Introduction

Communication is a concept derived from the Latin words communicare – which means to make common, to connect, to consult, to give someone a message, communicatio – exchange, connection, conversation and communio – community, a sense of connection [1].

Medical communication is the process of communication between healthcare professionals and patients and their relatives, as well as between healthcare professionals (in medical teams), occurring within the framework of a healthcare relationship, i.e. therapeutic or preventive treatment [2]. In relation to contact with the patient, it covers two spheres: the transmission of information by medical personnel and the way the patient receives it [3].

It plays a key role and achieves the intended goals through [4]: skilful development of interpersonal relations in a manner appropriate to the interlocutor; providing care and treatment in an individual manner adapted to the patient; respecting mutual relations; and resolving mutual conflicts. It should facilitate the recognition of the relationship between the patient’s mental state and the physical experience of the disease and openly reflect the principle of reciprocity, according to which the degree to which the expectations of its participants are met is negotiated, because the patient expects primarily specialist information in the process of communication with medical personnel [5].

In the narrow sense, medical communication focuses on the communication (meeting) between the patient and a representative of the medical staff. In contrast, the broad scope of medical communication encompasses activities whose purpose is consistent with the patient’s well-being, grounded in current knowledge, and respectful of their subjectivity [2].

Therefore, patient communication skills are crucial in oncology, especially when staff must deliver bad news and imanage the accompanying emotions [6–10]. It is important to remember that patient anxiety often stems from insufficient information about the diagnosis, prognosis, and treatment plan, as well as from information that is inconsistent, overly burdensome, and inadequate for the patient’s perceptual abilities.

The effectiveness of a physician’s communication skills significantly affects patients’ consent to the proposed therapy, their involvement in the treatment process, and the pace of recovery [11, 12]. Unfortunately, research [13, 14] indicates that the communication skills of Polish nurses require improvement.

The aim of this study was to assess potential communication difficulties among nurses caring for cancer patients. Specific objectives included determining which communication difficulties most frequently arise with cancer patients. What characteristics best define effective communication with cancer patients? In what situations do the greatest difficulties in communication with cancer patients occur?

What behaviours of cancer patients hinder communication? How do nurses assess their competence in communicating with cancer patients? And what emotions most often arise during conversations with cancer patients’ families?

Material and methods

The study was conducted between January 2025 and July 2025 using a diagnostic survey method with a custom-designed questionnaire administered to a randomly selected group of 200 nurses. A total of 250 surveys were sent, and 200 were returned. The response rate was 80%

Inclusion criteria for the study included having a nursing diploma, working professionally in a healthcare facility, willingness to participate in the study, and having had current or past contact with an oncological patient. Exclusion criteria for the study included not having a nursing diploma or not having experience working with oncological patients. The original survey consisted of Part I – General (4 questions) and Part II – Communication problems with cancer patients (32 questions).

Characteristics of the study group

The age of the surveyed nurses ranged from 22 to 70 years, with a mean of 46 ±11.4 years. Most respondents were aged 50–54 (2.1%), and the fewest were under 25 (0.4%). Nurses with master’s degrees were the majority (54.5%), while the remainder had bachelor’s degrees (26.5%) or additional master’s degrees (19%).

The length of service among the surveyed nurses ranged 0–42 years, with a mean of 12.9 ±10 years. Half of the nurses have worked with oncology patients for not more than 10 years, and one in four for not more than 2 years.

The majority (60%) of nurses reported specialty, including oncology (23.0%), internal medicine (12.0%), anaesthesia (5.5%), gynaecology and obstetrics (3.5%), surgery (3%), palliative nursing and emergency nursing (2.5% each), long-term nursing, surgical nursing, paediatrics, and intensive care (2.0% each), epidemiology (1.5%), family nursing (1.0%), and cardiology (0.5%).

9.2% of nurses had two specialties. In 71.5% of cases, their workplace was an oncology ward/hospice. 5.5% of respondents worked in an internal medicine ward, 3.0% in a haematology ward, and the remaining respondents worked in other wards where oncology patients were hospitalised. Two jobs were reported by 5.0% of respondents.

Results

Communication problems with an oncology patient

Nearly half (49.5%) of nurses reported not having enough time at work to talk to patients. 27.5% of respondents disagreed, and 23% had difficulty answering. These answers differed significantly (p < 0.01)

Respondents reported that the time spent talking with a patient was most often 6–10 minutes (35.5%) or up to 5 minutes (30%). The remaining nurses indicated 11–20 minutes (23.5%), 21–30 minutes (7.5%), or more than 30 minutes (3.5%).

