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Beach WA. Formulating cancer worries: How doctors establish medical expertise and authority to facilitate patients' care choices. Soc Sci Med 2024; 354:117071. [PMID: 39013282 DOI: 10.1016/j.socscimed.2024.117071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/25/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of "we worry" (and at times, non-specific and second person "you"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients' choices. In all cases patients agreed and displayed minimal resistance to doctors' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.
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Affiliation(s)
- Wayne A Beach
- School of Communication, Center for Communication, Health, & the Public Good, San Diego State University, USA; Department of Surgery, Moores Cancer Center, University of California, San Diego, USA; Social Science & Medicine, USA.
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Iversen C, Kevoe-Feldman H. The subjective and objective side of helplessness: Navigating between reassurance and risk management when people seek help for suicidal others. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2024. [PMID: 38554049 DOI: 10.1111/bjso.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/01/2024]
Abstract
Social psychologists interested in interaction have demonstrated that help-seeking is a fruitful area for understanding how people relate to one another, but there is insufficient knowledge on how people navigate emotional involvement in help activities. Drawing on discursive psychology and conversation analysis, this article examines third-party calls to a crisis helpline, with emergency calls as a point of comparison, to see how participants manage emotional involvement related to callers' concerns for others. The analysis unpacks how participants orient to helplessness-callers' uncertainty and inability to move forward-as justifying a focus on the at-risk person or on the caller's emotions. While dispatchers at emergency centres work to get pertinent information to send help, call-takers at the crisis helpline are trained to offer emotional support. In the latter case, a caller's displays of helplessness may be treated as a sign of danger for the person at-risk, but it can also be taken as a disposition to worry, warranting a focus on the caller's emotional state. Showing how participants manage this challenge as they navigate 'whom to help', the paper contributes to research on the accomplishment of subjectivity and objectivity and demonstrates the utility of this framework in suicide prevention.
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Affiliation(s)
- Clara Iversen
- Department of Social Work, Uppsala University, Uppsala, Sweden
| | - Heidi Kevoe-Feldman
- Department of Communication Studies, Northeastern University, Boston, MA, USA
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3
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Yasmina K, Valérie SDDA. The content of patients' emotional expressions during follow-up consultations for chronic diseases. Chronic Illn 2024:17423953241241758. [PMID: 38528745 DOI: 10.1177/17423953241241758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES In this article, we seek to extract the themes that patients share when they express negative emotions in the context of follow-up consultation of chronic illness. We are mainly interested in patients with chronic illnesses, as these pathologies have a significant emotional overload leading to a significant deterioration of the patient's quality of life. METHODS Our corpus included audio recordings of 12 chronic disease follow-up consultations conducted by physicians practicing in neurology, nutrition, internal medicine and infectiology. The 12 patients participating suffer from various chronic diseases: Parkinson's, HIV, diabetes, etc. We performed thematic content analyses on the emotional sequences in order to extract the themes underlying these emotional expressions. RESULTS The 10 themes we have extracted are related to physical aspects, psychological aspects, the healthcare system and/or the healthcare provider, prognostic elements, social life, family life, aspects of professional life, issues of daily life, treatments and finally, aspects related to objectives and disease progress. DISCUSSION/CONCLUSION Our results show that follow-up consultations for chronic illnesses are consultations during which patients express emotions for different purposes. These emotional expressions concern particular themes that are not found in other forms of medical consultations. We will compare these results in the discussion part of this article.
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Affiliation(s)
- Kebir Yasmina
- 2LPN (Psychology and Neuroscience Lab, UR7489), Université de Lorraine, Nancy, France
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Beach WA, Dozier DM, Gutzmer KM, Chapman C. The Pursuit of Positive Impacts: Translating Longitudinal Cancer Studies into Successful Health Communication Interventions. HEALTH COMMUNICATION 2024:1-7. [PMID: 38465426 DOI: 10.1080/10410236.2024.2326252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Over a decade ago, in the 100th issue of Health Communication (Volume 25, issues 6-7); 2010), 30 "impact" articles addressed how our collective research findings had been translated to make a positive difference for persons across diverse communities. It is laudable to develop projects helping others to enhance their awareness about healthy living, refine practical communication skills to promote behavioral change, and rely on findings to enact important practices and policies giving priority to how well and long we live in contemporary society. As a preview, however, an article entitled "Why is it so difficult to talk about impact?" raised a series of inherent challenges faced whenever we conduct our research to advance basic knowledge by pursuing meaningful translation opportunities. These efforts are constrained in various ways: A lack of motivation, ability, and training to envision and implement protocols beneficial for the public good; the need to procure adequate resources (e.g., time and money) for sustaining longitudinal investigations; dealing with misconceptions that "applied" communication research has less value than "basic" studies; and creating and managing cross-disciplinary collaborations necessary to achieve project goals. When designing interventions to change others' lives in meaningful ways, attention must also be given to balancing community outreach while avoiding unnecessary self-promotion and imposition of social scientific priorities.
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Affiliation(s)
- Wayne A Beach
- School of Communication, Center for Communication, Health, & the Public Good, Public Health, San Diego State University
- Department of Surgery, Member, Moores Cancer Center, University of California
| | - David M Dozier
- School of Journalism and Media Studies, San Diego State University
| | - Kyle M Gutzmer
- School of Communication, Center for Communication, Health, & the Public Good, Public Health, San Diego State University
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Gessesse AG, Haile JM, Woldearegay AG. Exploring Effective Communication Strategies Employed by Physicians in Delivering Bad News in Ethiopian State Hospitals. Patient Relat Outcome Meas 2023; 14:409-425. [PMID: 38144389 PMCID: PMC10749095 DOI: 10.2147/prom.s390164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Delivering Bad News (DBN) presents a highly challenging situation in physician-patient communication. This study aims to gain insight into the various communication strategies employed by physicians when DBN. Methods This qualitative study conducted thematic analysis of in-depth interviews. Physicians from two comprehensive hospitals with large patient populations were selected purposively based on their engagement in delivering bad news to patients. Thematic analysis was made. Results Thematic analysis of the data revealed several communication strategies physicians use when delivering bad news. These communication strategies include. Jointly Initiated Physician-Patient Communication Strategies: ((i) Discussing with patient family/caregivers, (ii) Collaborating with other physicians and specialists), Patient-Engaged/Led Communication Strategies: ((iii) Investigating with adolescents alone or without the family, (iv) Helping patients predict what the news is, (v) Identifying patients' emotions related to bad news, (vi) Assessing patients' level of understanding, (vii) Minimizing patient anxiety), Physician-Related Communication Strategies: ((viii) Making sure diagnostic results are accurate, (xi) Identifying causes for rejection, (x) deliveringbad news using clear and simple communication). Conclusion Delivering bad news to patients can be challenging for physicians. It is important to be clear and accurate, and to prepare patients for the news. Patients may feel more comfortable and open when they are unaccompanied and with their healthcare provider. The study concluded that physicians need to be prepared to deliver bad news in a sensitive and effective manner.
