1
|
Palmer Kelly E, Rush LJ, Eramo JL, Melnyk HL, Tarver WL, Waterman BL, Gustin J, Pawlik TM. Gaps in Patient-Centered Decision-Making Related to Complex Surgery: A Mixed-Methods Study. J Surg Res 2024; 295:740-745. [PMID: 38142577 DOI: 10.1016/j.jss.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION We sought to understand the perceptions of surgeons around patient preferred roles in decision-making and their approaches to patient-centered decision-making (PCDM). METHODS A concurrent embedded mixed-methods design was utilized among a cohort of surgeons performing complex surgical procedures. Data were collected through online surveys. Associations between perceptions and PCDM approaches were examined. RESULTS Among 241 participants, most respondents were male (67.2%) with an average age of 47.6 y (standard deviation = 10.3); roughly half (52.4%) had practiced medicine for 10 or more years. Surgeons most frequently agreed (94.2%) with the statement, "Patients prefer to make health decisions on their own after seriously considering their physician's opinion." Conversely, surgeons most frequently disagreed (73.0%) with the statement, "Patients prefer that their physician make health decisions for them." Nearly one-third (30.4%) of surgeon qualitative responses (n = 115) indicated that clinical/biological information would help them tailor their approach to PCDM. Only 12.2% of respondents indicated that they assess patient preferences regarding both decision-making and information needs. CONCLUSIONS Surgeons most frequently agree that patients want to make their own health decisions after seriously considering their physicians opinion. A greater focus on what information surgeons should know before treatment decision-making may help optimize patient experience and outcomes related to complex surgical procedures.
Collapse
Affiliation(s)
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jennifer L Eramo
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Halia L Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brittany L Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jillian Gustin
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
2
|
Lou Z, Vivas-Valencia C, Shields CG, Kong N. Examining how physician factors influence patient satisfaction during clinical consultations about cancer prognosis and pain. PEC INNOVATION 2022; 1:100017. [PMID: 37213781 PMCID: PMC10194410 DOI: 10.1016/j.pecinn.2022.100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 05/23/2023]
Abstract
Objective Patient-physician communication affects cancer patients' satisfaction, health outcomes, and reimbursement for physician services. Our objective is to use machine learning to comprehensively examine the association between patient satisfaction and physician factors in clinical consultations about cancer prognosis and pain. Methods We used data from audio-recorded, transcribed communications between physicians and standardized patients (SPs). We analyzed the data using logistic regression (LR) and random forests (RF). Results The LR models suggested that lower patient satisfaction was associated with more in-depth prognosis discussion; and higher patient satisfaction was associated with a greater extent of shared decision making, patient being black, and doctor being young. Conversely, the RF models suggested the opposite association with the same set of variables. Conclusion Somewhat contradicting results from distinct machine learning models suggested possible confounding factors (hidden variables) in prognosis discussion, shared decision-making, and doctor age, on the modeling of patient satisfaction. Practitioners should not make inferences with one single data-modeling method and enlarge the study cohort to help deal with population heterogeneity. Innovation Comparing diverse machine learning models (both parametric and non-parametric types) and carefully applying variable selection methods prior to regression modeling, can enrich the examination of physician factors in characterizing patient-physician communication outcomes.
Collapse
Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | | | - Cleveland G. Shields
- Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Corresponding author at: Nan Kong 206 S. Martin Jischke Dr., West Lafayette, IN 47907, USA.
| |
Collapse
|
3
|
Palmer Kelly E, Myers B, McGee J, Hyer M, Tsilimigras DI, Pawlik TM. Surgeon Strategies to Patient-Centered Decision-making in Cancer Care: Validation and Applications of a Conceptual Model. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1719-1726. [PMID: 33942256 DOI: 10.1007/s13187-021-02017-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
We sought to construct and validate a model of cancer surgeon approaches to patient-centered decision-making (PCDM) and compare applications of that model relative to surgical specialties. Ten PCDM strategies were assessed using a cross-sectional survey administered online to 295 board-certified cancer surgeons. Structural equation modeling was used to empirically validate and compare approaches to PCDM. Within the full sample, 7 strategies comprised a latent construct labeled, "physical & emotional accessibility," associated with surgeon approaches to PCDM (β = 0.37, p < .05). Three individual strategies were included: "expectations (Q4)" (β = 0.52, p < .05), "decision preferences (Q5) (β = 0.47, p < .05), and "access medical information (Q3)" (β = 0.75). Surgical specialties for subgroup analysis were classified as general/other (67.6%) or hepato-pancreato-biliary and upper gastrointestinal (HPB/UGI) (34.2%). For general/other surgeons, 7 individual strategies composed the model of surgeon approaches to PCDM, with "time (Q6) (β = 0.70, p < .001) and "therapeutic relationship building (Q9)" (β = 0.69, p < .001) being the strongest predictors. The HPB/UGI model included 2 latent constructs labeled "physical accessibility" (β = 0.72, p < .05) and "creating a decision-making dialogue" (β = 0.62) as well as the individual strategy, "effective communication (Q8)" (β = 0.51, p < .05). Although models of surgeon PCDM varied, there were 4 overlapping strategies, including effective communication. Tailoring models of PCDM may improve surgeon uptake and thus, overall patient satisfaction with their cancer care.
