R.N.
      • Li C.I.
      • Thompson B.
      Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis.
      ;
      • Herrmann A.
      • Holler E.
      • Edinger M.
      • Eickmann S.
      • Wolff D.
      A qualitative study on patients' and their support persons' preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation.
      ;
      • Hess V.
      • Meng K.
      • Schulte T.
      • Neuderth S.
      • Bengel J.
      • Jentschke E.
      • Zoll M.
      • Faller H.
      • Schuler M.
      Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation: a qualitative analysis.
      ;
      • Hillen M.A.
      • Onderwater A.T.
      • van Zwieten M.C.
      • de Haes H.C.
      • Smets E.M.
      Disentangling cancer patients' trust in their oncologist: a qualitative study.
      ;
      • Hopmans W.
      • Damman O.C.
      • Senan S.
      • Hartemink K.J.
      • Smit E.F.
      • Timmermans D.R.
      A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study.
      ;
      • Jacobsen S.K.
      • Bouchard G.M.
      • Emed J.
      • Lepage K.
      • Cook E.
      Experiences of "being known" by the healthcare team of young adult patients with cancer.
      ;
      • Jordan S.R.
      • Geiger C.L.
      • Fischer S.M.
      • Kessler E.R.
      Care planning priorities of older patients with advanced bladder cancer.
      ;
      • Kumar P.
      • Wixon-Genack J.
      • Kavanagh J.
      • Sanders J.J.
      • Paladino J.
      • O'Connor N.R.
      Serious illness conversations with outpatient oncology clinicians: understanding the patient experience.
      ;
      • Kvale K.
      • Bondevik M.
      Patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.
      ;
      • Lawhon V.M.
      • England R.E.
      • Wallace A.S.
      • Williams C.P.
      • Williams B.R.
      • Niranjan S.J.
      • Ingram S.A.
      • Rocque G.B.
      It's important to me": a qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer.
      ;
      • Lowe M.M.
      • Osther P.J.S.
      • Ammentorp J.
      • Birkelund R.
      The balance of patient involvement: patients' and health professionals' perspectives on decision-making in the treatment of advanced prostate cancer.
      ;
      • Martinsson L.
      • Axelsson B.
      • Melin-Johansson C.
      Patients' perspectives on information from physicians during palliative chemotherapy: a qualitative study.
      ;
      • Masel E.K.
      • Kitta A.
      • Huber P.
      • Rumpold T.
      • Unseld M.
      • Schur S.
      • Porpaczy E.
      • Watzke H.H.
      What makes a good palliative care physician? A qualitative study about the patient's expectations and needs when being admitted to a palliative care unit.
      ;
      • McNair A.G.K.
      • MacKichan F.
      • Donovan J.L.
      • Brookes S.T.
      • Avery K.N.L.
      • Griffin S.M.
      • Crosby T.
      • Blazeby J.M.
      What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study.
      ;
      • Myren B.J.
      • Hermens R.
      • Koksma J.J.
      • Bastiaans S.
      • de Hullu J.A.
      • Zusterzeel P.L.M.
      Openness to new perspectives created by patient participation at the morbidity and mortality meeting.
      ;
      • Nababan T.
      • Hoskins A.
      • Watters E.
      • Leong J.
      • Saunders C.
      • Slavova-Azmanova N.
      'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care.
      ;
      • Niranjan S.J.
      • Wallace A.
      • Williams B.R.
      • Turkman Y.
      • Williams C.P.
      • Bhatia S.
      • Knight S.
      • Rocque G.B.
      Trust but verify: exploring the role of treatment-related information and patient-physician trust in shared decision making among patients with metastatic breast cancer.
      ;
      • Noteboom E.A.
      • Vervoort S.
      • May A.M.
      • van Dorst E.B.L.
      • van Lindert A.S.R.
      • van Elst M.W.
      • Bijlsma R.M.
      • van der Wall E.
      • de Wit N.J.
      • Helsper C.W.
      Treatment decision-making and the added value of the general practitioner: a qualitative exploration of cancer patients' perspectives.
      ;
      • Pedersen B.
      • Koktved D.P.
      • Nielsen L.L.
      Living with side effects from cancer treatment--a challenge to target information.
      ;
      • Prip A.
      • Pii K.H.
      • Nielsen D.L.
      • Jarden M.
      Patients' experience of communication during their course of treatment in an oncology outpatient clinic: qualitative study.
      ;
      • Retrouvey H.
      • Zhong T.
      • Gagliardi A.R.
      • Baxter N.N.M.D.P.
      • Webster F.
      How patient acceptability affects access to breast reconstruction: a qualitative study.
      ;
      • Sattar S.
      • Alibhai S.M.H.
      • Fitch M.
      • Krzyzanowska M.
      • Leighl N.
      • Puts M.T.E.
      Chemotherapy and radiation treatment decision-making experiences of older adults with cancer: a qualitative study.
      ;
      • Schildmann J.
      • Ritter P.
      • Salloch S.
      • Uhl W.
      • Vollmann J.
      'One also needs a bit of trust in the doctor … ': a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.
      ;
      • Step M.M.
      • Ray E.B.
      Patient perceptions of oncologist-patient communication about prognosis: changes from initial diagnosis to cancer recurrence.
      ;
      • Tanay M.A.
      • Wiseman T.
      • Roberts J.
      • Ream E.
      A time to weep and a time to laugh: humour in the nurse-patient relationship in an adult cancer setting.
      ;
      • Twibell K.R.
      • Siela D.
      • Delaney L.
      • Avila P.
      • Spradlin A.M.
      • Coers G.
      Perspectives of inpatients with cancer on engagement in fall prevention.
      ;
      • van Bruinessen I.R.
      • van Weel-Baumgarten E.M.
      • Gouw H.
      • Zijlstra J.M.
      • Albada A.
      • van Dulmen S.
      Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.
      ;
      • van Egmond S.
      • Wakkee M.
      • Droger M.
      • Bastiaens M.T.
      • van Rengen A.
      • de Roos K.P.
      • Nijsten T.
      • Lugtenberg M.
      Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study.
      ;
      • Vaughan V.C.
      • Harrison M.
      • Dowd A.
      • Eastman P.
      • Martin P.
      Evaluation of a multidisciplinary cachexia and nutrition support service- the patient and carers perspective.
      ;
      • Wagland R.
      • Nayoan J.
      • Matheson L.
      • Rivas C.
      • Brett J.
      • Downing A.
      • Wilding S.
      • Butcher H.
      • Gavin A.
      • Glaser A.W.
      • Watson E.
      'Very difficult for an ordinary guy': factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study.
      ;
      • Wong J.J.
      • D'Alimonte L.
      • Angus J.
      • Paszat L.
      • Soren B.
      • Szumacher E.
      What do older patients with early breast cancer want to know while undergoing adjuvant radiotherapy?.
      )
      Timing and quantity of information provided“I like that the doctor was very expansive in what they were saying. And giving a lot of information, without the patient having to ask a lot of questions or think up what the next question is they should be asking.’’(
      • Back A.L.
      • Trinidad S.B.
      • Hopley E.K.
      • Edwards K.A.
      Reframing the goals of care conversation: "we're in a different place.
      ) (low-quality paper)