Most nurses experienced communication problems with patients, although these were infrequent (the dominant response was “sometimes,” given by 66.0% of respondents). 21% of respondents were convinced they had no such problems.

The frequency of communication problems with oncology patients was like that with other patients (including frequently: 26.5% vs. 24.0%; very frequently: 2.5% vs. 2.0%). A complete lack of problems with communication with oncology patients was reported by 2.5% of respondents, and with other patients by 4%. The remaining results are presented in Table 1.

In the context of communication difficulties with oncology patients, 71.0% of nurses indicated patient anxiety and stress, 59.0% indicated lack of understanding of medical information, and 45.5% indicated a negative attitude towards treatment (45.5% of respondents). The results are presented in Table 2.

The vast majority of respondents indicated the need to conduct the conversation on a partnership basis (71.0%) as the most important feature of effective communication with an oncological patient; 23.5% indicated the need to simplify the content being communicated, 4% indicated the managerial role of the nurse, and 1.5% indicated other features, which the remaining respondents did not specify.

Regarding the assessment of patients’ openness to discussing their health, balanced responses (average – 51.5%) or optimistic responses (high – 26.0% or very high – 2.0%) dominated. Negative responses were reported by 11% of nurses (low – 9.5%, very low – 1.5%), and 9.5% of respondents had difficulty with this declaration.

Difficult situations related to communication with oncology patients most often concerned medical issues, primarily providing information about the diagnosis (41.0%), the terminal condition (36.5%), and complications (35.0%). The results are presented in Table 3.

Regarding behaviours that hinder communication, the most frequently mentioned were the patient’s lack of concentration (59.0%), reluctance to talk (49.0%), and hostility towards life and staff (43.0%). The results are presented in Table 4.

42.5% of respondents believed that patients should be provided with as much information about treatment as possible; 24.0% believed that the amount of information should be tailored to the patient’s expectations; 12.0% believed that information should be provided gradually; 11.5% believed that the amount of information should depend on the need for knowledge; 5.0% believed that information should be selected; and 2.0% believed that as little information as possible should be provided. 3.0% of respondents had difficulty with a clear statement.

Nurses considered consultations with a psycho- oncologist (52.5%), developing a list of questions (32.0%), and the patient seeking information independently (1%) to be helpful in preparing the patient for the conversations, while 14.5% were unable to specify this.

75.5% of respondents always asked the patient whether he or she understood the information provided, 20.5% sometimes did so, and only 4.0% never did that.

When asked directly difficult questions by a cancer patient about their life expectancy, nurses most often attempted to discuss the general prognosis for cancer (46.0%), tailored their answers to the patient’s condition (19.5%), and avoided the topic (14.0%). Questions about the average survival time posed difficulties for 2.5% of the respondents, and 18.0% were unable to provide a clear answer.

The most common strategies for overcoming communication barriers included using plain language (44.5%), listening with empathy (31.5%), and tailoring the conversation to the situation (18.5%). Consultation with other specialists was preferred by 3.0% of respondents, while 2.5% had difficulty deciding what to do.

During conversations with patients’ families, negative feelings were most frequently expressed: anxiety (74.5%) and sadness (66.0%). Anger from the family was noted by 36.5% of nurses, and indifference by 9%. It is worth noting, however, that nearly half of the respondents (48.5%) also reported feeling hope during conversations with the patient’s family.

Nurses generally assessed the impact of patient-topatient conversations on their communication with nurses positively – only 4.5% responded negatively, compared to 27.5% who responded positively. However, the prevailing cautious opinion (54.0%) was that the effect of these conversations “depends on the patient’s condition.” 5% believed that patient-topatient conversations had no impact on patient-nurse communication, and 9% had difficulty answering.

In the opinion of the nurses surveyed, oncology patients are, at best, only moderately prepared to discuss their illness (41.5% of responses were partially positive and 31.5% negative). Only 4.0% of respondents answered affirmatively to this question, and as many as 23.5% were unable to express their opinion.

Nurses most often considered conversation with a psychologist (78.0%), use of educational material (56.5%), longer conversation with the patient (54.5%), group support sessions (50%) and other possibilities (7%) as ways to improve communication with the patient, but they did not specify which ones.

The most desirable characteristic of a patient in good contact with a nurse was openness (83.0%). However, they noted that the patient’s acceptance of the disease (7.0%) and their aggression (4.0%) could influence communication. 6.0% of respondents were unable to provide a clear opinion on this issue.