Collapse
Affiliation(s)
| | | | | | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
4
|
Patient activation reduces effects of implicit bias on doctor-patient interactions. Proc Natl Acad Sci U S A 2022; 119:e2203915119. [PMID: 35914161 PMCID: PMC9371681 DOI: 10.1073/pnas.2203915119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors' implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be "activated" or "typical" during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor-patient interactions, results showed that physicians' implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor-patient interactions.
Collapse
|
5
|
Communicating is analogous to caring: A systematic review and thematic synthesis of the patient-clinician communication experiences of individuals with ovarian cancer. Palliat Support Care 2022; 21:515-533. [PMID: 35582975 DOI: 10.1017/s1478951522000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically review and synthesize the patient-clinician communication experiences of individuals with ovarian cancer. METHODS The CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases were reviewed for articles that described (a) original qualitative or mixed methods research, (b) the experiences of individuals with ovarian cancer, and (c) findings related to patient-clinician communication. Relevant data were extracted from study results sections, then coded for descriptive and analytical themes in accordance with Thomas and Harden's approach to thematic synthesis. Data were coded by two authors and discrepancies were resolved through discussion. RESULTS Of 1,390 unique articles, 65 met criteria for inclusion. Four descriptive themes captured participants' experiences communicating with clinicians: respecting me, seeing me, supporting me, and advocating for myself. Findings were synthesized into three analytical themes: communication is analogous to caring, communication is essential to personalized care, and communication may mitigate or exacerbate the burden of illness. SIGNIFICANCE OF RESULTS Patient-clinician communication is a process by which individuals with ovarian cancer may engage in self-advocacy and appraise the extent to which they are seen, respected, and supported by clinicians. Strategies to enhance patient-clinician communication in the ovarian cancer care setting may promote patient perceptions of patient-centered care.
Collapse
|
6
|
Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. Perceived patient-centered communication, quality of life, and symptom burden in individuals with ovarian cancer. Gynecol Oncol 2021; 163:408-418. [PMID: 34454724 DOI: 10.1016/j.ygyno.2021.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe perceptions of patient-centered communication (PCC); assess whether physician specialty, patient characteristics, or health system characteristics are associated with PCC; and identify associations between PCC, health-related quality of life (HRQoL), and symptom burden among individuals with ovarian cancer. METHODS Cross-sectional, descriptive survey of English-speaking adults with ovarian cancer. PCC, HRQoL, and ovarian cancer symptom burden were assessed with the PCC-Ca-36, the FACT-G, and the FOSI-18, respectively. PCC-Ca-36 scores were summarized using descriptive statistics. Predictors of PCC-Ca-36, FACT-G, and FOSI-18 scores were identified using multiple linear regression. RESULTS Participants (n = 176) had a mean age of 59.4 years (SD = 12.1). The majority (65.9%) had advanced-stage disease, while 42.0% were receiving treatment. The mean PCC-Ca-36 total score was 4.09 (SD = 0.78) out of a possible 5, indicating participants often perceived that clinicians engaged in PCC. Among the PCC functions, participants reported that clinicians least often enabled patient self-management (M = 3.65, SD = 0.99), responded to emotions (M = 3.84, SD = 1.04), and managed uncertainty (M = 3.91, SD = 0.93). In multivariable analyses, neither physician specialty nor patient and health system characteristics were significantly associated with overall PCC. Greater overall PCC predicted better overall HRQoL; better social/family, emotional, and functional well-being; and lower overall and physical symptom burden (all p ≤ 0.05). CONCLUSION Greater PCC is significantly associated with better HRQoL and lower symptom burden among individuals with ovarian cancer. PRACTICE IMPLICATIONS Promotion of PCC is a promising strategy to improve patient-reported outcomes in the ovarian cancer care setting.
Collapse
Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Barbara A Goff
- University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
| | - Meghan L Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Rochester, 255 Crittenden Blvd., Rochester, NY 14642, United States
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Donna L Berry
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
| |
Collapse
|
7
|
Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain? PLoS One 2021; 16:e0257794. [PMID: 34705826 PMCID: PMC8550362 DOI: 10.1371/journal.pone.0257794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 08/28/2021] [Indexed: 11/19/2022] Open
Abstract
Rationale Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. Methods We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians’ implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. Results As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. Conclusion Using SP methodology, physicians’ implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.
Collapse
|
8
|
Enzinger AC, Uno H, McCleary N, Frank E, Sanoff H, Van Loon K, Matin K, Bullock A, Cronin C, Bagley J, Schrag D. The Effect of Disclosing Life Expectancy Information on Patients' Prognostic Understanding: Secondary Outcomes From a Multicenter Randomized Trial of a Palliative Chemotherapy Educational Intervention. J Pain Symptom Manage 2021; 61:1-11.e3. [PMID: 32777456 PMCID: PMC7769864 DOI: 10.1016/j.jpainsymman.2020.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Many advanced patients with cancer have unrealistic prognostic expectations. OBJECTIVES We tested whether offering life expectancy (LE) statistics within palliative chemotherapy (PC) education promotes realistic expectations. METHODS In this multicenter trial, patients with advanced colorectal and pancreatic cancers initiating first or second line PC were randomized to usual care versus a PC educational tool with optional LE information. Surveys at two weeks and three months assessed patients' review of the LE module and their reactions; at three months, patients estimated their LE and reported occurrence of prognosis and end-of-life (EOL) discussions. Wilcoxon tests and proportional odds models evaluated between-arm differences in LE self-estimates, and how realistic those estimates were (based on cancer type and line of treatment). RESULTS From 2015 to 2017, 92 patients were randomized to the intervention and 94 to usual care. At baseline most patients (80.9%) wanted "a lot" or "as much information as possible" about the impact of chemotherapy on LE. Among patients randomized to the intervention, 52.0% reviewed the LE module by two weeks and 66.7% by three months-of whom 88.2% reported the information was important, 31.4% reported it was upsetting, and 3.9% regretted reviewing it. Overall, patients' LE self-estimates were very optimistic; 71.4% of patients with colorectal cancer estimated greater than five years; 50% pancreatic patients estimated greater than two years. The intervention had no effect on the length or realism of patients' LE self-estimates, or on the occurrence of prognostic or EOL discussions. CONCLUSIONS Offering LE information within a PC educational intervention had no effect on patients' prognostic expectations.