      “I don't think I was as interested in that sort of detail. I know that there are risks, I don't want to dwell on it. It's always near the front of your mind at this particular time- and you're trying to get away from that as much as possible (IS017)(
      • McNair A.G.K.
      • MacKichan F.
      • Donovan J.L.
      • Brookes S.T.
      • Avery K.N.L.
      • Griffin S.M.
      • Crosby T.
      • Blazeby J.M.
      What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study.
      ) (low-quality paper)

      “Often when you have asked a question, you get an answer and you have to think it over. And then the consultation is finished before you have thought about it. Then you start to think, oh what are they sending me home with this time”.(
      • van Bruinessen I.R.
      • van Weel-Baumgarten E.M.
      • Gouw H.
      • Zijlstra J.M.
      • Albada A.
      • van Dulmen S.
      Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.
      ) (low-quality paper)
      Being provided with clear information“Yes, he said that to me in a clear, calm manner … he provided me such shocking information in a way that made me feel reassured, protected. I told myself ‘all right, nothing is going to happen’. I give full marks to the surgeon [ …] He perfectly explained what was going on and we were going to start (patient diagnosed in 2009).”(
      • Abt Sacks A.
      • Perestelo-Perez L.
      • Rodriguez-Martin B.
      • Cuellar-Pompa L.
      • Algara Lopez M.
      • Gonzalez Hernandez N.
      • Serrano-Aguilar P.
      Breast cancer patients' narrative experiences about communication during the oncology care process: a qualitative study.
      ) (high-quality paper)
      “[Clinician] made me understand a lot of things … making it clear what could happen.” (PID 20) (
      • Kumar P.
      • Wixon-Genack J.
      • Kavanagh J.
      • Sanders J.J.
      • Paladino J.
      • O'Connor N.R.
      Serious illness conversations with outpatient oncology clinicians: understanding the patient experience.
      ) (low-quality paper)
      Communication skills“[the information] was put so bluntly. And I thought it could have been more gentle. And the doctor admitted she doesn't take that approach. But when you're talking to someone older who already has other medical challenges perhaps it could have been done with a little more gentleness … rather than I don't believe in buttering things up, I′m gonna tell you straight as it is. We like that approach but in this particular case I think it could have been a little more gentle.” (Male, prostate cancer)(
      • Sattar S.
      • Alibhai S.M.H.
      • Fitch M.
      • Krzyzanowska M.
      • Leighl N.
      • Puts M.T.E.
      Chemotherapy and radiation treatment decision-making experiences of older adults with cancer: a qualitative study.
      ) (moderate-quality paper)
      “[About humor] It creates a bond …”(
      • Tanay M.A.
      • Wiseman T.
      • Roberts J.
      • Ream E.
      A time to weep and a time to laugh: humour in the nurse-patient relationship in an adult cancer setting.
      ) (low-quality paper)
      “I asked “[…] What are the chance that I live or not live? What are the odds 50/50 or 60/40?” He replied that we are not in the business of odds and removed the eye contact. And his body language showed either he was not confident, or it was bad news for me … so it gave me a bad feeling.” [P016]. (
      • Brincat A.
      • Vella Bonanno P.
      • Stewart D.
      • Weidmann A.E.
      Patients' experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study.
      ) (moderate-quality paper)
      Theme 3: Confidence, honesty, and expertise

