Carole Farrell

•Nurses were more able to attend to patients’ verbal cues of their needs for information than patients’ cues for psychosocial issues.•Long consultation time with patients has no impact on how nurses respond to patients’ verbal cues and concerns.•Priorities for medical information and clinical tasks may reduce nurses’ focus on psychosocial support.•Continuity of care was important for nurses although patient care was sometimes fragmented. To determine patterns of nurse-patient communication in fulfilling patients’ informational/psychosocial needs, effects of longer consultation/operational aspects on person-centred care experiences. Mixed-method design; secondary analysis of transcripts of nurse-patient communication within nurse-led chemotherapy clinics in UK [3]. Purposive sampling (13 nurses); non-participant observations (61 consultations). Qualitative content analysis of audio-recorded transcripts. Quantitative analysis using the Medical Interview Aural Rating Scale [14] to compare mean differences in the number of cues and level of responding using one-way ANOVA, and correlational analyses of discursive spaces. Nurses responded positively to informational cues, but not psychosocial cues. Longer consultations associated with more informational and psychosocial cues (p <  .0001), but not nurses’ cue-responding behaviours. Four main themes emerged: challenges/opportunities for person-centred communication in biomedical contexts; patients’ “life world” versus the “medical world”; three-way communication: nurse, patient and family; implications of continuity of care. The challenges/opportunities for cue-responding in nurse-led chemotherapy clinics were evident for informational and psychosocial support of patients. Shifting from a biomedical to biopsychosocial focus is difficult. Further evaluation is needed to integrate biopsychosocial elements into communication education/training. Careful planning is required to ensure continuity and effective use of time for person-centred care.

Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse. This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations. The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse—a person-oriented discourse localising health problems within the patient's personal and sociocultural context. The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions. •Nursing is theorised as a component of person-centred care.•We conducted a discourse analysis to identify communicative patterns in nurse consultations at chemotherapy outpatient clinics.•The nurses focus to far too great an extent on biological markers and a non-person-centred approach in communication.•Fragments of a person-oriented discourse show that it is possible to permit a person-centred approach to the consultation.

Parental grief is unlike any other grief and is physically and emotionally overwhelming. About 20-30 young people die each year at a treatment centre following a diagnosis of cancer. Treatment centres strive to provide individualised care to patients and families from the point of diagnosis and into bereavement. Support is often directed by the needs of families, therefore there is no standard. This article describes findings of a literature review of the needs of bereaved parents following the death of a young person between 16 and 25 years. Five themes were identified to summarise the nature of parental grief: preparedness and palliative care experience, relationships and 'telling the story', continuing bonds, parents' needs and adjusting to a new normal. Implications for practice are highlighted by the widespread acknowledgement of the need for individualised and appropriate support during grief, but the literature demonstrates a lack of information regarding this approach to support.