Collapse
Affiliation(s)
- Andrea C Enzinger
- Division of Population Sciences, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA; Division of Gastrointestinal Oncology, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA.
| | - Hajime Uno
- Division of Population Sciences, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Nadine McCleary
- Division of Gastrointestinal Oncology, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Elizabeth Frank
- Susan F. Smith Center for Women's Cancers, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Hanna Sanoff
- Division of Medical Oncology, University of North Carolina Lineberger Cancer Center, Chapel Hill, North Carolina, USA
| | - Katherine Van Loon
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Khalid Matin
- Division of Medical Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrea Bullock
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christine Cronin
- Division of Population Sciences, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Janet Bagley
- Department of Nursing, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA; Division of Gastrointestinal Oncology, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Social networks of older patients with advanced cancer: Potential contributions of an integrated mixed methods network analysis. J Geriatr Oncol 2020; 12:855-859. [PMID: 33342721 DOI: 10.1016/j.jgo.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/03/2020] [Indexed: 12/28/2022]
|
10
|
Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-1472. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
Collapse
|
11
|
Lee JL, Matthias MS, Menachemi N, Frankel RM, Weiner M. A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations. J Am Med Inform Assoc 2019; 25:413-418. [PMID: 29025086 DOI: 10.1093/jamia/ocx089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective To understand how existing guidelines align with current practice, evidence, and technology. Methods We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Results Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Conclusion Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care.
Collapse
Affiliation(s)
- Joy L Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Marianne S Matthias
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Nir Menachemi
- Regenstrief Institute, Indianapolis, IN, USA.,Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Richard M Frankel
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michael Weiner
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| |
Collapse
|
12
|
Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
|
13
|
Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
Collapse
Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
| | | |
Collapse
|
14
|
Brooke BS, Slager SL, Swords DS, Weir CR. Patient and caregiver perspectives on care coordination during transitions of surgical care. Transl Behav Med 2018; 8:429-438. [PMID: 29800402 DOI: 10.1093/tbm/ibx077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Care coordination for patients with chronic disease commonly involves multiple transitions between primary care and surgical providers. These transitions often cross healthcare settings, providers, and information systems. We performed a cross-sectional qualitative study to gain a better understanding of the factors that influence how patients and caregivers perceive care coordination during transitions of surgical care. Eight focus groups were conducted among individuals from three different U.S. states who had experienced an episode of surgical care within the past year. We included patients who had undergone major surgery for a chronic condition, as well as caregivers. We used Atlas.ti qualitative software and engaged in an iterative process of thematic analysis of focus group transcripts. After five-rounds of review, five main themes emerged that define chronic care coordination for surgical patients and caregivers: (a) Care coordination is embedded in the unwritten social con tract patients share with their surgical providers; (b) Patients expect all surgical and nonsurgical healthcare providers to be "on the same page"; (c) Patients are frightened and vulnerable during surgical care transitions; (d) Patients need to have accurate expectations of the processes associated with care coordination; and (e) Care coordination relies upon establishing patient trust with their surgical team and needs to be continually reaffirmed. Surgical patients and caregivers expect care coordination processes to involve informatics infrastructure, patient education, and information exchange between providers. Unfortunately, these aspects of care coordination are often lacking during transitions. These findings have implications for designing patient-centered interventions to improve coordination of chronic care.
Collapse
Affiliation(s)
- Benjamin S Brooke
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stacey L Slager
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas S Swords
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
15
|
Mukerji G, Weinerman A, Schwartz S, Atkinson A, Stroud L, Wong BM. Communicating wisely: teaching residents to communicate effectively with patients and caregivers about unnecessary tests. BMC MEDICAL EDUCATION 2017; 17:248. [PMID: 29228940 PMCID: PMC5725805 DOI: 10.1186/s12909-017-1086-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/27/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND With rising healthcare costs and a focus on quality, there is a growing need to promote resource stewardship in medical education. Physicians need to be able to communicate effectively with patients/caregivers seeking tests and treatments that are unnecessary. This study aimed to evaluate the impact of an interactive workshop on residents' knowledge of resource stewardship and communication skills when counseling patients/caregivers about requests for unnecessary testing. METHODS Participants were 83 Internal Medicine and Pediatrics residents at the University of Toronto in 2014-15. The evaluation compared resource stewardship knowledge and communication skills of 57 (69%) residents that attended the resource stewardship workshop to 26 residents (31%) who did not. Knowledge and communication skills assessment consisted of a written test and a structured assessment using standardized patient raters, respectively. A linear regression was applied to determine predictors of overall communication skills performance. RESULTS Workshop attendance resulted in better performance on the knowledge test (4.3 ± 1.9 vs. 3.1 ± 1.7 out of 8, p = 0.01), but not better performance on the communication skills assessment (4.1 ± 0.8 vs. 4.0 ± 0.9 out of 5, p = 0.56). Higher training level (p = 0.01) and knowledge test scores (p = 0.046) were independent predictors of better overall communication skills, after adjusting for gender, training level, workshop attendance, knowledge and self-reported prior feedback on communication skills. CONCLUSIONS An interactive workshop can improve knowledge of resource stewardship, but improving communication skills with patients/caregivers about unnecessary testing may require additional training or reinforcement in the clinical learning environment. These teaching and assessment approaches can support the integration of education on resource stewardship into medical education.