      41 studies (
      • Aagaard K.
      • Rasmussen B.S.
      • Sorensen E.E.
      • Laursen B.S.
      Patients scheduled for general anesthesia: betwixt and between worrying thoughts and keeping focus.
      ;
      • Abt Sacks A.
      • Perestelo-Perez L.
      • Rodriguez-Martin B.
      • Cuellar-Pompa L.
      • Algara Lopez M.
      • Gonzalez Hernandez N.
      • Serrano-Aguilar P.
      Breast cancer patients' narrative experiences about communication during the oncology care process: a qualitative study.
      ;
      • Anderson J.N.
      • Graff J.C.
      • Krukowski R.A.
      • Schwartzberg L.
      • Vidal G.A.
      • Waters T.M.
      • Paladino A.J.
      • Jones T.N.
      • Blue R.
      • Kocak M.
      • Graetz I.
      Nobody will tell you. You've got to ask!": an examination of patient-provider communication needs and preferences among black and white women with early-stage breast cancer.
      ;
      • Appleton L.
      • Poole H.
      • Wall C.
      Being in safe hands: patients' perceptions of how cancer services may support psychological well-being.
      ;
      • Back A.L.
      • Trinidad S.B.
      • Hopley E.K.
      • Edwards K.A.
      Reframing the goals of care conversation: "we're in a different place.
      ;
      • Best M.
      • Butow P.
      • Olver I.
      Spiritual support of cancer patients and the role of the doctor.
      ;
      • Blakely K.
      • Karanicolas P.J.
      • Wright F.C.
      • Gotlib Conn L.
      Optimistic honesty: understanding surgeon and patient perspectives on hopeful communication in pancreatic cancer care.
      ;
      • Brincat A.
      • Vella Bonanno P.
      • Stewart D.
      • Weidmann A.E.
      Patients' experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study.
      ;
      • Candela M.L.
      • Piredda M.
      • Marchetti A.
      • Facchinetti G.
      • Iacorossi L.
      • Capuzzo M.T.
      • Mecugni D.
      • Rasero L.
      • Matarese M.
      • De Marinis M.G.
      Finding meaning in life: an exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them.
      ;
      • Couchman E.
      • Lempp H.
      • Naismith J.
      • White P.
      The family physician's role in palliative care: views and experiences of patients with cancer.
      ;
      • Daem M.
      • Verbrugghe M.
      • Schrauwen W.
      • Leroux S.
      • Van Hecke A.
      • Grypdonck M.
      How interdisciplinary teamwork contributes to psychosocial cancer support.
      ;
      • den Herder-van der Eerden M.
      • Hasselaar J.
      • Payne S.
      • Varey S.
      • Schwabe S.
      • Radbruch L.
      • Van Beek K.
      • Menten J.
      • Busa C.
      • Csikos A.
      • Vissers K.
      • Groot M.
      How continuity of care is experienced within the context of integrated palliative care: a qualitative study with patients and family caregivers in five European countries.
      ;
      • Devitt B.
      • Philip J.
      • Singh M.
      • McLachlan S.A.
      Understanding patients' attitudes toward cancer multidisciplinary meetings: a mixed methods study.
      ;
      • Donachie K.
      • Cornel E.
      • Adriaansen M.
      • Mennes R.
      • Oort I.
      • Bakker E.
      • Lechner L.
      Optimizing psychosocial support in prostate cancer patients during active surveillance.
      ;
      • Farias A.J.
      • Ornelas I.J.
      • Hohl S.D.
      • Zeliadt S.B.
      • Hansen R.N.
      • Li C.I.
      • Thompson B.
      Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis.
      ;
      • Herrmann A.
      • Holler E.
      • Edinger M.
      • Eickmann S.
      • Wolff D.
      A qualitative study on patients' and their support persons' preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation.
      ;
      • Hess V.
      • Meng K.
      • Schulte T.
      • Neuderth S.
      • Bengel J.
      • Jentschke E.
      • Zoll M.
      • Faller H.
      • Schuler M.
      Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation: a qualitative analysis.
      ;
      • Hillen M.A.
      • Onderwater A.T.
      • van Zwieten M.C.
      • de Haes H.C.
      • Smets E.M.
      Disentangling cancer patients' trust in their oncologist: a qualitative study.
      ;
      • Hopmans W.
      • Damman O.C.
      • Senan S.
      • Hartemink K.J.
      • Smit E.F.
      • Timmermans D.R.
      A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study.
      ;
      • Jacobsen S.K.
      • Bouchard G.M.
      • Emed J.
      • Lepage K.
      • Cook E.
      Experiences of "being known" by the healthcare team of young adult patients with cancer.
      ;
      • Jordan S.R.
      • Geiger C.L.
      • Fischer S.M.
      • Kessler E.R.
      Care planning priorities of older patients with advanced bladder cancer.
      ;
      • Kumar P.
      • Wixon-Genack J.
      • Kavanagh J.
      • Sanders J.J.
      • Paladino J.
      • O'Connor N.R.
      Serious illness conversations with outpatient oncology clinicians: understanding the patient experience.
      ;
      • Kvale K.
      • Bondevik M.
      Patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.
      ;
      • Lawhon V.M.
      • England R.E.
      • Wallace A.S.
      • Williams C.P.
      • Williams B.R.
      • Niranjan S.J.
      • Ingram S.A.
      • Rocque G.B.
      It's important to me": a qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer.
      ;
      • Lowe M.M.
      • Osther P.J.S.
      • Ammentorp J.
      • Birkelund R.