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Affiliation(s)
| | - Jemal Mohammed Haile
- Departments of Journalism and Communication, Bahir Dar University, Bahir Dar, Ethiopia
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Coupé C, Ollagnier-Beldame M. Toward a phenomenology of taking care. Int J Qual Stud Health Well-being 2022; 17:2045671. [PMID: 35291910 PMCID: PMC8933010 DOI: 10.1080/17482631.2022.2045671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Christophe Coupé
- Department of Linguistics, The University of Hong Kong, Hong Kong, China
- Laboratoire DDL, CNRS – University of Lyon, Lyon, France
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Vaughan VC, Martin P. Multidisciplinary approaches to cancer cachexia: current service models and future perspectives. Expert Rev Anticancer Ther 2022; 22:737-749. [PMID: 35699257 DOI: 10.1080/14737140.2022.2088516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cancer cachexia remains a complex unmet need in oncology, despite its high prevalence and high impact. Patients with cachexia experience numerous complications, including reduced tolerance and effectiveness of anti-cancer therapy, reduced mobility, and reduced functional status, leading to decreased quality of life and survival. AREAS COVERED As the field moves toward greater consensus of definitions and measurements, we highlight tools currently available for identification and staging of cachexia, and the barriers that people with cancer face in timely identification and management of cachexia. Multidisciplinary cachexia service models have emerged to address practice gaps and needs identified by patients and clinicians. Person-centred approaches to cachexia care demonstrate promising improvements in patient outcomes, but controlled trials of service models are lacking. EXPERT OPINION While significant advances have been made in the understanding of cachexia, future trials of clinical service models require standardisation of definitions and outcome measures, with more robust controlled studies to establish the efficacy of proposed best practice. We remain excited with the potential benefit of these innovative models and continue to advocate for implementation of dedicated multidisciplinary cachexia teams to ensure patients and their families receive the right support, in the right place, at the right time.
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Affiliation(s)
| | - Peter Martin
- School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Health, Barwon Health Cachexia & Nutrition Support Service, Geelong, Australia
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Abstract
'Defining moments' are revealed by weaving three strands together in this essay. First, by reenacting stories as 'tell-aboutables,' 'defining moments' are achieved through participants' methods for drawing attention to significant events. Occasioned reconstructions are designed by speakers as timely and worthy to be heard, responded to, and appreciated by recipients. In turn, 'defining moments' of shared existence emerge through next stories, serial orderings of storytelling achievements exposing (in Goffman's terms) less about people and their moments than moments and their people. Second, numerous examples are provided of how stories about cancer comprise altogether routine everyday life activities for patients, family members, and providers. 'Defining moments' can and do become radically re-defined when landscapes of wellness give way to progressive entanglements and forfeitures of sickness. When 'health' comes into play, it is not uncommon for priorities to be given less to self-promotion (e.g. blaming and boasting), and more to efforts designed to optimize mental, emotional, spiritual, and physical well-being. Third, personal stories about 'defining moments' are shared from my long-term investigations of family cancer and patient-oncologist interactions. A vibrant reflexivity is cultivated when we recognize that, and how, our basic research can be successfully translated to advance the public good.
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Affiliation(s)
- Wayne A Beach
- School of Communication, San Diego State University
- Department of Surgery, Member, Moores Cancer Center, University of California
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Alpert JM, Markham MJ, Bjarnadottir RI, Bylund CL. Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:16-24. [PMID: 31342283 DOI: 10.1007/s13187-019-01592-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA.
| | - Merry Jennifer Markham
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | | | - Carma L Bylund
- College of Journalism and Communications / College of Medicine, University of Florida, Gainesville, FL, USA
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Karnieli-Miller O, Michael K, Gothelf AB, Palombo M, Meitar D. The associations between reflective ability and communication skills among medical students. PATIENT EDUCATION AND COUNSELING 2021; 104:92-98. [PMID: 32624329 DOI: 10.1016/j.pec.2020.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keren Michael
- Department of Human Services, Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel
| | - Ayelet Brand Gothelf
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Palombo
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Family Medicine, Clalit Health Services, Dan-Petah Tikva District, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
This study focuses on oncology interviews with returning patients who have been diagnosed with cancer, are undergoing various treatment regimens, and have been informed by doctors of their current “stable” medical condition. Conversation analysis was conducted on 112 video recorded and transcribed oncology interviews involving 30 doctors. In 44 of 112 (39 percent) interviews, doctors announced stable as good cancer news. In response, patients rarely affirm stable as good news for them. Nonreponses and minimal responses lacking enthusiasm occurred in one third of instances, and in the majority of interactions, patients resisted and questioned impacts of the need to endure ongoing treatments yet reduced possibilities for cancer shrinkage or remission. These interactional disjunctures reflect epistemic dilemmas for doctors seeking to provide quality care and especially for patients who must simultaneously manage good and bad news. Findings extend ongoing research and theoretical development that address the social psychological burdens inherent in disappointment, medical diagnosis, and prognosis. A focus on how patients and doctors manage stable cancer reveals recurring tensions between patients’ lay experiences with illness and how doctors give biomedical priority to controlling cancer.
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Affiliation(s)
- Wayne A. Beach
- San Diego State University, San Diego, CA, USA
- University of California, San Diego
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12
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Beach WA, Dozier DM, Allen BJ, Chapman C, Gutzmer K. A White Family's Oral Storytelling About Cancer Generates More Favorable Evaluations From Black American Audiences. HEALTH COMMUNICATION 2020; 35:1520-1530. [PMID: 31475579 PMCID: PMC7050336 DOI: 10.1080/10410236.2019.1652387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
One proposition of Entertainment Education (EE) suggests that actors communicating messages should be ethnically and culturally homogenous with targeted audiences. The present study challenges this assumption by investigating audience evaluations of When Cancer Calls... (WCC), a unique 80-minute theatrical production based on actual phone conversations between family members dealing with a loved one's cancer diagnosis, treatment, and eventual death. In WCC, the family is White and all interactions are drawn verbatim from 61 recorded phone calls made over 13 months. This study addresses whether authentic family storytelling about cancer minimizes differences between the White family in WCC, diverse Persons of Color (POC), and specifically how WCC resonates with Black Americans' cancer experiences. Data collected (n=483) from audiences in four U.S. cities confirmed overall positive audience reactions to viewings of WCC. Blacks were significantly more likely to evaluate WCC favorably than Whites or other POC. Rooted in the prominence of oral communication traditions, these findings confirm the power of family storytelling as a vehicle for designing health communication campaigns for Black American audiences. For example, when Blacks were forbidden to learn how to read and write during American slavery, family storytelling was a powerful tool for preserving history, sharing news, resisting racism in hostile environments, and sustaining resilience necessary for survival. These WCC findings provide innovative strategies for facilitating communication among cancer patients and family members, especially Black Americans who are deeply affected and face ongoing challenges talking about cancer.