Collapse
Affiliation(s)
- Geetha Mukerji
- Department of Medicine, University of Toronto and Women’s College Hospital Institute of Health Systems Solutions and Virtual Care, 76 Grenville Street, Room 3414, Toronto, ON M5S 1B2 Canada
| | - Adina Weinerman
- Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Sarah Schwartz
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Adelle Atkinson
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Brian M. Wong
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON Canada
| |
Collapse
|
16
|
Fenton JJ, Duberstein PR, Kravitz RL, Xing G, Tancredi DJ, Fiscella K, Mohile S, Epstein RM. Impact of Prognostic Discussions on the Patient-Physician Relationship: Prospective Cohort Study. J Clin Oncol 2017; 36:225-230. [PMID: 29148892 DOI: 10.1200/jco.2017.75.6288] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Some research has suggested that discussion of prognosis can disrupt the patient-physician relationship. This study assessed whether physician discussion of prognosis is associated with detrimental changes in measures of the strength of the patient-physician relationship. Methods This was a longitudinal cohort study of 265 adult patients with advanced cancer who visited 38 oncologists within community- and hospital-based cancer clinics in Western New York and Northern California. Prognostic discussion was assessed by coding transcribed audio-recorded visits using the Prognostic and Treatment Choices (PTCC) scale and by patient survey at 3 months after the clinic visit. Changes in the strength of the patient-physician relationship were computed as differences in patient responses to The Human Connection and the Perceived Efficacy in Patient-Physician Interactions scales from baseline to 2 to 7 days and 3 months after the clinic visit. Results Prognostic discussion was not associated with a temporal decline in either measure. Indeed, a one-unit increase in PTCC during the audio-recorded visit was associated with improvement in The Human Connection scale at 2 to 7 days after the visit (parameter estimate, 0.10; 95% CI, -0.02 to 0.23) and 3 months after the visit (parameter estimate, 0.18; 95% CI, 0.02 to 0.35) relative to baseline. Standardized effect sizes (SES) associated with an increase of two standard deviations in the PTCC at each time point were consistent with small beneficial effects (SES, 0.14 [95% CI, -0.02 to 0.29] at 2 to 7 days; SES, 0.24 [95% CI, 0.02 to 0.45] at 3 months), and lower bounds of CIs indicated that substantial detrimental effects of prognostic discussion were unlikely. Conclusion Prognostic discussion is not intrinsically harmful to the patient-physician relationship and may even strengthen the therapeutic alliance between patients and oncologists.
Collapse
Affiliation(s)
- Joshua J Fenton
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Paul R Duberstein
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Richard L Kravitz
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Guibo Xing
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Daniel J Tancredi
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Kevin Fiscella
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Supriya Mohile
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| | - Ronald M Epstein
- Joshua J. Fenton, Richard L. Kravitz, Guibo Xing, and Daniel J. Tancredi, University of California, Davis, Sacramento, CA; Paul R. Duberstein, Kevin Fiscella, and Ronald M. Epstein, University of Rochester; Supriya Mohile and Ronald M. Epstein, UR Medicine Wilmot Cancer Institute, Rochester, NY
| |
Collapse
|
17
|
McLawhorn VC, Vess J, Dumas BP. Integrating a Question Prompt List on an Inpatient Oncology Unit to Increase Prognostic Awareness. Clin J Oncol Nurs 2017; 20:385-90. [PMID: 27441510 DOI: 10.1188/16.cjon.385-390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many patients with incurable cancer do not accurately understand their prognosis, which can lead to aggressive and, often, futile treatment. Improved prognostic awareness can help patients to appropriately de-escalate aggressive treatment sooner in an illness trajectory. OBJECTIVES The purpose of this article is to introduce a patient-initiated discussion aid (question prompt list) on an oncology unit to increase prognostic awareness by promoting patient-provider dialogue, which could lead to limitation of life-sustaining treatments at the end of life and increased do-not-resuscitate (DNR) orders and hospice referrals. METHODS Medical records of consecutively admitted patients with a solid malignancy who were urgently admitted to the inpatient setting were reviewed for three months to determine the percentage of DNR orders and referrals to hospice care. After inclusion of the communication aid in admission packets, records of consecutively admitted patients to the inpatient setting were reviewed for three months to reassess the percentage of DNR orders and referrals to hospice care. FINDINGS An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.