      The balance of patient involvement: patients' and health professionals' perspectives on decision-making in the treatment of advanced prostate cancer.
      ;
      • Martinsson L.
      • Axelsson B.
      • Melin-Johansson C.
      Patients' perspectives on information from physicians during palliative chemotherapy: a qualitative study.
      ;
      • Masel E.K.
      • Kitta A.
      • Huber P.
      • Rumpold T.
      • Unseld M.
      • Schur S.
      • Porpaczy E.
      • Watzke H.H.
      What makes a good palliative care physician? A qualitative study about the patient's expectations and needs when being admitted to a palliative care unit.
      ;
      • McNair A.G.K.
      • MacKichan F.
      • Donovan J.L.
      • Brookes S.T.
      • Avery K.N.L.
      • Griffin S.M.
      • Crosby T.
      • Blazeby J.M.
      What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study.
      ;
      • Myren B.J.
      • Hermens R.
      • Koksma J.J.
      • Bastiaans S.
      • de Hullu J.A.
      • Zusterzeel P.L.M.
      Openness to new perspectives created by patient participation at the morbidity and mortality meeting.
      ;
      • Nababan T.
      • Hoskins A.
      • Watters E.
      • Leong J.
      • Saunders C.
      • Slavova-Azmanova N.
      'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care.
      ;
      • Niranjan S.J.
      • Wallace A.
      • Williams B.R.
      • Turkman Y.
      • Williams C.P.
      • Bhatia S.
      • Knight S.
      • Rocque G.B.
      Trust but verify: exploring the role of treatment-related information and patient-physician trust in shared decision making among patients with metastatic breast cancer.
      ;
      • Noteboom E.A.
      • Vervoort S.
      • May A.M.
      • van Dorst E.B.L.
      • van Lindert A.S.R.
      • van Elst M.W.
      • Bijlsma R.M.
      • van der Wall E.
      • de Wit N.J.
      • Helsper C.W.
      Treatment decision-making and the added value of the general practitioner: a qualitative exploration of cancer patients' perspectives.
      ;
      • Pedersen B.
      • Koktved D.P.
      • Nielsen L.L.
      Living with side effects from cancer treatment--a challenge to target information.
      ;
      • Retrouvey H.
      • Zhong T.
      • Gagliardi A.R.
      • Baxter N.N.M.D.P.
      • Webster F.
      How patient acceptability affects access to breast reconstruction: a qualitative study.
      ;
      • Rocque G.B.
      • Rasool A.
      • Williams B.R.
      • Wallace A.S.
      • Niranjan S.J.
      • Halilova K.I.
      • Turkman Y.E.
      • Ingram S.A.
      • Williams C.P.
      • Forero-Torres A.
      • Smith T.
      • Bhatia S.
      • Knight S.J.
      What is important when making treatment decisions in metastatic breast cancer? A qualitative analysis of decision-making in patients and oncologists.
      ;
      • Salmon P.
      • Mendick N.
      • Young B.
      Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships.
      ;
      • Sattar S.
      • Alibhai S.M.H.
      • Fitch M.
      • Krzyzanowska M.
      • Leighl N.
      • Puts M.T.E.
      Chemotherapy and radiation treatment decision-making experiences of older adults with cancer: a qualitative study.
      ;
      • Schildmann J.
      • Ritter P.
      • Salloch S.
      • Uhl W.
      • Vollmann J.
      'One also needs a bit of trust in the doctor … ': a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.
      ;
      • van Bruinessen I.R.
      • van Weel-Baumgarten E.M.
      • Gouw H.
      • Zijlstra J.M.
      • Albada A.
      • van Dulmen S.
      Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.
      ;
      • van Egmond S.
      • Wakkee M.
      • Droger M.
      • Bastiaens M.T.
      • van Rengen A.
      • de Roos K.P.
      • Nijsten T.
      • Lugtenberg M.
      Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study.
      ;
      • Wagland R.
      • Nayoan J.
      • Matheson L.
      • Rivas C.
      • Brett J.
      • Downing A.
      • Wilding S.
      • Butcher H.
      • Gavin A.
      • Glaser A.W.
      • Watson E.
      'Very difficult for an ordinary guy': factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study.
      )
      Being in the hands of confident and honest professionals“I trust their judgement more than mine” (patient 6) (
      • Rocque G.B.
      • Rasool A.
      • Williams B.R.
      • Wallace A.S.
      • Niranjan S.J.
      • Halilova K.I.
      • Turkman Y.E.
      • Ingram S.A.
      • Williams C.P.
      • Forero-Torres A.
      • Smith T.
      • Bhatia S.
      • Knight S.J.
      What is important when making treatment decisions in metastatic breast cancer? A qualitative analysis of decision-making in patients and oncologists.
      ) (moderate-quality paper)
      “I don't want you to, like, half-lie to me. That [qualitative statement], to me, is half lying, you know, it's saying, ‘Oh,’ you know, ‘it often returns,’ whereas this one tells me, ‘Hey, it does return most of the time. It's up to you to help it not return.’” Patient 8. (
      • Blakely K.
      • Karanicolas P.J.
      • Wright F.C.
      • Gotlib Conn L.
      Optimistic honesty: understanding surgeon and patient perspectives on hopeful communication in pancreatic cancer care.
      ) (low-quality paper)
      “One discovers very quickly if the nurses have knowledge about the disease. They know what they are talking about. That makes me feel secure. I do not have confidence in all the nurses. I ask the ones I trust.” (
      • Kvale K.
      • Bondevik M.
      Patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.
      ) (low-quality paper)