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Affiliation(s)
- Wayne A Beach
- School of Communication, Center for Communication, Health, and the Public Good, SDSU/UCSD Joint Doctoral Program in Public Health, San Diego State University
- Department of Surgery, Moores Cancer Center, University of California
| | - David M Dozier
- School of Journalism & Media Studies, San Diego State University
| | - Brenda J Allen
- Department of Communication, Vice Chancellor for Diversity and Inclusion, University of Colorado Denver, Anschutz Medical Campus
| | - Chelsea Chapman
- UCSD School of Medicine, Department of Family and Preventive Medicine, SDSU Graduate School of Public Health
| | - Kyle Gutzmer
- UCSD School of Medicine, Department of Family and Preventive Medicine, SDSU Graduate School of Public Health
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Chapman CR, Beach WA. Patient-Initiated Pain Expressions: Interactional Asymmetries and Consequences for Cancer Care. HEALTH COMMUNICATION 2020; 35:1643-1655. [PMID: 31469598 PMCID: PMC7048651 DOI: 10.1080/10410236.2019.1654178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Only minimal attention has been given to analyzing interactional moments when patients and providers talk about "pain" in general consultations and primary care, and no attention has focused on how pain gets managed during oncology interviews. Conversation analysis (CA) is used to examine a sampling of instances drawn from a collection of 146 pain instances across 65 video recorded and transcribed clinical encounters in a comprehensive cancer clinic. Specific attention is drawn to how pain descriptions are not static but malleable as cancer patients upgrade, downgrade, and produce combined orientations when making their experiences available to oncologists. In response, it is shown that doctors acknowledge patients' descriptions, but do not elaborate nor affiliate with, important pain disclosures. Three interactional environments are closely examined: 1) Reporting and responding to past pain/hurt incidents; 2) Doctor's missing assessments in response to good news announcements about patients' minimal pain; and 3) Patient-initiated pain responses to doctors' questions. These empirical findings confirm identified patterns of interactional asymmetries comprising pain events in UK consultations and USA primary care. Close examination of these social actions provides basic knowledge about how pain communication reframes historical understandings of individuals' pain experiences. Implications for future research are identified, and a protocol is described for how clinical practice and medical education can be improved by refining understandings of pain communication to promote increased sensitivities and more personalized responses to pain expressions.
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Affiliation(s)
- Chelsea R Chapman
- Department of Family and Preventive Medicine, UCSD School of Medicine, SDSU Graduate School of Public Health
| | - Wayne A Beach
- School of Communication
- Center for Communication, Health, & The Public Good, SDSU/UCSD Joint Doctoral Program in Public Health, San Diego State University
- Department of Surgery, Moores Cancer Center, University of California, San Diego
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Caren J, Mose G, Kurgat K. Experience of communication among cervical cancer patients in Kenya. Int J Palliat Nurs 2020; 26:346-352. [PMID: 33108922 DOI: 10.12968/ijpn.2020.26.7.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Communication influences patient disclosure, treatment adherence, and outcome, adaptation to illness, and bereavement. Different cancer patients and caregivers communicate their various experiences in unique ways. These distinctive experiences are necessary to be told, because it empowers both the teller and everyone who hears and shares that experience. However, there is little research documenting the experiences of cervical cancer patients and caregivers in Kenya and the rest of Africa. This study therefore sought to assess the communication experience among cervical cancer patients and their caregivers. This study was a qualitative study employing the phenomenological method to obtain data from cervical patients and caregivers. It was carried out in Uasin Gishu County, Kenya, where a range of in-depth interviews were held with eight patients and eight caregivers purposively sampled. Data from the interviews were analysed thematically and presented in narrative form using paraphrases and quotations. Ethical issues such as informed consent, confidentiality and official authorisation were observed at all levels. To enrich this study, hermeneutic theory, which explains more about the individual's experience, was used. The findings of the study indicated that communication is therapeutic, although most of the patients and the caregivers were reluctant to talk about their illness. The findings of this study will be of interest to scholars, policy-makers and caregivers of terminally ill patients.
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Affiliation(s)
- Jerop Caren
- Student Alupe University College, Alupe, Kenya
| | - George Mose
- Lecturer, School of Information, Kisii University, Nairobi, Kenya
| | - Kibiwott Kurgat
- Professor, School of Information, Kisii University, Nairobi, Kenya
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What symptoms tell us: A multiple case study of oncology consultations. Palliat Support Care 2020; 19:421-436. [PMID: 32912373 DOI: 10.1017/s1478951520000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach. METHODS Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature. RESULTS Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential. SIGNIFICANCE OF RESULTS Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.
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Flinkfeldt M. Respecifying ‘worry’: Service and emotion in welfare encounters. QUALITATIVE RESEARCH IN PSYCHOLOGY 2020. [DOI: 10.1080/14780887.2020.1725949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Marie Flinkfeldt
- Department of Sociology, Uppsala University, Uppsala, Sweden
- Department of Sociology, Umeå University, Umeå, Sweden
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Langewitz W. Reaching wise decisions, shared decision making, and information recall-A causal relationship or just an association? PATIENT EDUCATION AND COUNSELING 2020; 103:2-4. [PMID: 31801678 DOI: 10.1016/j.pec.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Wolf Langewitz
- Basel University Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland.
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Beach WA. "Tiny Tiny Little Nothings": Minimization and Reassurance in the Face of Cancer. HEALTH COMMUNICATION 2019; 34:1697-1710. [PMID: 30453778 DOI: 10.1080/10410236.2018.1536945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drawing from a sub-sample of video recorded and transcribed oncology interviews, Conversation Analysis is used to examine moments when cancer is portrayed as absent or minimally present but not dangerously invasive. Though cancer patients and their doctors invest considerable efforts pursuing life-affirming and hopeful possibilities advancing the quality of living and healing outcomes, little is known about how"good news" and thus hopeful social actions get organized. An interactional practice is identified for depicting tumor sizes as small or shrinking - a displayed preference to tumors that are large, growing, and spreading (i.e., metastasizing). By relying on gestural depictions (e.g., pinched fingers and open hands), in precise unison with paired lexical affiliates (e.g., tiny, little, nothing), it is shown how patients seek to justify their wellness and doctors offer reassurance by demonstrating that tumor sizes are minimally threatening. These interactional practices provide a needed balance to deathly cancer stereotypes, criticisms of health-care bureaucracies as inhumane, and overreliance on biomedical authority enacted during clinical encounters. A need exists to verify the existence of a benign social order in the midst of cancer care, actions designed to address malignant diagnoses by curtailing uncontrolled cancer growth.
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Affiliation(s)
- Wayne A Beach
- School of Communication, Center for Communication, Health, & the Public Good, SDSU/UCSD Joint Doctoral Program in Public Health, San Diego State University
- Department of Surgery, Moores Cancer Center, University of California
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Beach WA. Making Cancer Visible: Unmasking Patients' Subjective Experiences. HEALTH COMMUNICATION 2019; 34:1683-1696. [PMID: 30430879 DOI: 10.1080/10410236.2018.1536941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Face of Cancer, an article and patient's painting published nearly 15 years ago, has contributed in significant ways to a body of research focusing on communication during oncology interviews. Impacts from this painting helped to create a sensitivity for analyzing naturally occurring video recordings, including moments when patients' subjective experiences are raised and responded to. Analysis begins with how a melanoma patient's facial expression bears striking resemblance to the painting, vocal and other visible social actions (e.g., gaze, gesture), and how patient's story about a friend's metastatic cancer reveals her primal fears and hopes about cancer. Actions displayed by other patients (breast, testicular, abdominal, and leukemia) are also examined to unmask how their faces and bodies make cancer visible, doctors' responses, and the complexities of how patients' stressful stories get constructed. Implications are raised for improving patient-provider relationships by offering more personalized care. Understanding how patients display their concerns and emotions, through spoken and embodied actions, enhances discernment about how best to provide tailored and supportive responses to patients' life-world experiences especially, but not exclusively, when dealing with the stresses and angst of cancer.
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Affiliation(s)
- Wayne A Beach
- School of Communication, Center for Communication, Health, & the Public Good, SDSU/UCSD Joint Doctoral Program in Public Health, San Diego State University
- Department of Surgery, Moores Cancer Center, University of California
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Responses to a cancer diagnosis: a qualitative patient-centred interview study. Support Care Cancer 2019; 28:229-238. [PMID: 31020437 DOI: 10.1007/s00520-019-04796-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice. METHODS Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach. RESULTS A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others. CONCLUSIONS A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective.