Collapse
Affiliation(s)
| | - Joy Vess
- Medical University of South Carolina
| | | |
Collapse
|
18
|
Elias CM, Shields CG, Griggs JJ, Fiscella K, Christ SL, Colbert J, Henry SG, Hoh BG, Hunte HER, Marshall M, Mohile SG, Plumb S, Tejani MA, Venuti A, Epstein RM. The social and behavioral influences (SBI) study: study design and rationale for studying the effects of race and activation on cancer pain management. BMC Cancer 2017; 17:575. [PMID: 28841847 PMCID: PMC6389115 DOI: 10.1186/s12885-017-3564-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racial disparities exist in the care provided to advanced cancer patients. This article describes an investigation designed to advance the science of healthcare disparities by isolating the effects of patient race and patient activation on physician behavior using novel standardized patient (SP) methodology. METHODS/DESIGN The Social and Behavioral Influences (SBI) Study is a National Cancer Institute sponsored trial conducted in Western New York State, Northern/Central Indiana, and lower Michigan. The trial uses an incomplete randomized block design, randomizing physicians to see patients who are either black or white and who are "typical" or "activated" (e.g., ask questions, express opinions, ask for clarification, etc.). The study will enroll 91 physicians. DISCUSSION The SBI study addresses important gaps in our knowledge about racial disparities and methods to reduce them in patients with advanced cancer by using standardized patient methodology. This study is innovative in aims, design, and methodology and will point the way to interventions that can reduce racial disparities and discrimination and draw links between implicit attitudes and physician behaviors. TRIAL REGISTRATION https://clinicaltrials.gov/ , #NCT01501006, November 30, 2011.
Collapse
Affiliation(s)
- Cezanne M. Elias
- Department of Statistics, West Lafayette, Purdue University, Human Development & Family Studies, Indiana, 47906 USA
| | - Cleveland G. Shields
- Purdue University Center for Cancer Research, Regenstrief Center for Healthcare Engineering, Human Development & Family Studies, Fowler Memorial House, 1200 W State Street, West Lafayette, IN 47906 USA
| | - Jennifer J. Griggs
- Department of Internal Medicine, Hematology & Oncology Division and Department of Health Management & Policy Ann Arbor, University of Michigan School of Medicine, Ann Arbor, MI 48109-0419 USA
| | - Kevin Fiscella
- Department of Public Health Sciences, University of Rochester School of Medicine, Family Medicine, Rochester, NY 14642 USA
| | - Sharon L. Christ
- Department of Statistics, West Lafayette, Purdue University, Human Development & Family Studies, Indiana, 47906 USA
| | - Joseph Colbert
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI 48109, 14642 USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, University of Rochester Medical Center, Rochester, NY USA
| | - Beth G. Hoh
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, University of Rochester Medical Center, Rochester, NY USA
| | - Haslyn E. R. Hunte
- West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, West VA 26506 USA
| | - Mary Marshall
- Department of Statistics, West Lafayette, Purdue University, Human Development & Family Studies, Indiana, 47906 USA
| | - Supriya Gupta Mohile
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Family Medicine, James P Wilmot Cancer Center, Rochester, NY 14642 USA
| | - Sandy Plumb
- University of Rochester School of Medicine, Family Medicine, Rochester, NY 14642 USA
| | - Mohamedtaki A. Tejani
- James P Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14642 USA
| | - Alison Venuti
- University of Rochester School of Medicine, Family Medicine, Rochester, NY 14642 USA
| | - Ronald M. Epstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Family Medicine, James P Wilmot Cancer Center, Rochester, NY 14642 USA
| |
Collapse
|
19
|
Epstein RM, Duberstein PR, Fenton JJ, Fiscella K, Hoerger M, Tancredi DJ, Xing G, Gramling R, Mohile S, Franks P, Kaesberg P, Plumb S, Cipri CS, Street RL, Shields CG, Back AL, Butow P, Walczak A, Tattersall M, Venuti A, Sullivan P, Robinson M, Hoh B, Lewis L, Kravitz RL. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer: The VOICE Randomized Clinical Trial. JAMA Oncol 2017; 3:92-100. [PMID: 27612178 PMCID: PMC5832439 DOI: 10.1001/jamaoncol.2016.4373] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized to intervention) and 265 patients (130 intervention) were analyzed. In fully adjusted models, the intervention resulted in clinically and statistically significant improvements in the primary physician-patient communication end point (adjusted intervention effect, 0.34; 95% CI, 0.06-0.62; P = .02). Differences in secondary outcomes were not statistically significant. CONCLUSIONS AND RELEVANCE A combined intervention that included oncologist communication training and coaching for patients with advanced cancer was effective in improving patient-centered communication but did not affect secondary outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01485627.