      3.3.1.1 Experiencing emotional, spiritual, and social support

      Patients' experiences of support received from healthcare professionals were positive in most studies. It was highly appreciated when healthcare professionals had a caring attitude and showed personal interest in patients extending beyond health issues (references 2, 9, 12, 14, 17, 21, 22, 24, 30, 36, 39, 40, 42, 45, 47 in Table 2). Moreover, if healthcare professionals were perceived as available, by allocating enough time during consultations, this comforted patients in the idea that they were met with genuine concern (references 2, 5, 7, 9, 10, 12, 18–22, 30, 32, 33, 35–37, 39, 40 in Table 2). Patients reported positive experiences when healthcare professionals showed empathy, were understanding or provided emotional support (references 1, 5, 7–9, 12, 13, 16, 18, 19, 21, 23, 25, 32–35, 37, 41, 45, 48, 50 in Table 2). Receiving social support towards home and financial situations was appreciated, and providing access to spiritual support or allowing patients to talk about spiritual beliefs openly was perceived positively (references 5, 8 in Table 2). When facing financial and familial challenges being able to count on healthcare professionals to deal with these issues was positively perceived (references 2, 9, 14, 30, 50 in Table 2).

      3.3.1.2 Feeling respected and treated as a person

      Feeling respected during interaction with healthcare professionals was perceived as essential by patients in many studies (references 2, 12, 17, 19, 21, 30 in Table 2). Being given consideration when expressing preferences and opinions improved patient-professional relationships (reference 21 in Table 2). A personalized approach made patients feel like “normal human-beings” and valued (references 2, 6–8, 13, 14, 17, 18, 20, 22, 26, 36, 38, 45, 50 in Table 2).

      3.3.1.3 Feeling safe in a welcoming and familiar environment

      Studies identified a patient-perceived reduced burden of disease when experiencing a friendly and positive social and physical environment in which they received their treatments (references 2, 6, 18, 22, 30, 36, 37 in Table 2). In addition, relational continuity, defined as being able to count on the same healthcare professionals throughout the entire care process, was positively perceived and increased feelings of safety in the healthcare institution (references 1, 2, 12, 14, 22–24, 27, 36, 46, 47 in Table 2).

      3.3.1.4 Having agency

      Several studies identified patients being appreciative of being involved in decision-making regarding their treatment plan, as this was perceived as being given control and being part of the team striving towards the best possible outcome (references 2, 8, 14, 15, 21, 22, 25, 26, 28, 30, 35, 38, 39, 41, 46, 47, 49 in Table 2). In this context, patients perceived it as essential that healthcare professionals provide advice regarding treatment decision-making (references 7, 17, 23, 35, 38, 41, 49 in Table 2). In contrast, several other studies described patients' negative experiences regarding shared decision-making, experiencing this as a burden. Instead, patients in these studies expressed that healthcare professionals should use their expertise to recommend treatment options (references 2, 28, 41, 47, 49 in Table 2). (See Table 3 for example quotes).

      3.3.2 Theme 2: quantity, timing and clarity of information

      Themes related to quantity, timing, and clarity of received information were identified in 45 studies (8 high, 15 medium, and 23 low-quality studies) (Table 3) as important aspects to a positively perceived interaction between patients and healthcare professionals. However, preferences varied across study populations. Some studies reported patients’ preferences for receiving detailed disease information, treatment options and consequences, whereas other studies reported on patients preferring less detail. Several studies identified patients perceiving the quantity of information as being overwhelming and therefore difficult to grasp. The following subcategories illustrate experiences of quantity, timing, and clarity of information provided and verbal and non-verbal communication aspects in patient-professional interaction.

      3.3.2.1 Timing and quantity of information provided

      Patients’ experiences with the quantity of information varied across studies. Nine studies identified information needs being dependent on individual patient preferences (references 2, 9 10, 25, 28, 33, 36, 43, 50 in Table 2). Some study respondents appreciated when efforts were made to provide extensive information, as this confirmed to them that healthcare professionals are experts on the topic and it facilitated decision-making (references 1, 2, 4–10, 16–19, 21–26, 28, 31–33, 36–38, 49, 50 in Table 2). In contrast, a high quantity of information can be overwhelming or even unwanted, as patients deemed technical details unnecessary (references 2, 7, 18, 36, 42, 46 in Table 2). Therefore, being provided with (treatment) information gradually, on-demand and by choice was positively perceived by patients (references 2, 7, 22, 47 in Table 2).

      3.3.2.2 Being provided with clear information

      Clarity of information seemed to revolve around the negative experience of the information being inadequate or incomplete (references 2, 20, 23, 25, 29, 30, 33, 41, 47, 50 in Table 2). Information provision was perceived as adequate when it was understandable and when time was taken to answer questions and check how the information was received (references 2, 6, 9, 21–23, 30, 31, 33, 36, 47, 49, 50 in Table 2). Studies identified being shown what to do and where to go, receiving graphics including visual aids, and receiving structured and succinct information as positive experiences (references 6, 7, 9, 36, 50 in Table 2).

      3.3.2.3 Communication skills

      Patients positively perceived healthcare professionals' use of reflective and sensitive ways of communication. Personal preferences were leading in how direct, or more indirect forms of communication were applied (references 19, 22, 23, 41, 44 in Table 2). Patients appreciated active listening skills, demonstrating concern and understanding (references 7–9, 19, 33, 48 in Table 2). In contrast, in 9 studies, patients experienced the use of metaphors, complicated language, or being cryptic in communication as confusing (references 2, 5, 10, 18, 23, 29, 41, 43, 46 in Table 2). Five studies reported on patients’ positive experiences with healthcare professionals applying humor during their consultations, although individual preferences make it necessary to check when the use of humor is appropriate (references 1, 2, 6, 22, 44 in Table 2). Several studies identified the importance of non-verbal communication in patient-professional interaction and a friendly and positive attitude (references 1, 2, 4, 7, 9, 13, 17, 21, 22, 30, 36, 37 in Table 2).

      3.3.3 Theme 3: confidence, honesty, and expertise

      A show of confidence, honesty, and expertise by healthcare providers was perceived positively by patient populations in 41 studies (7 high, 15 medium, and 19 low-quality papers) (Table 3), and these aspects were identified as key elements in developing a trusting relationship between patients, relatives, and healthcare professionals. The following subcategory illustrates patient experiences further:

      3.3.3.1 Being in the hands of confident and honest professionals

      In most studies where "trust" was identified as a theme, patients experienced this as a given because of the professional's qualifications. Trust increased when dealing with known experts in the field, as this increased feelings of safety (references 1, 2, 5–7, 9–14, 17, 18, 20, 22–24, 26, 28, 30, 32–35, 38–42, 47 in Table 2). In addition, greater trust in healthcare professionals was experienced when patients were met with self-confident professionals showing to be in control and projecting honesty and integrity (references 1, 2, 5–9, 13, 17, 20, 22–32, 40, 41 in Table 2). Nevertheless, professionals being able to recognize the limit to their own expertise and who do not hesitate to consult or refer to a colleague or scientific literature were highly appreciated by patients (references 2, 14, 24 in Table 2).