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Murtagh GM, Thomas AL, Furber L. Does the delivery of diagnostic news affect the likelihood of whether or not patients ask questions about the results? A conversation analytical study. Health Expect 2018; 21:1002-1012. [PMID: 29726069 PMCID: PMC6250863 DOI: 10.1111/hex.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 01/26/2023] Open
Abstract
Background Asymmetries in knowledge and competence in the medical encounter often mean that doctor‐patient communication can be compromised. This study explores this issue and examines whether the likelihood of patient question asking is increased following the delivery of diagnostic test results. It also examines whether that likelihood is related to the way in which the test results are delivered. Objective To examine when and how patients initiate questions following diagnostic news announcements. Methods We audio‐recorded oncology consultations (n = 47) consisting of both first consultations and follow‐up consultations with patients with different types of cancer, at a leading UK teaching hospital. From the primary sample, we identified 30 consultations based on a basic count of the frequency of patient questions and their positioning in relation to diagnostic announcements. This subset of 30 consultations consisted of a mix of first and follow‐up consultations. Results Our data demonstrate how the design and delivery of diagnostic news announcements can either discourage or provide the opportunity for a patient‐initiated question in the next turn of talk. We identified two types of announcement. Q+ generally provided for a patient‐initiated question as a relevant next turn following the news announcement, whereas Q− did not. Q+ was sometimes followed up with the explanation of test results, which appeared to encourage further patient questions. Conclusion The design and delivery of diagnostic news announcements can make a patient‐initiated question more or less appropriate, in the next turn of talk. In addition, showing and explaining test results can encourage further opportunities for patients’ questions.
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Affiliation(s)
- Ged M Murtagh
- Division of Surgery, Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, UK
| | - Anne L Thomas
- Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, Leicester, UK
| | - Lynn Furber
- School of Nursing and Midwifery, Edith Murphy, De Montfort University, Leicester, UK
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Karnieli-Miller O, Palombo M, Meitar D. See, reflect, learn more: qualitative analysis of breaking bad news reflective narratives. MEDICAL EDUCATION 2018; 52:497-512. [PMID: 29672937 DOI: 10.1111/medu.13582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/21/2017] [Accepted: 02/08/2018] [Indexed: 05/21/2023]
Abstract
CONTEXT Breaking bad news (BBN) is a challenge that requires multiple professional competencies. BBN teaching often includes didactic and group role-playing sessions. Both are useful and important, but exclude another critical component of students' learning: day-to-day role-model observation in the clinics. Given the importance of observation and the potential benefit of reflective writing in teaching, we have incorporated reflective writing into our BBN course. The aim of this study was to enhance our understanding of the learning potential in reflective writing about BBN encounters and the ability to identify components that inhibit this learning. METHODS This was a systematic qualitative immersion/crystallization analysis of 166 randomly selected BBN narratives written by 83 senior medical students. We analysed the narratives in an iterative consensus-building process to identify the issues discussed, the lessons learned and the enhanced understanding of BBN. RESULTS Having previously been unaware of, not invited to or having avoided BBN encounters, the mandatory assignment led students to search for or ask their mentors to join them in BBN encounters. Observation and reflective writing enhanced students' awareness that 'bad news' is relative and subjective, while shedding light on patients', families', physicians' and their own experiences and needs, revealing the importance of the different components of the BBN protocol. We identified diversity among the narratives and the extent of students' learning. DISCUSSION Narrative writing provided students with an opportunity for a deliberative learning process. This led to deeper understanding of BBN encounters, of how to apply the newly taught protocol, or of the need for it. This process connected the formal and informal or hidden curricula. To maximise learning through reflective writing, students should be encouraged to write in detail about a recent observed encounter, analyse it according to the protocol, address different participants' behaviours and emotions, and identify dilemmas and clear lessons learned.
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Affiliation(s)
- Orit Karnieli-Miller
- Sackler Faculty of Medicine, Department of Medical Education, Tel Aviv University, Tel Aviv, Israel
| | - Michal Palombo
- Sackler Faculty of Medicine, Department of Medical Education, Tel Aviv University, Tel Aviv, Israel
- Department of Family Medicine, Clalit Health Services, Dan-Petah Tikva District, Israel
| | - Dafna Meitar
- Sackler Faculty of Medicine, Department of Medical Education, Tel Aviv University, Tel Aviv, Israel
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Alzahrani AS, Alqahtani A, Alhazmi M, Gaafar R, Bajabir D, Alharbi IM, Alharbi AM, Kheshaifaty G, Alzahrani A. Attitudes of cancer patients and their families toward disclosure of cancer diagnosis in Saudi Arabia: a Middle Eastern population example. Patient Prefer Adherence 2018; 12:1659-1666. [PMID: 30214168 PMCID: PMC6126501 DOI: 10.2147/ppa.s176651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Particularly in the Middle East, few studies have explored the attitude of cancer patients and their families toward cancer diagnosis disclosure (CDD). This study was conducted to investigate the preference and attitude of a sample of cancer patients and their families in Saudi Arabia toward CDD. METHODS We constructed a questionnaire based on previous studies. The questionnaire assessed preference and attitude toward CDD. Participants were recruited from the King Abdullah Medical City, which has one of the largest cancer centers in Saudi Arabia. RESULTS Three hundred and four cancer patients and 277 of their family members participated in the study. The patient group preferred CDD more than the family group (82.6% vs 75.3%, P<0.05). This preference is especially more evident toward disclosure of detailed cancer information (status, prognosis, and treatment) (83.6% vs 59.9%, P<0.001). In a binary logistic regression, factors associated with preference toward CDD included having information about cancer (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.15-2.84) and being employed (OR, 1.77; 95% CI, 1-2.82) while being from the patient group was the only factor associated with preference toward detailed cancer information (OR, 3.25; 95% CI, 2.11-5.05). In terms of patient reaction after CDD, "fear" was the attitude expected by the family group more than the patient group (56.3% vs 70.4%, P<0.001) while "acceptance" was the attitude anticipated by the patient group more than the family group (38% vs 15.2%, P<0.001). CONCLUSION Patients preferred CDD and disclosure of related information, while their families were more inclined toward scarce disclosure. Family members seem to experience negative attitudes more than the patients themselves.
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Affiliation(s)
- Ahmad S Alzahrani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Abdullah Alqahtani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Maher Alhazmi
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | - Doaa Bajabir
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | | | - Ghufran Kheshaifaty
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Aamer Alzahrani
- College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Estacio CF, Butow PN, Lovell MR, Dong ST, Clayton JM. What is symptom meaning? A framework analysis of communication in palliative care consultations. PATIENT EDUCATION AND COUNSELING 2017; 100:2088-2094. [PMID: 28619270 DOI: 10.1016/j.pec.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations. METHODS Framework analysis was conducted with 40 palliative care consultation transcripts. RESULTS 55% of consultations discussed symptom meaning. Six themes regarding patients' symptom meanings emerged while four themes conveyed physicians' responses to these utterances. Key symptom meanings included symptoms representing diminished function and uncertainty about symptom cause or future. Physicians usually gave scientific medical responses concerning symptom cause and treatment, versus reassurance or empathy. CONCLUSION This study has provided greater insight into the different symptom meanings that exist for palliative care patients. Physicians' responses highlight their reliance on medical information when patients are distressed. Future studies should explore the impact of different responses on patient outcomes, and health practitioners' views about optimal responses. PRACTICE IMPLICATIONS Physicians could explore symptom meanings with their patients, looking out for those identified here. Apart from information-giving and treatment, active listening to these concerns as they present in consultations may help improve the therapeutic relationship and better guide optimal care.
