To investigate how communication among physicians, patients, and family/companions influences patients' decision making about participation in clinical trials.
We video recorded 235 outpatient ...interactions occurring among oncologists, patients, and family/companions (if present) at two comprehensive cancer centers. We combined interaction analysis of the real-time video-recorded observations (collected at Time 1) with patient self-reports (Time 2) to determine how communication about trial offers influenced accrual decisions.
Clinical trials were explicitly offered in 20% of the interactions. When offers were made and patients perceived they were offered a trial, 75% of patients assented. Observed messages (at Time 1) directly related to patients' self-reports regarding their decisions (2 weeks later), and how they felt about their decisions and their physicians. Specifically, messages that help build a sense of an alliance (among all parties, including the family/companions), provide support (tangible assistance and reassurance about managing adverse effects), and provide medical content in language that patients and family/companions understand are associated with the patient's decision and decision-making process.
In two urban, National Cancer Institute-designated comprehensive cancer centers, a large percentage of patients are not offered trials. When offered a trial, most patients enroll. The quality and quantity of communication occurring among the oncologist, patient, and family/companion when trials are discussed matter in the patient's decision-making process. These findings can help increase physician awareness of the ways that messages and communication behaviors can be observed and evaluated to improve clinical practice and research.
To assess the impact of confirmatory tests on active surveillance (AS) biopsy disease reclassification and progression to treatment in men with favorable risk prostate cancer (FRPC).
We searched the ...MUSIC registry for men with FRPC managed with AS without or with a confirmatory test. Confirmatory tests included (1) repeat prostate biopsy, (2) genomic tests, (3) prostate magnetic resonance imaging (MRI), or (4) MRI followed by a post-MRI biopsy. Confirmatory test results were deemed reassuring (RA) or nonreassuring (nonRA) according to predefined criteria. Kaplan-Meier curves and multivariable Cox regression models were used to compare surveillance biopsy disease reclassification-free survival and treatment-free survival.
Of the 2,514 men with FRPC who were managed on AS, 1211 (48%) men obtained a confirmatory test. We noted differences in the 12-month unadjusted surveillance biopsy disease reclassification-free probability (68%, 83%, and 90%, P < .0001) and 24-month unadjusted treatment-free probability (55%, 81%, and 79%, P < .0001), for men with nonRA confirmatory tests, no confirmatory test, and RA confirmatory tests, respectively. Excluding patients with genomic confirmatory tests, men with RA confirmatory tests were associated with a lower hazard (hazard ratio HR 0.57, 95% confidence interval CI 0.38-0.84, P = .005) and men with nonRA confirmatory tests had an increased hazard (HR 1.97, 95% CI 1.22-3.19, P = .006) of surveillance disease reclassification compared with men without confirmatory tests in the multivariable model.
These data suggest men with RA confirmatory tests have less surveillance biopsy reclassification and remain on AS longer than men with nonRA test results. Confirmatory tests may help risk stratify men considering active surveillance.
Much cancer-related health communication research has involved studies of the effects of media campaigns and strategies on secondary prevention. Cancer diagnosis rates, however, continue to affect ...millions of people. The need exists for communication studies to address the quality of the clinical interaction, the point of actual care delivery in addressing diagnosis, treatment, and survivorship. Using examples from a 6-year communication and behavioral oncology research program established at the Karmanos Cancer Institute (KCI) in Detroit, Michigan, we describe selected empirical issues; models, particularly the "convergence model" (adapted from Rogers & Kincaid,
1981
); and associated constructs that are relevant and promising foundations for building future research in cancer clinical settings. Two examples from our empirical research program are described.