      3.4 Sensitivity analysis

      All studies were conducted in western countries with various healthcare models. The larger part of the studies (78%) included patient populations in disease stages I-III. The three transcending themes identified in this meta-synthesis were equally distributed across the 50 studies. See Fig. 2 for an overview of the themes, cross-checked against the individual study results, settings, and populations.

      4. Discussion

      The objective of this systematic qualitative meta-synthesis was to gather, appraise, and provide an overarching thematic synthesis of results from the current body of qualitative research on positive and negative experiences of patients receiving cancer treatment regarding their interaction with healthcare professionals, and to identify elements that professionals can use to optimize the interaction with their patients. This study identified three themes: “Support, respect, and agency”, “Amount, timing and clarity of information provided”, and “Confidence, honesty, and expertise”, within one overarching concept connected with positive experiences of patient-professional interaction: “Person-centered care”.
      Person-centered care is a concept that actively involves patients as partners of healthcare professionals, ensuring that patients’ preferences, needs, and values guide clinical decisions. In the past decades, person-centered care has been shown to improve health outcomes and increase patient satisfaction, making it a key component of high-quality care (
      • Loonen J.J.
      • Blijlevens N.M.
      • Prins J.
      • Dona D.J.
      • Den Hartogh J.
      • Senden T.
      • van Dulmen-Den Broeder E.
      • van der Velden K.
      • Hermens R.P.
      Cancer survivorship care: person centered care in a multidisciplinary shared care model.
      ;
      • McMillan S.S.
      • Kendall E.
      • Sav A.
      • King M.A.
      • Whitty J.A.
      • Kelly F.
      • Wheeler A.J.
      Patient-centered approaches to health care: a systematic review of randomized controlled trials.
      ).
      Across all included studies, positive experiences related to fundamental principles of person-centered care, as defined by Geirtes et al. (
      • Gerteis M.
      • Edgman-Levitan S.
      • Walker J.D.
      • Stoke D.M.
      • Cleary P.D.
      • Delbanco T.L.
      What patients really want.
      ) and the National Academy of Medicine (
      Institute of Medicine Committee on Quality of Health Care in, A
      Crossing the Quality Chasm: A New Health System for the 21st Century.
      ): “respect for patients' values, preferences, and expressed needs”, “information, communication, and education”, “physical comfort”, and “emotional support - relieving fear and anxiety”. In contrast, as shown in this qualitative meta-synthesis, the provision of care which lacked person-centeredness, especially when adopting a paternalistic approach and ignoring patients’ preferences regarding information provision and support needs, repeatedly resulted in negative experiences. Since even the most recent studies report negative patient experiences, our results seem to indicate that the application of the person-centered concept is not yet optimal.
      The first theme – Support, respect, and agency – reflects that each person with cancer has personal needs and expectations and wants to be seen and treated accordingly. It also reflects that individuals with cancer value being supported in their autonomy. However, although supporting patients’ autonomy by providing them with information, giving them the possibility to make their own decisions, and empowering them towards healthier behaviors is an important goal for healthcare professionals (
      • Chen J.
      • Mullins C.D.
      • Novak P.
      • Thomas S.B.
      Personalized strategies to activate and empower patients in health care and reduce health disparities.
      ;
      • Velikova G.
      • Fallowfield L.
      • Younger J.
      • Board R.E.
      • Selby P.
      Problem Solving in Patient-Centred and Integrated Cancer Care.
      ), recent literature shows that this goal is often unmet. For example, in a recently published overview of systematic reviews, Chaboyer et al. identify self-management, autonomy, education of patients and families, and emotional and psychological care, including spiritual support, as missed nursing care, i.e., nursing care that is often lacking, which is consistent with our findings (
      • Chaboyer W.
      • Harbeck E.
      • Lee B.O.
      • Grealish L.
      Missed nursing care: an overview of reviews.
      ).
      The results of this meta-synthesis also highlight interpersonal differences in the amount and kind of (emotional, social and/or spiritual) support needed and the extent to which each individual wants to have agency. Previous studies found that discrepancies between information needed to be able to take part in decision making and the information available and provided, as well as an authoritarian attitude of the healthcare professional, were potential reasons for patients preferring to leave the decisions up to healthcare professionals (
      • Frosch D.L.
      • May S.G.
      • Rendle K.A.
      • Tietbohl C.
      • Elwyn G.
      Authoritarian physicians and patients' fear of being labeled ‘difficult’among key obstacles to shared decision making.
      ;
      • Rutten L.J.
      • Arora N.K.
      • Bakos A.D.
      • Aziz N.
      • Rowland J.
      Information needs and sources of information among cancer patients: a systematic review of research (1980-2003).
      ). On the contrary, in a survey study of cancer survivors, Chawla and Arora reported that patients who preferred not taking part in decision making had greater trust in their physicians (
      • Chawla N.
      • Arora N.K.
      Why do some patients prefer to leave decisions up to the doctor: lack of self-efficacy or a matter of trust?.
      ). These findings imply that healthcare professionals should be aware of the need to create a safe and welcoming environment and individualize their approach to facilitate shared decision making.
      In cancer care, providing individualized support is essential to improve health outcomes (
      • Berman R.
      • Davies A.
      • Cooksley T.
      • Gralla R.
      • Carter L.
      • Darlington E.
      • Scotté F.
      • Higham C.
      Supportive care: an indispensable component of modern oncology.
      ). Several studies found that the support provided by healthcare professionals plays an important role in improving the quality of life of patients with cancer. This support is not merely instrumental (i.e., making sure treatment is adequately followed or providing effective symptom remediation) but also strongly related to feelings of being seen, heard, encouraged, and coached in an individualized manner (
      • Cochrane A.
      • Woods S.
      • Dunne S.
      • Gallagher P.
      Unmet supportive care needs associated with quality of life for people with lung cancer: a systematic review of the evidence 2007–2020.
      ;
      • Faller H.
      • Hass H.G.
      • Engehausen D.
      • Reuss-Borst M.
      • Wöckel A.
      Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study.
      ;
      • Sweegers M.G.
      • Buffart L.M.
      • van Veldhuizen W.M.
      • Geleijn E.
      • Verheul H.M.W.
      • Brug J.
      • Chinapaw M.J.M.
      • Altenburg T.M.