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Affiliation(s)
- Celina F Estacio
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia.
| | - Melanie R Lovell
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Skye T Dong
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Josephine M Clayton
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
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Beach WA, Prickett E. Laughter, Humor, and Cancer: Delicate Moments and Poignant Interactional Circumstances. HEALTH COMMUNICATION 2017; 32:791-802. [PMID: 27420294 DOI: 10.1080/10410236.2016.1172291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Conversation analysis is employed to examine transcribed excerpts drawn from a subsample of 75 naturally occurring and video recorded interviews between cancer patients and 30 doctors. Close examination is provided of how cancer patients initiate, and doctors respond, to laughter and humor during oncology interviews. Interactions demonstrate that communication about the disease "cancer" shares qualities similar to other medical areas (e.g., primary care): the tendency for patients to initiate laughter or humor to address troubling and challenging circumstances; and that during moments when patients address personal matters, doctors are not invited and do not reciprocate with shared laughter and humor. Prominent in talk about cancer are various precarious circumstances, awkward and delicate moments mirroring the lived experiences of cancer patients (e.g., when patients attempt to minimize fears, justify that they are well when threatened with sickness, claim normality in the midst of chronic conditions, and take stances that weight loss and gain are not problematic). These examples provide a compelling case that routine cancer care involves many poignant situations managed through laughter and humor. Implications are raised for how quality care might be improved through grounded understandings of laughter, humor, and cancer.
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Affiliation(s)
- Wayne A Beach
- a School of Communication, San Diego State University, Department of Surgery , Moores Cancer Center, University of California, UCSD/SDSU Joint Doctoral Program in Public Health
| | - Erin Prickett
- b College of Arts & Sciences , University of San Diego and Department of Communication Studies, University of San Diego
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26
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Girardon-Perlini NMO, Ângelo M. The experience of rural families in the face of cancer. Rev Bras Enferm 2017; 70:550-557. [PMID: 28562803 DOI: 10.1590/0034-7167-2016-0367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/02/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To understand the meanings of cancer within the experience of rural families and how such meanings influence family dynamics. Method Qualitative study guided by Symbolic Interactionism as a theoretical framework and Grounded Theory as a methodological framework. Six rural families (18 participants) undergoing the experience of having a relative with cancer participated in the interview. Results Constant comparative analysis of data allowed the elaboration of an explanatory substantive theory, defined by the main category Caregiving to support the family world, which represents the family's symbolic actions and strategies to reconcile care for the patient and care for family life. Final considerations Throughout the experience, rural families seek to preserve the interconnected symbolic elements that provide support for the family world: family unit, land, work and care.
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Affiliation(s)
| | - Margareth Ângelo
- Universidade de São Paulo, School of Nursing, Postgraduate Program in Nursing. São Paulo, Brazil
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Nightingale JM, Murphy F, Eaton C, Borgen R. A qualitative analysis of staff-client interactions within a breast cancer assessment clinic. Radiography (Lond) 2016; 23:38-47. [PMID: 28290339 DOI: 10.1016/j.radi.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/30/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Breast screening clients recalled to an assessment clinic experience high levels of anxiety. The culture of the assessment clinic may impact upon client experience, which may influence their future re-engagement in screening. This study aimed to explore the culture of staff-client interactions within a breast cancer assessment clinic. MATERIALS AND METHODS Following an ethnographic approach, twenty-three client journeys were observed, followed by semi-structured interviews with the clients. The observation and interview data were analysed to produce research themes, which were then explored within two focus groups to add a practitioner perspective. RESULTS Multiple staff-client interaction events were observed over a period of several weeks. Client interview feedback was overwhelmingly positive. Three recurrent and sequential themes emerged: breaking down barriers, preparing the ground and sign-posting. These themes outline the changing focus of staff-client interactions during the client's clinic journey, encompassing how anxieties were expressed by clients, and responded to by practitioners. CONCLUSION This study was the first to explore in depth the staff-client interaction culture within a breast assessment clinic using an ethnographic approach. A new perspective on professional values and behaviours has been demonstrated via a model of staff-client interaction. The model documents the process of guiding the client from initial confusion and distress to an enhanced clarity of understanding. A recommendation most likely to have a positive impact on the client experience is the introduction of a client navigator role to guide the clients through what is often a lengthy, stressful and confusing process.
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Affiliation(s)
| | - F Murphy
- University of Salford, United Kingdom
| | - C Eaton
- University of Salford, United Kingdom
| | - R Borgen
- East Lancashire Hospitals NHS Trust, United Kingdom
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Fatigante M, Alby F, Zucchermaglio C, Baruzzo M. Formulating treatment recommendation as a logical consequence of the diagnosis in post-surgical oncological visits. PATIENT EDUCATION AND COUNSELING 2016; 99:878-887. [PMID: 26898599 DOI: 10.1016/j.pec.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE the article analyzes how a doctor delivers diagnoses and recommends treatment in a set of post-surgical oncological visits. The pattern of activities are explored in two different cases: when all diagnostic information is available, and when information is still missing. METHODS The data consist of 12 video-recorded visits of breast cancer patients to a senior oncologist. Conversation analysis is employed to analyze sequences in which the delivery of diagnosis and treatment recommendation unfold. RESULTS The oncologist formulates the treatment recommendation as a logical consequence deriving from the available diagnostic information. In cases when definitive diagnostic information on the cancer type is missing, the oncologist opts to anticipate hypothetical diagnostic scenarios, and to draw the therapeutic alternatives as logical outcomes envisionable from each of the different scenarios. CONCLUSION The communicative practice appears functional to encourage the patients' acceptance of a single treatment option rather than present the patients to and involve them in deliberating over multiple available treatment alternatives. PRACTICE IMPLICATIONS Rather than a normative adoption of existing protocols of communication in cancer care, a better understanding of communication practices in use can help practitioners to reflect upon and make intentional choices about different arrangements for the patient's participation.
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Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy.
| | - Francesca Alby
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
| | - Mattia Baruzzo
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
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Maynard DW, Cortez D, Campbell TC. 'End of life' conversations, appreciation sequences, and the interaction order in cancer clinics. PATIENT EDUCATION AND COUNSELING 2016; 99:92-100. [PMID: 26299872 PMCID: PMC6555150 DOI: 10.1016/j.pec.2015.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To address the organization of conversations in oncology visits by taking an "interaction order" perspective and asking how these visits are intrinsically organized. METHODS Conversation analysis. RESULTS Using audio recordings of talk in oncology visits involving patients with non-small cell lung cancer, we identify and analyze an "appreciation sequence" that is designed to elicit patients' understanding and positive assessment of treatments in terms of their prolongation of life. CONCLUSION An "appreciation sequence," regularly initiated after the delivery of scan results and/or treatment recommendations, simultaneously reminds patients of their mortality while suggesting that the treatment received has prolonged their lives, and in some cases significantly beyond the median time of survival. PRACTICE IMPLICATIONS We explore the functions of the appreciation sequence for cancer care and set the stage for considering where and when physicians have choices about the order and direction the talk can take and how to allocate time for end of life and quality of life conversations.