Clinician communication is critical to positive outcomes for patients and families in most health contexts. Researchers have investigated areas such as defining and teaching effective communication ...and identifying specific outcomes that can be improved through more effective communication. In the area of cancer care, advances in detection and treatment require that clinicians develop new skills to adapt to the evolving needs of patients, families, and other members of the health care team. Some areas that require the attention of researchers are defining, assessing, and teaching effective communication in the context of the specific desires and preferences of individual patients and special populations; and meeting the needs of patients across the cancer continuum from screening, diagnosis, treatment to palliative care and survivorship. This report highlights three areas of research in cancer clinician communication including key areas of current and emerging research and theories and approaches for future research.
Oncology providers in the U.S. are increasingly responsible for helping patients manage the financial impact of cancer; however, their experiences and perspectives have not been studied ...systematically. This work describes the communication-related concerns of U.S. oncology providers who address financial issues.
We conducted semi-structured interviews with 10 providers (oncologists, social workers, navigators, attorneys) who assist patients in accessing resources and/or information related to the financial impacts of cancer in their professional roles. Interview topics included cost-related concerns of patients, how providers address those concerns, resources providers use to assist patients, and unmet needs related to addressing financial issues. Two authors (TH, MN) iteratively examined transcripts to identify themes, developed codes, and coded transcripts.
Communication related to addressing financial concerns was a main theme; however, its expression differed by provider type. Oncologists endorsed lack of time as a barrier to fully communicating about financial issues and instead preferred to refer patients to social workers or to a specialty pharmacy for assistance. Social workers and navigators identified lack of knowledge of individual patients’ ultimate out-of-pocket costs as a barrier to providing timely and accurate information and resources. Timing of communication around financial issues was a concern for several providers. Attorneys expressed the importance of discussing financial concerns and resources as soon as possible after diagnosis so that patients can make informed decisions related to insurance and employment. Financial navigators, meanwhile, reported the need to build a relationship with patients before communicating about financial issues or resources to prevent patients believing they are trying to collect money or refusing assistance because of a self-image as someone who does not take “charity”.
Clinical interventions to address the financial impacts of cancer will benefit from understanding the distinct roles and communication concerns of oncology providers who help patients address these concerns.
Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and ...responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences. Although challenges to successful implementation exist, the growing body of evidence suggests that PFCC is beneficial to patients, families, and staff.
Plain language, either written or spoken, is associated with higher-quality communication in healthcare settings, but little research has focused on plain language and clinical trial discussions. The ...objective of this study was to describe physicians’ use of plain language during interactions in which patients were invited to participate in cancer clinical trials.
Video-recorded clinical interactions, accompanying transcripts, and self-reported demographic data were taken from a larger study of communication and clinical trials (PACCT). Interactions (n=25) were selected if they included an explicit or pending invitation to participate in a clinical trial. We conducted a qualitative discourse analysis of transcripts. We excerpted all mentions of clinical trials and then inductively coded the excerpts to identify physicians’ plain language strategies.
The analysis revealed five plain language strategies used by physicians. First, physicians used lexical simplification to replace medical terminology with simpler alternatives, such as replacing “combination study” with “add a second pill.” Second, they used patient-centered definitions to differentiate medical terminology from similar concepts, such as clarifying the differences between remissions and cures. Third, they used metaphors to connect medical terminology with familiar concepts, such as “testosterone is the baseball and the receptor is the glove.” Fourth, they used second-person narration to describe patients’ potential experiences, such as “your brain’s okay but your body doesn’t want to get off the couch.” Finally, they used constructed dialogues, in which they spoke from patients’ perspectives, to illustrate potential experiences or choices during a trial. For example, voluntary participation was explained through a hypothetical scenario where the patient might say, “This doesn’t make sense. I’m not ready.”
This study identified plain language strategies that may help patients understand information about cancer clinical trials. These strategies hold promise as part of a shared decision-making process in the context of cancer clinical trials.
Abstract Purpose Mindfulness (ie, purposeful and nonjudgmental attentiveness to one's own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether ...clinician self-rated mindfulness is associated with the quality of patient care. Methods We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. Results In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted β = 1.17; 95% CI, 0.46-1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio APR = 1.48; 95% CI, 1.17-1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. Conclusions Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes.
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