Leonard Berry, Texas A&M University
Joseph Jacobson, Texas A&M University
Brad Stuart, Texas A&M University

After building a strong relationship with her medical oncologist and giving informed consent for intensive chemotherapy, a middle-aged woman with newly diagnosed large cell lymphoma was ushered through an unmarked door into a large, poorly lighted, windowless room. She saw 12 closely spaced infusion chairs, separated only by thin, dingy curtains. Nurses with their backs to the patients sat in front of computer monitors scattered throughout the room. She found little room to navigate through patients, family members, and staff on her way to the only available chair. Although she had managed her fears with poise during the preceding weeks, she now experienced severe anxiety and a sudden loss of confidence in her oncologist.

Cancer care is a high-emotion service. The need for the service alone elicits intense emotions. Patients’ experiences, good and bad, accumulate as a result of clues embedded in these experiences. Clues are the signals patients perceive in using a service. When interacting with a system of care, patients filter clues, organizing them into a set of impressions. Patients may perceive clues rationally or emotionally, and clues may be defined by their presence or absence. Optimizing cancer patients’ service experiences requires sensitive management of the clues that comprise the overall service. Well-managed clues can evoke positive feelings, such as trust and hope. Poorly managed clues can exacerbate negative emotions, such as anxiety, stress, helplessness, anger, and fear.

The more important, variable, complex, and personal the service, the more clue sensitive customers are likely to be. Few services are more important, variable, complex, and personal than cancer care. Cancer patients are likely to be acutely aware of experiential clues during health care. What may seem to clinicians and staff to be a minor detail can constitute a powerful stimulus to patients. As one cancer patient said in an interview: “Patients are ultra-sensitive to the doctor’s words as clues to whether they will live or die.”

“Managing the Clues in Cancer Care,” Journal of Oncology Practice, May 2016, pp. 407-410.