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Affiliation(s)
- Douglas W Maynard
- University of Wisconsin, 1180 Observatory Drive, Madison 53706, United States
| | - Dagoberto Cortez
- University of Wisconsin, 1180 Observatory Drive, Madison 53706, United States
| | - Toby C Campbell
- University of Wisconsin, 1180 Observatory Drive, Madison 53706, United States
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30
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Yoon S, Chan M, Hung WK, Ying M, Or A, Lam WWT. Communicative characteristics of interactions between surgeons and Chinese women with breast cancer in oncology consultation: a conversation analysis. Health Expect 2015; 18:2825-40. [PMID: 25200668 PMCID: PMC5810679 DOI: 10.1111/hex.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk-in-interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent. OBJECTIVE To provide insight into the talk-in-interaction in surgical-oncology consultations in the context of a Chinese medical setting. METHODS Thirty-one consultations involving 31 patients with breast cancer and eight surgeons were videotaped. The recordings were transcribed verbatim and analysed using conversation analysis. RESULTS The manner in which surgeons delivered the diagnostic results was fairly similar across all the consultations. Most surgeons gave the diagnosis in a very straightforward and abrupt manner at the outset of the consultation with no mitigation. While patients in our study conformed to the traditional information giving and receiving roles, how information was presented by surgeons shaped the subsequent sequential organization of surgeon-patient interaction and turn-taking patterns. More importantly, there was a tendency by the surgeons to move from issues of psychosocial nature to clinical matters regardless of the topics taken up in the specific encounter. CONCLUSIONS This study demonstrated the potential of conversation analysis as a context-sensitive method that enabled researchers to gain a more thorough understanding of dynamics of interaction in cancer consultations, thereby informing training interventions for surgeons. Our findings underscore the importance of discursive practices in shaping and encouraging (or discouraging) patient participation in oncology consultation.
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Affiliation(s)
- Sungwon Yoon
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
| | - Miranda Chan
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wai Ka Hung
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Marcus Ying
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Amy Or
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wendy WT Lam
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
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Beach WA, Dozier DM. Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1243-54. [PMID: 26134261 PMCID: PMC5114848 DOI: 10.1080/10810730.2015.1018644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.
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Affiliation(s)
- Wayne A. Beach
- Professor, School of Communication, San Diego State University, San Diego, CA 92182-4561, Phone: (619) 594-4948, FAX: (619) 594-0704, Adjunct Professor, Department of Surgery, Member, Moores Cancer Center, University of California, San Diego
| | - David M. Dozier
- Professor, Public Relations Emphasis, School of Journalism & Media Studies, San Diego State University, San Diego, CA 92182-4561
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Clayton MF, Reblin M, Carlisle M, Ellington L. Communication Behaviors and Patient and Caregiver Emotional Concerns: A Description of Home Hospice Communication. Oncol Nurs Forum 2014; 41:311-21. [DOI: 10.1188/14.onf.311-321] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Furber L, Bonas S, Murtagh G, Thomas A. Patients' experiences of an initial consultation in oncology: knowing and not knowing. Br J Health Psychol 2014; 20:261-73. [PMID: 24628860 DOI: 10.1111/bjhp.12096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this paper was to explore how patients experience an initial oncology consultation. This study was part of a larger mixed methods research project designed to address the issue of improving communication and enhancing patient satisfaction with oncology consultations. DESIGN Interpretive phenomenological analysis was used to interpret the participants' meanings of their experiences in their initial consultation. It is an idiographic approach that focuses in depth on a small set of cases in order to explore how individuals make sense of a similar experience. This retains the complexity and diversity of experiences. METHODS In the larger study, semi-structured interviews were carried out with 36 patients as soon as possible after a consultation in oncology to explore their experiences. Five cases were selected for this study on the basis of homogeneity; they had all undergone some prior investigations of their illness, and this was their first consultation in oncology; they all provided rich accounts relating to how they had experienced the consultation. RESULTS Patients' experiences of being given their diagnosis differed both between participants and within the same participant. Various defences seemed to be used in order to protect them from fully engaging with the knowledge they were given. Their accounts of what they wished to know in the consultation could be affected by a desire to protect themselves and/or family members from distress and by the practical need to know that may vary over time. CONCLUSION The complexity of patients' needs and preferences regarding information means that the doctor's role in communicating that information in a patient-centred way is difficult. The findings are discussed in relation to open awareness theory as to how the emotional context of the consultation process affects information needs. Doctors need strategies to elicit information from patients about their needs from the consultation. This needs to be done at the start of consultations and throughout investigations and treatment, as needs may change over time. Statement of contribution What is already known on this subject? Patients' desire to know information is sometimes tempered with by a desire to avoid distress to themselves. Patients do not always understand or make accurate sense of what they have been told. Receiving a diagnosis of cancer is distressing for patients. What does this study add? Doctors need strategies to elicit information from patients about their needs for each consultation. This needs to be done consistently throughout the patient journey as needs may change over time. Patients control what they do or do not do with information but do not openly share this with the doctor. Our interpretations of the interviews stray beyond the conscious accounts of the consultations and draw on (unconscious) absences that may also be of significance in making sense of overall experience. The complexity of patients' needs and preferences regarding information means that the doctors' role is very difficult. Patients have a right to know but not a duty to know their diagnosis and prognosis.
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Affiliation(s)
- Lynn Furber
- Department of Cancer Studies and Molecular Medicine, University of Leicester, UK
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Blanch-Hartigan D, Ruben MA. Training clinicians to accurately perceive their patients: current state and future directions. PATIENT EDUCATION AND COUNSELING 2013; 92:328-336. [PMID: 23490175 DOI: 10.1016/j.pec.2013.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 02/12/2013] [Accepted: 02/16/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the literature on training clinicians' person perception accuracy, or the ability to correctly judge patients' states and traits. To present the importance of training this skill, share evidence it is a trainable skill, and suggest evidence-based recommendations for implementing training. METHODS We conducted a literature review on person perception training studies developed for or implemented with clinicians. We also summarized measures to evaluate training efficacy, barriers to implementation, and future research directions. RESULTS Training studies exist to improve clinicians' ability to perceive patients' emotions, pain, distress, and depression. These varied in training approach, length of training, and study design. Ten of 13 studies showed training benefited person perception accuracy. CONCLUSIONS The medical literature and previous meta-analysis on person perception training across contexts demonstrate that training person perception accuracy can be effective. Examples of effective trainings provide suggestions of best-practices for future efforts in this area. PRACTICE IMPLICATIONS More evidence is needed to create and implement trainings which produce not only differences in accuracy but also in patient care and outcomes. Medical curriculum developers and researchers should collaborate to create effective person perception trainings for clinicians.
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Affiliation(s)
- Danielle Blanch-Hartigan
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA.
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Furber L, Cox K, Murphy R, Steward W. Investigating communication in cancer consultations: what can be learned from doctor and patient accounts of their experience? Eur J Cancer Care (Engl) 2013; 22:653-62. [DOI: 10.1111/ecc.12074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- L. Furber
- Oncology and Haematology Clinical Trials Office; University Hospitals of Leicester NHS Trust; Leicester
| | - K. Cox
- University of Nottingham; Nottingham
| | - R. Murphy
- Faculty of Social Science; Dearing, Jubilee Campus; Nottingham
| | - W. Steward
- Department of Cancer Studies and Molecular Medicine; University of Leicester; Leicester; UK
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Caldwell KL, Gray J, Wolever RQ. The Process of Patient Empowerment in Integrative Health Coaching: How Does it Happen? Glob Adv Health Med 2013; 2:48-57. [PMID: 24416672 PMCID: PMC3833537 DOI: 10.7453/gahmj.2013.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative health coaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the mechanisms through which empowerment occurs in the health coaching process. The purpose of this qualitative study is to describe apparent key components of the empowerment process as it actually occurs in IHC. A sample of 69 recorded health coaching sessions was drawn from 12 participants enrolled in a randomized controlled study comparing two different methods of weight-loss maintenance. Two researchers coded the word-for-word transcripts of sessions focusing on the structure of the sessions and communication strategies used by the coaches. Three basic sections of a coaching session were identified, and two main themes emerged from the communication strategies used: Exploring Participant's Experience and Active Interventions. In IHC, health coaches do not direct with prefabricated education based on the patient's presenting problem; rather, they use a concordant style of communication. The major tenets of the health coaching process are patient-centeredness and patient control focused around patient-originated health goals that guide the work within a supportive coaching partnership. As the field of health coaching continues to define itself, an important ongoing question involves how the structure of the provider-patient interaction is informed by the role of the healthcare provider (eg, nurse, therapist, coach) and in turn shapes the empowerment process.
