Understanding experiences and impact of triadic communication for young people with cancer, supporters and healthcare professionals. A qualitative enquiry.

Abstract

Triadic communication, when a third person (supporter) is present, is prevalent in adolescent and young adult cancer (AYAC) care. Limited research has examined triadic communication and these encounters are poorly understood. Furthermore, healthcare professionals find triadic communication with AYAC difficult and there are few opportunities for training. A multiphase qualitative study was undertaken involving young people with cancer, their supporters, and professionals. This aimed to gain a greater understanding of triadic communication, namely the impact supporters have on young people in communication with professionals. Twenty-seven semi-structured interviews were undertaken, involving nine young person-supporter-professional triads. Focus groups with young people (n = 4), supporters (n = 3) and professionals (n = 6) were conducted. All were recorded and analysed using framework analysis. Four themes were identified. Young people are disempowered in triadic communication by multiple factors including shock, ill health, indirect communication and protectionism. Supporters who are not parents are important but can be sidelined by professionals and parents, and parents of adult children continue to seek communication from professionals. Professionals perceived multi-level threats that collectively hindered communication, including experience, fluctuating confidence and difficult requests from parents. Differing perspectives and responses to threat led to pervasive tension and conflict. Young people experience considerable unmet needs in relation to triadic communication. Their perspective was not always elicited, and they could experience limited involvement, especially during high threat in the cancer journey. Sometimes communication did not adhere to legal frameworks and this increased young people's vulnerability and limited autonomy. Professionals should enable young people to communicate in the presence of a supporter and elicit the patient's perspective. Training professionals in triadic communication is of critical importance and this must include how to elicit the young person's perspective, navigating different agendas, offering explicit one to one time alone and communicating within legal frameworks.