Methods of improving communication with cancer patients

Nurses rated the usefulness of patient communication guides highly (70.5%). 24.5% of respondents considered them sometimes useful, 1.0% considered them not useful at all, and 4.0% were unable to provide a clear opinion.

Nurses’ self-assessment of their preparedness for conversations with oncology patients can be assessed as average, with a slight preponderance of positive responses over negative ones (26.0% of responses were “yes,” 29.0% were “sometimes”, and 19.0% were “not useful”). However, 26.0% of respondents did not take a clear position on this issue, suggesting a low rather than high assessment of their ability to communicate with patients.

Respondents rated their communication skills slightly better than their preparation – 43% as “good,” 27.5% as “sufficient,” and almost the same number as “insufficient” or “very good” (9.0% and 8.5%, respectively). 12.0% of respondents had difficulty answering.

The majority of nurses indicated reading the literature on the subject (60.5%) and training in patient communication (46.5%) as activities improving communication with the patient, 29.0% considered cooperation with a psychologist necessary, 16.5% were unable to indicate any activities improving communication with the patient, and 17.0% preferred other activities, but their precise definition was required.

Most respondents (65.0%) indicated poor access to material that could aid communication with patients. 21.5% of nurses believed this was sufficient, 6.5% believed it was not, and 7.0% had no opinion.

95% of respondents reported participating in classes that prepared them for patient communication during their studies. More concerning, however, is that 24.5% of respondents answered negatively, and 10.5% were unable to provide a clear answer. At the same time, over half of the nurses (55.5%) indicated that insufficient time was devoted to patient communication during their studies. 17.5% of respondents held the opposite opinion, and 27.0% were unable to provide a clear opinion.

Staff experience in working with oncology patients

Regarding staff experience working with oncology patients, the nurses surveyed provided very diverse responses, which significantly hindered the presentation of clear findings. Therefore, the decision was made to classify them into seven thematic groups. The nurses identified the patient’s negative attitude towards the conversation (43.5%), the inability to manage the patient’s emotions and anxiety (34.5%), lack of time for the patient (29.5%), and the inability to convey medical information in an understandable manner (20.5%) as the greatest challenges in their daily work with oncology patients (Table 5).

When asked for suggestions to improve communication with patients, the surveyed nurses provi­ded as many as 28 diverse suggestions. To facilitate a clear and communicative presentation of the data, these responses were grouped into six broad categories. The top suggestion was the need for more time for communication (39.0%), followed by a more empathetic, positive attitude among nurses (29.5%) and communication training for nurses (27.5%). The results are presented in Table 6.

The sum does not have to be 100% because any number of answer variants could be indicated.

Most nurses reported that communication with patients did not influence the course of treatment (81.5%). Some effect was reported by 15.5% of respondents, although 3.0% did not specify whether it was positive or negative or what it involved.

When asked about the most challenging situations in communication with patients with cancer, nurses gave 34 diverse responses. For statistical purposes, these were grouped into seven broad categories. The most frequently reported causes of difficult situations were poor patient mental health (33.0%), the need to discuss health status and prognosis (26.5%), negative patient attitudes (25.5%), and deterioration in health (21.0%). The results are presented in Table 7.

Discussion

Communication is not only about transmitting information, but also everything that happens between people who understand each other at a given moment – ​​their mutual feelings, the feeling of being heard, and closeness or emotional distance [15]. On the part of the medical staff, the quality of communication with a cancer patient depends on their knowledge of oncology and psychology, their ability to clearly formulate a message, their ability to maintain a balance between distance and engagement, and their ability to respond to feedback.

On the part of the patient and their relatives, it is influenced by beliefs and myths about the disease and treatment, level of medical knowledge, communication skills, way of interpreting and evaluating the message, attitude towards the disease and therapy, and the emotional attitude of the patient and family [16]. It is worth remembering that various studies indicate that patients perceive a lack of communication with medical personnel as a message of disregard for them or intentional silence [17].

Pitts et al. [18] emphasise that the choice of communication strategies in contacts with healthcare professionals is influenced by knowledge of the person, family, and disease, as well as understanding of the symptoms. The aim of the study by Rochmawati et al. [19] was to analyse communication in oncological care, and the results suggest that communication during oncological treatment is important, as it can help patients and relatives cope with cancer. It should include compassion, spiritual and religious aspects, and hope. Therefore, oncological communication should enable the integration of biopsychosocial, spiritual, and religious aspects [19].