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Affiliation(s)
- Karen L Caldwell
- Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina, United States
| | - Jennifer Gray
- Department of Communication, Appalachian State University, Boone, North Carolina, United States
| | - Ruth Q Wolever
- Duke Integrative Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States
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Gany F, Yogendran L, Massie D, Ramirez J, Lee T, Winkel G, Diamond L, Leng J. "Doctor, what do i have?" Knowledge of cancer diagnosis among immigrant/migrant minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:165-70. [PMID: 23093484 PMCID: PMC5469292 DOI: 10.1007/s13187-012-0429-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study explores patient knowledge of cancer diagnosis among underserved immigrant/migrant minorities. Patients were recruited at a hospital-based cancer clinic in New York City. Demographic and self-reported diagnosis and treatment information were collected; charts were reviewed to ascertain cancer diagnosis. Four hundred thirty-four patients were included. Eighty-seven percent preferred to speak a language other than English in the health care setting. Sixteen percent had incorrect knowledge of their cancer diagnosis. Multivariate analysis indicated that both preference for a non-English language and diagnosis of a "below the belt" cancer were jointly predictive of incorrect knowledge (LR = 17.01; p = 0.0002). "Below the belt" cancers included bladder, colorectal, gynecological, penile, prostate, and testicular cancers. Among this cohort of immigrant/migrant cancer patients, a considerable proportion was unaware of their correct cancer diagnoses. This may have a significant impact on subsequent cancer education, treatment, and care. Limited-English-proficiency patients may be at particular risk.
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Affiliation(s)
- Francesca Gany
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, 300 E. 66 St, 15 floor, New York, NY 10065
| | - Lalanthica Yogendran
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, 300 E. 66 Street, 15 floor, New York, NY 10065
| | - Dana Massie
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, 300 E. 66 Street, 15 floor, New York, NY 10065
| | - Julia Ramirez
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, 300 E. 66 Street, 15 floor, New York, NY 10065
| | - Trevor Lee
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, 300 E. 66 Street, 15 floor, New York, NY 10065
| | - Gary Winkel
- Mount Sinai School of Medicine, Department of Oncological Sciences, Icahn Medical Institute, Room 15-70, One Gustave L. Levy Place, Box 1130, New York, NY 10029
| | - Lisa Diamond
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, 300 E. 66 St, 15 floor, New York, NY 10065
| | - Jennifer Leng
- Memorial Sloan-Kettering Cancer Center, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, 300 E. 66 St, 15 floor, New York, NY 10065
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Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: cancer patient perspectives. PATIENT EDUCATION AND COUNSELING 2013; 90:291-296. [PMID: 22464665 DOI: 10.1016/j.pec.2012.02.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients' perspectives. METHODS Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients. RESULTS Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care. CONCLUSION In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities. PRACTICE IMPLICATIONS Shared decision-making as a practice standard must be balanced against individual patient preferences.
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Affiliation(s)
- Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, Canada.
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Beach WA. Patients' efforts to justify wellness in a comprehensive cancer clinic. HEALTH COMMUNICATION 2012; 28:577-591. [PMID: 22928718 DOI: 10.1080/10410236.2012.704544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Conversation analysis (CA) is employed to examine oncology interviews within a comprehensive cancer clinic. Data are drawn from a sampling of 75 video-recorded and transcribed encounters involving 30 oncologists. During history-taking, by expanding answers to doctor's questions designed to solicit "yes/no" responses, patients manage constraints on interaction by initiating and pursuing distinct courses of action. One prominent set of nonconforming actions involves how cancer patients "justify wellness" and contest doctors' orientations to sickness. In response, doctors treat patients' expansions as dispreferred (e.g., through lack of acknowledgment or topic shift) because they do not conform with questions designed to solicit minimal answers. Patients initiate "justifying wellness" by invoking epistemic knowledge, using extreme language to optimize medical histories, emphasizing and bolstering wellness claims, and reporting healthy lifestyles. As a resource for managing vulnerability in the face of cancer, and for advancing resilient stances toward health and healing, patients attempt to counter the likelihood, severity, and overall threat of cancer. These and related actions ward off otherwise troubling diagnoses and, directly or indirectly, make the case for minimal or even dismissing the need for ongoing cancer care. Implications are raised for recalibrating "sick role" and "well role" activities as practical achievements, distributions of yes/no questions and expanded answers, a benign theory of social order in cancer clinics, the importance of responding to patients' wellness efforts, and the need for a more refined understanding of moments when hurting patients report, demonstrate, and seek treatment for various cancer-related problems.
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Affiliation(s)
- Wayne A Beach
- School of Communication San Diego State University, SanDiego, CA 92182-4561, USA
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Singy P, Bourquin C, Sulstarova B, Stiefel F. The impact of communication skills training in oncology: a linguistic analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:404-408. [PMID: 22714790 DOI: 10.1007/s13187-012-0385-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate the impact of a communication skills training (CST) in oncology on clinicians' linguistic strategies. A verbal communication analysis software (Logiciel d'Analyse de la Communication Verbale) was used to compare simulated patients interviews with oncology clinicians who participated in CST (N=57) (pre/post with a 6-month interval) with a control group of oncology clinicians who did not (N=56) (T1/T2 with a 6-month interval). A significant improvement of linguistic strategies related to biomedical, psychological and social issues was observed. Analysis of linguistic aspects of videotaped interviews might become in the future a part of individualised feedback in CST and utilised as a marker for an evaluation of training.
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Affiliation(s)
- Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011, Lausanne-CHUV, Switzerland.
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Thorne SE, Stajduhar KI. Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses. J Cancer Surviv 2012; 6:229-37. [DOI: 10.1007/s11764-012-0216-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 02/16/2012] [Indexed: 12/31/2022]
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Bourquin C, Stiefel F, Berney A, Singy P. Dunno if you've any plans for the future: medical student indirect questioning in simulated oncology interviews. BMC MEDICAL EDUCATION 2012; 12:8. [PMID: 22385555 PMCID: PMC3310746 DOI: 10.1186/1472-6920-12-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND This exploratory study investigated the motives of medical students (N = 63) for using indirect questions of the type I don't know if [you have already heard about chemotherapies], I don't know how [you are], or I don't know what [you do for a living] in simulated patient interviews during a communication skills course. METHODS I don't know questions (IDK-Qs) were observed during the initial evaluation of students' communication skills; they were systematically identified through video screening and subjected to a qualitative content and discourse analysis considering their context, their content, their intent and their effect on the simulated patients. To evaluate the specificity of medical students' IDK-Qs, the data were compared with a data set of oncologists (N = 31) conducting simulated patient interviews in the context of a Communication Skills Training (CST). RESULTS During the interviews, 41.3% of the students asked 1-6 IDK-Qs. The IDK-Qs were attributed to three content categories: medical/treatment questions (N = 24); lifestyle/psychosocial questions (N = 18); and "inviting questions" questions (N = 11). Most of the IDK-Qs had an exploratory function (46/53), with simulated patients providing detailed responses or asking for more information (36/53). IDK-Qs were rare in the oncologist sample compared to the student sample (5 vs. 53 occurrences). CONCLUSIONS IDK-Qs showed a question design difference between medical students and oncologists in simulated patient interviews. Among other reasons for this difference, the possible function of IDK-Qs as a protective linguistic strategy and marker for psychological discomfort is discussed.