Collapse
Affiliation(s)
- Ronald M Epstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York3Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York4James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R Duberstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York3Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joshua J Fenton
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento6UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento7Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Kevin Fiscella
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York8Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York9Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Hoerger
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York10Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana11Tulane Cancer Center, Tulane University, New Orleans, Louisiana
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento12Department of Pediatrics, University of California, Davis, Sacramento
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Robert Gramling
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York8Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York13School of Nursing, University of Rochester, Rochester, New York14Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York15Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter Franks
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Paul Kaesberg
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento16Department of Internal Medicine, University of California, Davis, Sacramento
| | - Sandy Plumb
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Camille S Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Richard L Street
- Department of Communication, Texas A & M University, College Station18Houston Center for Healthcare Innovation, Quality, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas19Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cleveland G Shields
- Human Development and Family Studies Department, Purdue University, West Lafayette, Indiana21Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana22Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana23Center on Poverty and Health Inequities, Purdue University, West Lafayette, Indiana24College of Health of Human Sciences, Purdue University, West Lafayette, Indiana
| | - Anthony L Back
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle26Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia28Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, Australia
| | - Adam Walczak
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia29School of Psychology, University of Sydney, Sydney, Australia
| | - Martin Tattersall
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia30Sydney Medical School, University of Sydney, Sydney, Australia31Royal Prince Alfred Hospital, Sydney, Australia
| | - Alison Venuti
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter Sullivan
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mark Robinson
- University of California, Davis School of Medicine, University of California, Davis, Sacramento
| | - Beth Hoh
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York34Department of Social Work, Strong Memorial Hospital, Rochester, New York
| | - Linda Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Richard L Kravitz
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento6UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento35Division of General Medicine, University of California, Davis, Sacramento
| |
Collapse
|
20
|
Zucca A, Sanson-Fisher R, Waller A, Carey M, Boadle D. The first step in ensuring patient-centred quality of care: ask the patient. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12435] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Zucca
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - R. Sanson-Fisher
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - A. Waller
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - M. Carey
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - D. Boadle
- Department of Medical Oncology; Royal Hobart Hospital; Hobart TAS Australia
| |
Collapse
|
21
|
Grassi L. Communicating anticancer treatment cessation and transition to palliative care: The need for a comprehensive and culturally relevant, person-centered approach. Cancer 2015; 121:4104-7. [PMID: 26308576 DOI: 10.1002/cncr.29638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| |
Collapse
|
22
|
Kim Y, Winner M, Page A, Tisnado DM, Martinez KA, Buettner S, Ejaz A, Spolverato G, Morss Dy SE, Pawlik TM. Patient perceptions regarding the likelihood of cure after surgical resection of lung and colorectal cancer. Cancer 2015. [PMID: 26094729 DOI: 10.1002/cncr.29530%0a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the current study was to characterize the prevalence of the expectation that surgical resection of lung or colorectal cancer might be curative. The authors sought to assess patient-level, tumor-level, and communication-level factors associated with the perception of cure. METHODS Between 2003 and 2005, a total of 3954 patients who underwent cancer-directed surgery for lung (30.3%) or colorectal (69.7%) cancer were identified from a population-based and health system-based survey of participants from multiple US regions. RESULTS Approximately 80.0% of patients with lung cancer and 89.7% of those with colorectal cancer responded that surgery would cure their cancer. Even 57.4% and 79.8% of patients with stage IV lung and colorectal cancer, respectively, believed surgery was likely to be curative. On multivariable analyses, the odds ratio (OR) of the perception of curative intent was found to be higher among patients with colorectal versus lung cancer (OR, 2.27). Patients who were female, with an advanced tumor stage, unmarried, and having a higher number of comorbidities were less likely to believe that surgery would cure their cancer; educational level, physical function, and insurance status were not found to be associated with perception of cure. Patients who reported optimal physician communication scores (reference score, 0-80; score of 80-100 [OR, 1.40] and score of 100 [OR, 1.89]) and a shared role in decision-making with their physician (OR, 1.16) or family (OR, 1.17) had a higher odds of perceiving surgery would be curative, whereas patients who reported physician-controlled (OR, 0.56) or family-controlled (OR, 0.72) decision-making were less likely to believe surgery would provide a cure. CONCLUSIONS Greater focus on patient-physician engagement, communication, and barriers to discussing goals of care with patients who are diagnosed with cancer is needed.
Collapse
Affiliation(s)
- Yuhree Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan Winner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Page
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diana M Tisnado
- Department of Health Science, California State University at Fullerton, Fullerton, California
| | | | - Stefan Buettner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aslam Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sydney E Morss Dy
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
23
|
Cipolat Mis C, Truccolo I, Ravaioli V, Cocchi S, Gangeri L, Mosconi P, Drace C, Pomicino L, Paradiso A, De Paoli P. Making patient centered care a reality: a survey of patient educational programs in Italian Cancer Research and Care Institutes. BMC Health Serv Res 2015. [PMID: 26223861 PMCID: PMC4518580 DOI: 10.1186/s12913-015-0962-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Educational intervention represents an essential element of care for cancer patients; while several single institutions develop their own patient education (PE) programs on cancer, little information is available on the effective existence of PE programs at the level of research and care institutes. In Italy such institutes - Istituti di Ricovero e Cura a Carattere Scientifico - are appointed by the Ministry of Health, and 11 (Cancer Research & Care Istitute-CRCI) of the 48 are specific for cancer on the basis of specific requirements regarding cancer care, research and education. Therefore, they represent an ideal and homogeneous model through which to investigate PE policies and activities throughout the country. The objective of this study was to assess PE activities in Italian CRCI. Methods We carried out a survey on PE strategies and services through a questionnaire. Four key points were investigated: a) PE as a cancer care priority, b) activities that are routinely part of PE, c) real involvement of the patients, and d) involvement of healthcare workers in PE activities. Results Most CRCI (85 %) completed the survey. All reported having ongoing PE activities, and 4 of the 11 considered PE an institutional activity. More than 90 % of CRCI organize classes and prepare PE handouts, while other PE activities (e.g., Cancer Information Services, mutual support groups) are less frequently part of institutional PE programs. Patients are frequently involved in the organization and preparation of educational activities on the basis of their own needs. Various PE activities are carried out for caregivers in 8 (73 %) out of 11 institutes. Finally, health care workers have an active role in the organization of PE programs, although nurses take part in these activities in only half of CRCI and pharmacists are seldom included. Conclusions The information arising from our research constitutes a necessary framework to identify areas of development and to design new strategies and standards to disseminate the culture of PE. This may ultimately help and stimulate the establishment of institutional integrated PE programs, including policies and interventions that can benefit a significant proportion of cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0962-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Cipolat Mis
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - I Truccolo
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - V Ravaioli
- Public Relations, Communication and Press Office, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl IRCCS, Meldola, Italy.