      How does a supervised exercise program improve quality of life in patients with cancer? A concept mapping study examining patients' perspectives.
      ). In contrast, poorly executed fundamental care threatens patients’ feelings of safety, quality of life, empowerment, functioning, and satisfaction (
      • Feo R.
      • Kitson A.
      Promoting patient-centred fundamental care in acute healthcare systems.
      ;
      • Jackson D.
      • Kozlowska O.
      Fundamental care-the quest for evidence.
      ).
      Together, these findings imply that healthcare professionals should be consciously aware of their supportive role in treating patients during cancer care. While individualized support is invaluable, care should be taken to avoid patients’ dependency on healthcare professionals. Such reliance is not desirable from a healthcare cost containment perspective but also conflicts with the objective to improve adaptation and self-management in patients (
      • Huber M.
      • Knottnerus J.A.
      • Green L.
      • van der Horst H.
      • Jadad A.R.
      • Kromhout D.
      • Leonard B.
      • Lorig K.
      • Loureiro M.I.
      • van der Meer J.W.
      • Schnabel P.
      • Smith R.
      • van Weel C.
      • Smid H.
      How should we define health?.
      ).
      The second theme – Quantity, timing, and clarity of information – shows the need for tailoring the information provision to patients. Too much information can be overwhelming or confusing, but too little information may cause anxiety. Previous systematic reviews found that communication and information needs of patients with cancer evolve throughout the continuum of care and are often unmet. During the treatment phase, information needs revolve around the stage of the disease, treatment options, and side effects. In the post-treatment phase, patients need more information on rehabilitation, self-management, follow-up, and long-term side effects (
      • Chaboyer W.
      • Harbeck E.
      • Lee B.O.
      • Grealish L.
      Missed nursing care: an overview of reviews.
      ;
      • Rutten L.J.
      • Arora N.K.
      • Bakos A.D.
      • Aziz N.
      • Rowland J.
      Information needs and sources of information among cancer patients: a systematic review of research (1980-2003).
      ;
      • Wang T.
      • Molassiotis A.
      • Chung B.P.M.
      • Tan J.-Y.
      Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review.
      ).
      Furthermore, many patients are anxious or show signs of depression, which influences their needs concerning information communication and their ability to process such information (
      • Goerling U.
      • Faller H.
      • Hornemann B.
      • Hönig K.
      • Bergelt C.
      • Maatouk I.
      • Stein B.
      • Teufel M.
      • Erim Y.
      • Geiser F.
      Information needs in cancer patients across the disease trajectory. A prospective study.
      ;
      • Nguyen M.H.
      • Smets E.M.
      • Bol N.
      • Bronner M.B.
      • Tytgat K.M.
      • Loos E.F.
      • van Weert J.C.
      Fear and forget: how anxiety impacts information recall in newly diagnosed cancer patients visiting a fast-track clinic.
      ).
      • Kessels R.P.
      Patients' memory for medical information.
      reported patients' recall of medical information to be poor, as 40–80% of the information provided by healthcare professionals was immediately forgotten. This was explained by the use of complex medical terminology or patient educational level, as well as the mode in which information was presented. As our meta-synthesis shows, timely and effective provision of personalized information to patients with cancer is challenging for many healthcare professionals. Indeed, the results of this meta-synthesis show negative patient experiences when receiving an overwhelming or unclear amount of information. This was due to healthcare professionals' use of technical terminologies or ignored patients' preferences to receive less information or at another moment. Since patients’ preferences regarding disease information, treatment options, and consequences differ substantially from one individual to another, healthcare professionals should continually assess what information is needed and when, and if it is correctly received.
      All in all, patients should be involved in deciding the timing, quantity and mode of information provided, and healthcare professionals should include this as an explicit point of discussion in their consultations.
      The last theme of this review – Confidence, honesty, and expertise – reveals that people with cancer prefer interacting with honest professionals who are experts in their field and show confidence. The findings of this theme are consistent with the results of a literature review looking into the strength, correlates, and consequences of patients' trust in their physician which identified honesty and communication of expertise as elements enhancing patients’ trust (
      • Hillen M.A.
      • De Haes H.C.
      • Smets E.M.
      Cancer patients' trust in their physician—a review.
      ). In addition, a recent study investigated the preferences of patients with metastasized breast cancer regarding supervised exercise programs also identified lack of expertise of healthcare professionals as a barrier for patients to adhere to their physiotherapy treatment (
      • Ten Tusscher M.R.
      • Groen W.G.
      • Geleijn E.
      • Sonke G.S.
      • Konings I.R.
      • Van der Vorst M.J.
      • van Zweeden A.
      • Aaronson N.K.
      • Stuiver M.M.
      Physical problems, functional limitations, and preferences for physical therapist-guided exercise programs among Dutch patients with metastatic breast cancer: a mixed methods study.
      ). Therefore, patients need to know that their healthcare providers are qualified to provide cancer care. At the same time, as shown in several studies on the learning needs of healthcare professionals for the treatment of patients with cancer, professionals of several disciplines, including physicians, nurses, and allied health professionals, indicate a lack of expertise in several aspects of cancer care such as knowledge of medical treatment or psychosocial and practical education on managing emotional and late effects of cancer treatment (
      • Bradford N.K.
      • Greenslade R.
      • Edwards R.M.
      • Orford R.
      • Roach J.
      • Henney R.
      Educational needs of health professionals caring for adolescents and young adults with cancer.
      ;
      • Klemp J.R.
      • Frazier L.M.
      • Glennon C.
      • Trunecek J.
      • Irwin M.
      Improving cancer survivorship care: oncology nurses' educational needs and preferred methods of learning.
      ;
      • Puts M.
      • Szumacher E.
      • Dawe D.
      • Fitch M.
      • Jones J.
      • Fülöp T.
      • Alibhai S.M.
      • Hsu T.
      • Strohschein F.
      Never too old to learn new tricks: surveying Canadian healthcare professionals about learning needs in caring for older adults with cancer.
      ;
      • Ten Tusscher M.R.
      • Groen W.G.
      • Geleijn E.
      • Berkelaar D.
      • Aaronson N.K.
      • Stuiver M.M.
      Education needs of Dutch physical therapists for the treatment of patients with advanced cancer: a mixed methods study.
      ). The findings of these studies, along with the results of this meta-synthesis, suggest that providing high-quality cancer care requires ongoing education and training opportunities specific to oncology healthcare professionals.