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Affiliation(s)
- Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
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Knudsen LV, Laplante-Lévesque A, Jones L, Preminger JE, Nielsen C, Lunner T, Hickson L, Naylor G, Kramer SE. Conducting qualitative research in audiology: a tutorial. Int J Audiol 2011; 51:83-92. [PMID: 21916797 DOI: 10.3109/14992027.2011.606283] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Qualitative research methodologies are being used more frequently in audiology as it allows for a better understanding of the perspectives of people with hearing impairment. This article describes why and how international interdisciplinary qualitative research can be conducted. DESIGN This paper is based on a literature review and our recent experience with the conduction of an international interdisciplinary qualitative study in audiology. RESULTS We describe some available qualitative methods for sampling, data collection, and analysis and we discuss the rationale for choosing particular methods. The focus is on four approaches which have all previously been applied to audiologic research: grounded theory, interpretative phenomenological analysis, conversational analysis, and qualitative content analysis. CONCLUSIONS This article provides a review of methodological issues useful for those designing qualitative research projects in audiology or needing assistance in the interpretation of qualitative literature.
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Affiliation(s)
- Line V Knudsen
- Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
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Hulsman RL, Smets EMA, Karemaker JM, de Haes HJCJM. The psychophysiology of medical communication. Linking two worlds of research. PATIENT EDUCATION AND COUNSELING 2011; 84:420-427. [PMID: 21676575 DOI: 10.1016/j.pec.2011.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports. The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior. METHODS In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication. CONCLUSION This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system. PRACTICE IMPLICATIONS When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.
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Affiliation(s)
- Robert L Hulsman
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Keeney S, McKenna H, Fleming P, McIlfatrick S. Attitudes to cancer and cancer prevention: what do people aged 35-54 years think? Eur J Cancer Care (Engl) 2011; 19:769-77. [PMID: 19708946 DOI: 10.1111/j.1365-2354.2009.01137.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to explore the knowledge, attitudes and behaviours of people in mid-life towards cancer prevention. The study was undertaken in Northern Ireland between 2003 and 2007. This was a mixed methods study using a sequential exploratory design. The theoretical framework was the Theory of Planned Behaviour and the methodology was based on Sutton's framework. There were three methodological stages in the study using focus groups, a large cross-sectional survey and a volunteer sample survey. This paper focuses on the findings of the cross-sectional survey relating to the attitudes of people in mid-life towards cancer and cancer prevention. Findings are considered in relation to the respondents' level of knowledge, age, gender, level of educational attainment and socio-economic status. Evidence from this study shows that attitudes towards cancer and cancer prevention are associated significantly with level of knowledge about cancer, gender, socio-economic status and level of educational attainment. In conclusion, the evidence from this study shows that men, those with a lower level of education, those with a lower level of knowledge and those in a lower socio-economic group were more likely to hold negative attitudes about cancer and cancer prevention.
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Affiliation(s)
- S Keeney
- Institute of Nursing Research, School of Nursing, University of Ulster, UK.
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Petronio S, Sargent J. Disclosure predicaments arising during the course of patient care: nurses' privacy management. HEALTH COMMUNICATION 2011; 26:255-266. [PMID: 21347936 DOI: 10.1080/10410236.2010.549812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
At times, nurses receive patient disclosures that have the potential to create challenges resulting in needs for strategies to manage patient information and expectations. This study examines disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital. Utilizing the constant comparative method to identify disclosure themes guided by the principles of communication privacy management (CPM), the findings show that nurses regulate patient privacy in the role of stakeholder confidants. Second, disclosure predicaments occur in three different contexts: during the course of nurses' professional routine; when the nurses created safe terminals or havens for patients to talk; and when family matters became an inseparable part of caring for the patient. Third, the results indicate that there are several specific strategies that nurses use to manage disclosure predicaments they encounter. The lens of CPM is used to interpret these findings and offers a context in which to better understand the needs of nurses concerning patient disclosive behavior and privacy issues for nurses.
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Affiliation(s)
- Sandra Petronio
- Department of Communication Studies and Indiana University School of Medicine, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46228, USA.
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McCormack LA, Treiman K, Rupert D, Williams-Piehota P, Nadler E, Arora NK, Lawrence W, Street RL. Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach. Soc Sci Med 2011; 72:1085-95. [PMID: 21376443 DOI: 10.1016/j.socscimed.2011.01.020] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 11/07/2010] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.
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Affiliation(s)
- Lauren A McCormack
- Health Communication Program, RTI International, 3040 Cornwallis Road, RTP, NC 27709, USA.
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Blanch-Hartigan D. Measuring providers' verbal and nonverbal emotion recognition ability: reliability and validity of the Patient Emotion Cue Test (PECT). PATIENT EDUCATION AND COUNSELING 2011; 82:370-376. [PMID: 21196095 DOI: 10.1016/j.pec.2010.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 11/23/2010] [Accepted: 11/25/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To describe the development and validation of the Patient Emotion Cue Test (PECT) as a tool to measure providers' emotion cue recognition ability. METHODS The PECT consists of 47 video clips depicting emotion cues that systematically vary in intensity of both verbal and nonverbal contents. The PECT assesses the provider's ability to detect and identify patients' emotion cues accurately. A multi-stage development process produced the PECT. Reliability and validity were assessed in three studies. RESULTS Scores on the PECT are normally distributed with significantly above chance responding. Across three studies, the PECT demonstrates convergent validity through significant correlations with standardized tests representing multiple channels of emotion recognition, including the face, body, and voice. The PECT shows adequate inter-item and split-half reliability. CONCLUSION The PECT is an easily administered, reliable, and valid test of emotion cue recognition. PRACTICE IMPLICATIONS The PECT can be used in future research on providers' emotion recognition ability, for evaluating self-assessment of ability, and as a teaching tool in medical schools.
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Mirivel JC. Communicative conduct in commercial medicine: initial consultations between plastic surgeons and prospective clients. QUALITATIVE HEALTH RESEARCH 2010; 20:788-804. [PMID: 20207955 DOI: 10.1177/1049732310362986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this study, I investigated naturally occurring medical interaction in commercial medicine. Drawing on 30+ hours of videotaped data and 9 months of fieldwork in a cosmetic surgery clinic, this analysis focuses on how plastic surgeons interact with patients who seek to alter their bodily appearance. The ethnographically informed discourse analysis reveals how plastic surgeons manage multiple and competing interactive demands. Specifically, I describe plastic surgeons' key strategies for meeting both health-related and institutional goals. In the conclusion, I reflect on the communication challenges that medical professionals and patients face when consumerism and medicine meet.
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Affiliation(s)
- Julien C Mirivel
- Department of Speech Communication, University of Arkansas at Little Rock, Little Rock, AR 72204-1099, USA.
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