| | - S Cocchi
- Medical Library, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - L Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - P Mosconi
- Laboratory for medical research and consumer involvement, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
| | - C Drace
- Familiar Cancer Clinic, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
| | - L Pomicino
- Department of Pediatrics, Institute of Maternal and Child Health, Burlo Garofolo, Trieste, Italy.
| | - A Paradiso
- Experimental Medical Oncology Unit, National Cancer Research Centre, Istituto Tumori'Giovanni Paolo II', Bari, Italy.
| | - P De Paoli
- Scientific Director, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | | |
Collapse
|
24
|
Kim Y, Winner M, Page A, Tisnado DM, Martinez KA, Buettner S, Ejaz A, Spolverato G, Morss Dy SE, Pawlik TM. Patient perceptions regarding the likelihood of cure after surgical resection of lung and colorectal cancer. Cancer 2015; 121:3564-73. [PMID: 26094729 DOI: 10.1002/cncr.29530] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the current study was to characterize the prevalence of the expectation that surgical resection of lung or colorectal cancer might be curative. The authors sought to assess patient-level, tumor-level, and communication-level factors associated with the perception of cure. METHODS Between 2003 and 2005, a total of 3954 patients who underwent cancer-directed surgery for lung (30.3%) or colorectal (69.7%) cancer were identified from a population-based and health system-based survey of participants from multiple US regions. RESULTS Approximately 80.0% of patients with lung cancer and 89.7% of those with colorectal cancer responded that surgery would cure their cancer. Even 57.4% and 79.8% of patients with stage IV lung and colorectal cancer, respectively, believed surgery was likely to be curative. On multivariable analyses, the odds ratio (OR) of the perception of curative intent was found to be higher among patients with colorectal versus lung cancer (OR, 2.27). Patients who were female, with an advanced tumor stage, unmarried, and having a higher number of comorbidities were less likely to believe that surgery would cure their cancer; educational level, physical function, and insurance status were not found to be associated with perception of cure. Patients who reported optimal physician communication scores (reference score, 0-80; score of 80-100 [OR, 1.40] and score of 100 [OR, 1.89]) and a shared role in decision-making with their physician (OR, 1.16) or family (OR, 1.17) had a higher odds of perceiving surgery would be curative, whereas patients who reported physician-controlled (OR, 0.56) or family-controlled (OR, 0.72) decision-making were less likely to believe surgery would provide a cure. CONCLUSIONS Greater focus on patient-physician engagement, communication, and barriers to discussing goals of care with patients who are diagnosed with cancer is needed.
Collapse
Affiliation(s)
- Yuhree Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan Winner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Page
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diana M Tisnado
- Department of Health Science, California State University at Fullerton, Fullerton, California
| | | | - Stefan Buettner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aslam Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sydney E Morss Dy
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
25
|
Abstract
OBJECTIVES To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. DATA SOURCES Published articles, textbooks, reports, and clinical experience. CONCLUSION The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. IMPLICATIONS FOR NURSING PRACTICE Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.
Collapse
|
26
|
Zucca A, Sanson-Fisher R, Waller A, Carey M. Patient-centred care: making cancer treatment centres accountable. Support Care Cancer 2014; 22:1989-97. [DOI: 10.1007/s00520-014-2221-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
|
27
|
Abstract
Purpose
– It is well recognised that individuals have much to contribute to the care that they receive, with attendant benefits on outcomes and reduction in cost. The recognition of individuals who access care services as interdependent citizens embedded in both formal and informal support networks is a shift that acknowledges their active role as partners in management of their own care and in service innovation and development. The purpose of this paper is therefore to explore and illustrate some of the domains of co-production.
Design/methodology/approach
– In this paper, the authors review the literature, both peer-reviewed and professional, in order to provide a broad and contemporary commentary on this emergent approach. This literature is critically summarised and presented along with a narrative that discusses the context in Wales, where the authors are based. The approach to this paper is to bring together existing knowledge and also propose potential avenues for further research and practise development.
Findings
– There is a diverse literature on this topic and the application of co-production appears potentially transformational within health and social care. Implementation of the principles of co-production has the potential to improve health and social care services in a range of settings. Real changes in outcomes and experience and reduction in societal cost can be achieved by making the people of Wales active partners in the design and delivery of their own health and social care.
Originality/value
– This review offers a readily accessible commentary on co-production, which may be of value to a wide range of professional groups and policy makers. This paper also reflects an original attempt to summarise knowledge and propose further areas for work. Most importantly, this paper offers a start point for co-production to become a reality for service provision with all the attendant benefits that will arise from this development.