Czerw et al. [20] emphasise that if staff use appropriate communication methods, patients are more likely to follow recommendations, better accept information about the disease, and have a greater chance of recovery, as treatment involves not only instrumental activities but also a proper approach to the patient, understanding their problems, and supporting them. Lehman et al. [21] suggested that poor communication causes stress and uncertainty in patients, whereas good communication can help them accept both bad news and the disease itself. This correlates with the results from the surveyed nurses, who mostly (77.5%) stated that the patient’s condition affects the possibility, method, and effectiveness of communication. However, the majority of them (81.5%) believed that the course of treatment has no impact on communication with the patient.

Lam et al. [22] investigated factors influencing satisfaction with nurse-patient communication among cancer patients during daily routines. The observational study involved 25 registered nurses and 94 patients from an oncology ward. They found that patients with stage 3 cancer and those undergoing admission procedures were significantly more satisfied with communication with nurses compared to patients who were more concerned about the impact of their disease on self-care. These results suggest that the stage of cancer, the time of admission, and psychological concerns related to self-care are potential factors influencing the level of satisfaction with nurse-patient communication. Therefore, to improve communication with cancer patients, nurses must emphasise utilising the admission time for patient interaction [22].

The literature [23–25] also emphasises that without first establishing good contact with the patient, it is not possible to provide proper care. Nonverbal communication can significantly influence the patient’s satisfaction with interactions not only with the physician but also with other members of the therapeutic team [23, 24]. This is of great importance because the nurse is not only an interlocutor, but also a listener to the patient’s complaints, grumblings, resentment, and suffering [23–25]. Therefore, the individual interpretation of the received signals becomes important, sometimes resulting from the complexity of the communication process, for example, due to the progression of the disease, the patient’s significant emotional variability, their changing expectations, and their changing well-being and personality [24].

In a study conducted by Brayer et al. [26] among 272 nursing graduates, 5.3% were dissatisfied with the organisation of work, indicating, among other things, that only necessary activities were performed with the patient, and there was no time for conversation. This was confirmed in our own research, as 49.5% of nurses declared that in their work, they did not have enough time to talk to the patient, most often spending up to 5 minutes (30%) or 6–10 minutes (35.5%).

The lack of time for patient conversations among nurses may be due to staff shortages, traditional hospital nursing management, and the burdening of nurses with additional activities that do not require professional qualifications. Therefore, conversation with the patient was one of the activities often omitted by nurses (nearly 40%) [23, 24].

The ALL.CAN Report [27], entitled “How Polish patients assess oncology care in the area of ​​support and access to information”, shows that more than half of respondents did not receive sufficient information (31%) or were unable to understand information related to oncology care and treatment (22%). This was confirmed in our own research, as 60% of nurses stated that patients had difficulty understanding medical information.

HematoKoalicja report [28] about people with haematological and oncological diseases indicates that 77% of patients believed the most effective type of communication is collaborative, engaged, and goal-focused. Our own research also confirmed this, as most respondents indicated the need for a collaborative conversation (71.0%), and 89% of patients expected as much information as possible [28]. This also aligned with our own research, in which over 40% of nurses surveyed believed that patients should be provided with as much information as possible about their treatment.

The aforementioned ALL.CAN Report [27] also indicates that 50% of respondents lacked access to other specialists who support oncological treatment, such as psychologists, during therapy. Our research also confirmed this, as nurses believed that consultations with a psycho-oncologist or the development of a list of questions would be helpful in this regard.

Zielazny et al. [29] also point out that medical personnel first focus on diagnosis and treatment choice, often neglecting the patient’s family. Meanwhile, relatives and caregivers can effectively support a chronically ill person only if they receive clear information about the cancer itself, its causes, course, planned therapy, possible side effects, prognosis, and limitations in the patient’s daily functioning.

Family members of patients diagnosed with cancer hospitalised in the Bialystok Oncology Centre, surveyed by Aniśko-Trambecka et al. [30], mostly stated that the information provided to the family should be comprehensive (89.8%), the patient should receive as much information as he or she wishes (64.5%), the patient and the family should be informed about their rights (65.2%) and that the doctor (97.5%) and the nurse (96.8%) should be willing to provide information to the patient’s family.

In the study by Lipińska et al. [31], communicating with patients at the end of life posed a significant challenge. At the same time, 40.8% of the respondents claimed that they would tell the patient the truth about an incurable, terminal illness, including 84.6% who believed that such knowledge should be delivered gradually, considering the patient’s mental and physical condition. Most respondents (63.8%) believed that patients should be informed of their progressive illness because they have the right to fully understand their health [31, 32].

