Nurse-Patient Rapport During Videoconferencing Visits in Oncology Ambulatory Care

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2023

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Abstract

Care of individuals with cancer represents a significant aspect of nursing; projections of new cases will continue to rise nationally and internationally. Rapport is generated within the context of an interaction between individuals and is especially important in oncological care. Interpersonal interventions that cultivate rapport between patients and clinicians have the potential to improve patient health outcomes and satisfaction. Research suggests that rapport makes a trusting and therapeutic relationship more likely, thus enabling clinicians to become a source of emotional support helping patients to adapt to and navigate their cancer journey.

Despite the importance of rapport, little research has explored how it is developed in an ambulatory care environment, where most oncology care is delivered. Even less is known about the impact of telehealth videoconferencing on relationship building, but studies suggest that interactions during videoconferencing, although similar to in-person encounters, present unique challenges that can impact rapport, diagnostic accuracy, and treatment compliance. When the COVID-19 pandemic necessitated telehealth videoconferencing for patients with cancer, clinicians had little research to help them understand how the subsequent change in interactive practice might affect patient-clinician relationships. Additionally, limited tools are available to measure clinician-patient rapport, and few have been used in health care encounters or videoconferencing.

To establish what is known about the development of in-person rapport between nurses and patients with cancer, both in videoconferencing and in-person ambulatory oncology encounters, literature was examined using systematic review methodologies. These reviews demonstrated a lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care and videoconferencing encounters. This gap in the literature indicates a need for future research with aims and variables specifically focused on rapport to enhance understanding of this aspect of the nurse-patient relationship.

In response to this need, a qualitative descriptive study in which patients (n = 10) and oncology nurses (n = 12) were interviewed about their experiences of rapport-building during videoconferencing visits was conducted. Patient and nurse interviews were analyzed separately using conventional content analysis, with a comparative analysis of patient and nurse results performed in the final analysis. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a “bedside” manner to facilitate rapport during videoconferencing visits is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship-building in videoconferencing visits included unexpected interruptions from others, breaks in internet connection, concerns about privacy, and limitations associated with not being physically present.

Finally, an observational study was designed to evaluate the use of behavioral indicators of positivity resonance and self-report items of perceived positivity resonance to measure rapport between nurses and patients with cancer in videoconferencing visits. This initial evaluation suggests this behavioral observational measure is feasible and could be a useful measure in this setting and with this population. In addition, the recruitment and study procedures were acceptable to participants and effective. This feasibility study established the foundation for a planned future investigation to test the reliability and validity of positivity resonance measures in health care encounters.

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Koppel, Paula Dianne (2023). Nurse-Patient Rapport During Videoconferencing Visits in Oncology Ambulatory Care. Dissertation, Duke University. Retrieved from https://hdl.handle.net/10161/27671.

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