Collapse
|
28
|
McDaniel SH, Morse DS, Reis S, Edwardsen EA, Gurnsey MG, Taupin A, Griggs JJ, Shields CG. Physicians criticizing physicians to patients. J Gen Intern Med 2013; 28:1405-9. [PMID: 23715689 PMCID: PMC3797330 DOI: 10.1007/s11606-013-2499-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being. OBJECTIVE This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians. DESIGN Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians. PARTICIPANTS Twenty community-based oncologists and 19 family physicians had encounters with SPs. APPROACH Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments. KEY RESULTS Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient's previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians. CONCLUSION This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
Collapse
Affiliation(s)
- Susan H McDaniel
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA,
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Silbermann M, Epner DE, Charalambous H, Baider L, Puchalski CM, Balducci L, Gultekin M, Abdalla RF, Daher M, Al-Tarawneh MR, Smith TJ. Promoting new approaches for cancer care in the Middle East. Ann Oncol 2013; 24 Suppl 7:vii5-10. [PMID: 24001764 PMCID: PMC3767160 DOI: 10.1093/annonc/mdt267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cancer is now the fastest growing killing disease in the Middle East. Accordingly, there is an urgent need to train local health professionals: oncologists, palliative care experts, oncology nurses, psychologists, along with social workers, physiotherapists and spiritual counselors on strategies for early detection, curative therapies and palliation. Professionals in the region, along with the public, need to convince medical administrators, regulators and policymakers about investing in education and training of YOUNG professionals, as well as those with already proven experience in cancer care. Training is the basis for any future cancer care program, which aims at the integration of palliative care practices into standard oncology care across the trajectory of the illness.
Collapse
Affiliation(s)
- M Silbermann
- Technion-Israel Institute of Technology, 15 Kiryat Sefer Street, Haifa, Israel.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hoerger M, Epstein RM, Winters PC, Fiscella K, Duberstein PR, Gramling R, Butow PN, Mohile SG, Kaesberg PR, Tang W, Plumb S, Walczak A, Back AL, Tancredi D, Venuti A, Cipri C, Escalera G, Ferro C, Gaudion D, Hoh B, Leatherwood B, Lewis L, Robinson M, Sullivan P, Kravitz RL. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer 2013; 13:188. [PMID: 23570278 PMCID: PMC3637237 DOI: 10.1186/1471-2407-13-188] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/26/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. METHODS/DESIGN The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. DISCUSSION The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). TRIAL REGISTRATION Clinical Trials Identifier: NCT01485627.
Collapse
Affiliation(s)
- Michael Hoerger
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, USA
| | - Ronald M Epstein
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul C Winters
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Fiscella
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul R Duberstein
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert Gramling
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul R Kaesberg
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - Wan Tang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandy Plumb
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Adam Walczak
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Anthony L Back
- Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Daniel Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Alison Venuti
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Gisela Escalera
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Carol Ferro
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Don Gaudion
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beth Hoh
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Blair Leatherwood
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Linda Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Mark Robinson
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Peter Sullivan
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| |
Collapse
|
31
|
van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
Collapse
Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
32
|
Harvey-Knowles JA, Kosenko KA. Diagnosing women with HPV: the impact of diagnosis disclosure methods. PATIENT EDUCATION AND COUNSELING 2012; 88:152-156. [PMID: 22370198 DOI: 10.1016/j.pec.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/30/2011] [Accepted: 02/01/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Little data exists on women's HPV diagnosis encounters. This research focuses on impacts of the communicative medium used to inform women of their HPV status. We conducted a qualitative study to identify the mediums used to communicate HPV diagnoses and the impact of each medium on the diagnosis experience. METHOD Twenty-five women with HPV completed semi-structured interviews, which we recorded and transcribed. We relied on grounded theory techniques in both data collection and analysis. RESULTS There are three primary mediums health care providers use to inform women of their HPV diagnosis: phone calls, mailed letters/email, and face-to-face interactions. Implications regarding each medium are identified and discussed. CONCLUSION There are drawbacks associated with the use of each medium that healthcare practitioners should be aware of and seek to avoid. PRACTICE IMPLICATIONS Healthcare providers can utilize descriptions of diagnosis encounters and the recommendations accompanying them to understand and modify ways they choose to inform individuals of an HPV diagnosis.
Collapse
|
33
|
Shavers VL, Fagan P, Jones D, Klein WMP, Boyington J, Moten C, Rorie E. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health 2012; 102:953-66. [PMID: 22494002 DOI: 10.2105/ajph.2012.300773] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients. METHODS We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed. RESULTS Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism within health care settings on racial/ethnic disparities in health care. CONCLUSIONS Better instrumentation, innovative methodology, and strategies are needed for identifying and tracking racial/ethnic discrimination in health care settings.
Collapse
Affiliation(s)
- Vickie L Shavers
- Division of Cancer Control and Population Sciences, National Cancer Institute, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Jantausch BA, Marcdante K. Enhanced professionalism in pediatric practice. Pediatr Ann 2011; 40:442-6. [PMID: 21902121 DOI: 10.3928/00904481-20110815-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
35
|
Arora NK, Street RL, Epstein RM, Butow PN. Facilitating patient-centered cancer communication: a road map. PATIENT EDUCATION AND COUNSELING 2009; 77:319-321. [PMID: 19948297 DOI: 10.1016/j.pec.2009.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|