In the study by Aniśko-Trambecka et al. [30], 68.6% of respondents linked patients’ awareness of being in the hospice to their physical, mental, and spiritual condition, as well as to their attitude. In addition, 64.5% believed that patients should receive as much information as they want. Similar findings were obtained in our study: over 40% of nurses believed that patients should be given as much information as possible about treatment, while one in four thought the amount of information should be adjusted to the patient’s expectations.

It is worth noting that, beyond professional competence, oncology nursing also requires appropriate personal qualities and attitudes [33, 34]. In daily practice, nurses face many challenges: explaining procedures and the patient’s role in them, helping manage anxiety, uncertainty, stress, and other difficult emotions during diagnostic process and treatment, clarifying unfamiliar medical terms, building trust and a sense of security, supporting patients and their families in accepting the disease, explaining its consequences.

In the current study, the nurses considered the patient’s negative attitude towards the conversation to be the biggest challenge in their daily work with an oncological patient (43.5% of respondents), 34.5% indicated the lack of ability to control the patient’s emotions and anxiety, 29.5% saw the problem in the lack of time for the patient, and 20.5% admitted the lack of ability to convey medical information in an understandable way (20.5%).

Anxiety, for example, can also be a barrier to communication/contact with a cancer patient. In a study by Aniśko-Trambecka et al. [30], 48.2% of family members experienced anxiety during contact with the dying person. Similarly, in our study, over 70% of respondents indicated the patient’s anxiety and stress as communication barriers and claimed that anxiety (74.5%) and sadness (66.0%) were most frequently expressed during conversations with patients’ families.

In a survey of 132 nurses, Gonigroszek [35] found that the most commonly reported communication barriers included verbal aggression, language difficulties, being ignored, a rude tone of voice, poor manners, failure to follow instructions, the presence of an endotracheal tube, mental disorders, dementia, confusion, agitation, selective listening, interrupting nursing procedures with questions, misinterpretation of instructions, and poor understanding of information.

In life-threatening illness, patients expect understanding, compassion, empathy, informational support that reduces anxiety and a sense of threat, and information presented in a clear and accessible way [10]. Encouragingly, more than three-quarters of the nurses surveyed reported always asking patients whether they understood the information provided, while one in five did so sometimes.

The literature [36] emphasises that unfavourable information is a highly time-consuming and dynamic process, yet a skill that should be mastered by all members of the therapeutic team, especially those working with chronically ill patients. These are undoubtedly difficult moments in professional work, as reported by the nurses surveyed, who primarily communicated information about the diagnosis (41%), a terminal condition (36.5%), and complications (35%).

Most respondents (66%) in the Gonigroszek stu- dy [35] did not participate in interpersonal communication classes during their studies or in the nursing school. In the current study, two-thirds of nurses reported participating in classes that prepared them for patient communication during their studies, whereas 24.5% did not.

Limitations

The findings should be interpreted considering several important limitations.

The sample size was limited. Although the study included nurses from several hospitals in different provinces, the results cannot be fully generalised to the entire nursing population in Poland. Only female nurses were included in the study. The analysis did not account for access to training, differences in work standards, or hospital workload, all of which may have influenced respondents’ opinions.

Despite these limitations, the data obtained contribute to understanding the issues of communication between nurses and patients and constitute a starting point for further in-depth research, primarily qualitative.

Conclusions

According to respondents, the main communication barriers were patient anxiety and stress, poor understanding of medical information, lack of concentration, and a negative attitude towards conversation.

Diagnosis, terminal condition, and complications were the most difficult aspects of communicating with oncology patients.

According to nurses, consultations with a psychologist or psycho-oncologist would be the most helpful form of support in preparing oncology patients for conversations with healthcare professionals.

Most respondents acknowledged limitations in their communication skills.

Recommendations

Undergraduate and postgraduate nursing education should place greater emphasis on communication by expanding training in simulations, empathy, and managing patients’ emotions, particularly in emotionally challenging situations.

Nurses’ workflows should be reorganised to allow more direct contact with patients.

Current medical staff should receive training in empathetic, patient-friendly communication and in handling critical conversations that involve emotional, ethical, and spiritual concerns.

Mental health specialists should be integrated into the routine care of oncology patients, alongside brief psychoeducational interventions to prepare patients for conversations with staff and strengthen nurses’ awareness of the value of therapeutic communication.

Disclosures

1. Institutional review board statement: This study was approved by the Bioethics Committee of the Medical University of Bialystok (UMB) (approval decision no. APK.002.88.2025, dated: 20.02.2025).

2. Assistance with the article: None.

3. Financial support and sponsorship: None.

4. Conflicts of interest: None.

References