      4.1 Strengths and limitations

      This qualitative meta-synthesis included an extensive systematic search, selection, and appraisal method and followed the guidelines of several scientific publications regarding the synthesis of data from the included studies. Although we did not search in grey literature or unpublished work, a vast number of articles was identified, and we found indications for data saturation. Therefore, we do not think that any missed paper would have had major consequences for our findings and conclusions. We provide a comprehensive overview of themes related to patient-professional interaction, as found in qualitative cancer care studies published in the last decade, that can inform clinical practice. However, several limitations to our study can be identified.
      Firstly, since few guidelines exist for conducting qualitative meta-syntheses, our methodological approach leaned heavily on the review protocol proposed by
      • Butler A.
      • Hall H.
      • Copnell B.
      A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care.
      . We applied a strict cut-off score on our quality appraisal (<7.5/10 is considered low quality). Therefore, studies contributing to our topic were possibly excluded from this review due to this strict appraisal method. However, our search yielded an extensive and varied amount of high-quality studies representative of the study domain. Within this body of literature, consistency and saturation of findings seem to be present, and we doubt that studies of lower quality would change the current insights.
      Secondly, data synthesis was conducted based on the published reports of qualitative studies as we did not have access to the raw data. Although we followed strict guidelines for data analysis, we recognize that this approach might impact the richness of the data.
      Thirdly, most papers included focus on patients' interaction with physicians and nurses and not with other essential (allied health) professionals. Nevertheless, we believe that the lessons learned from the patients' experiences described in the studies we included apply to all healthcare professionals who provide supportive care to patients with cancer. In relation to this, as the sensitivity analysis shows, this study's results were equally distributed across the included studies within various healthcare systems and patient populations. However, results cannot be extrapolated to contexts markedly different from the healthcare settings and systems in which the included studies were conducted.

      4.2 Implications

      Healthcare professionals are trained to assess patients’ (dis)ability and needs before or during treatment. We believe this needs assessment should include preferences regarding communication and the type of personal support needed. In addition, our analysis shows that people with cancer have particular interaction needs and healthcare professionals working in cancer care need to recognize what these needs are to provide high-quality care. All in all, the results of this review highlight that even though enhanced interpersonal aptitudes of healthcare professionals are already recognized as indispensable when providing supportive cancer care, the negative experiences voiced by patients in many of the included studies show that better and constant attention should be given to these skills. Therefore, theoretical and practical training aiming to improve verbal and non-verbal communication, empathy, active listening, and collaboration skills should be emphasized in the undergraduate education of healthcare professionals and through continuing education related to oncology specializations. Besides, future research should focus on developing educational programs providing healthcare professionals with the knowledge and abilities to improve patient-professional interaction, thus delivering optimal person-centered care. Furthermore, healthcare professionals' perspective of patient interaction is underexposed in this meta-synthesis, as this was beyond the scope of our study. Future studies investigating this critical aspect could further enhance the insights provided in our review.

      5. Conclusions

      This systematic review underscores that patients with cancer highly value healthcare professionals with strong interpersonal skills who are able to provide care in a person-centered manner. It is currently acknowledged that skills, such as verbal and non-verbal communication, empathy, active listening, and collaboration are essential for healthcare professionals providing supportive care to patients with cancer and should continuously be emphasized in the education of oncology healthcare professionals. Our results clarify the meaning of these skills by breaking them down into two categories. Firstly, into an interpersonal aspect depicting the importance of inspiring trust and showing personal interest in the patient. Secondly, into a technical aspect including the ability of healthcare professionals to know when, how and what type of information to communicate to actively involve the patient in the treatment process to stimulate self-management and shared decision making.

      Declaration of competing interest

      None declared.

      Acknowledgements

      Erica Wilthagen, medical information specialist at the Netherlands Cancer Institute in Amsterdam is acknowledged for her support and advice in identifying relevant literature and key search terms, building of the search strings and retrieving all records for screening.

      Appendix A. Supplementary data

      The following is the Supplementary data to this article:

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