Patient proactivity enhancing doctor-patient-family communication in cancer prevention and care among the aged

How technology impacts communication between cancer patients and their health care providers: A systematic literature review

OBJECTIVE

To ensure the well-being of their patients, health care providers (HCPs) are putting more effort into the quality of the communication they provide in oncology clinics. With the emergence of Health Information Technology (HIT), the dynamics between doctors and patients in oncology settings have changed. The purpose of this literature review is to explore and demonstrate how various health information technologies impact doctor-patient communication in oncology settings.

METHOD

A systematic literature review was conducted in 4 databases (PubMed, Cochrane, Web of Science, IEEE Xplore) to select publications that are in English, published between January 2009 and September 2020. This review reports outcomes related to the impacts of using health information technologies on doctor-patient communication according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Reviews and Meta-Analysis guidelines (PRISMA).

RESULTS

We identified 31 studies which satisfied the selection and eligibility criteria. The review revealed a diverse range of HIT used to support communication between cancer patients and their HCPs in oncology settings. Outcomes related to communication were examined to demonstrate how technology can improve access to care in clinical settings and online. When technology is used effectively to support patient knowledge and shared understanding, this increases the patient's satisfaction and ability to manage emotions, make decisions, and progress in their treatment, in addition to increasing social support and building a stronger therapeutic alliance based on shared knowledge and transparency between clinicians and patients.

CONCLUSION

Technology-based solutions can help strengthen the relationship and communication between patients and their doctors. They can empower the patient's well-being, help doctors make better decisions and enhance the therapeutic alliance between them. Thus, using technology to enhance communication in healthcare settings remains beneficial if its use is structured and target oriented. Future studies should focus on comparing in-depth the difference between outpatient and inpatient settings in terms of the efforts required and the extent of the impacts from both clinicians' and cancer patients' perspectives.

Pharmacist-led cardiovascular risk prevention in Western Canada: a qualitative study

OBJECTIVES

Preventing cardiovascular diseases (CVD) is a public health and policy priority, including for employers. A novel CVD risk management programme that included medication management was delivered by pharmacists to employees of a Canadian university. This qualitative study describes the experiences and perceptions of participants who received individual health consultations in this programme.

METHODS

A qualitative study design using free-text responses was adopted. Data (5658 words) came from evaluation surveys completed by 119 programme participants were iteratively coded and thematically analysed.

KEY FINDINGS

We identified four themes characterising participant experiences of pharmacist-led CVD prevention. Theme one was labelled self-efficacy because personalised health information and advice on CVD risk factor management empowered participants to make improvements for their health. Participants expressed a range of positive responses about the longer consultations, supportive communication and safe setting of their pharmacist-led encounters; hence, Theme two is labelled pharmacists' interpersonal skills. The wider context of the programme included a number of enabling factors (Theme three) that either supported or limited participant engagement in the programme. A number of changes to behaviour and health measures were identified and participant suggestions to expand and continue the programme further contributed to perceptions of positive programme impact (Theme four).

CONCLUSIONS

This study raises questions about how external resources and broader determinants might enable, or hinder, future programme success and sustainability. It also highlights the need for greater understanding and communication of the importance of primary prevention and the role of pharmacists in CVD risk reduction and workplace health promotion.

"I Could Do Stereotypical Old People Things … but I Feel Like I Would Get Bored With That Stuff": College Students' Proactive Steps to Avoid Negative Aspects of Aging

The preventive and corrective proactivity model explores how internal and external resources mediate age-related stressors to counter negative outcomes of aging. Older adults' proactivity about their future is consistently associated with higher quality of life, but research has not explored younger adults' perceptions of their aging. We used interpretive phenomenology analysis to analyze 24 students' essays from the beginning and end of an introductory gerontology course to understand anticipated adaptation to their 75-year-old self. The superordinate theme proactive steps to avoid negative aspects of aging comprised five subordinate themes (being productive, exercising and eating right, being financially stable, being socially connected, and the roles of older adults). Students presented unrealistically positive selves at 75 and discussed how to maintain and adapt to redefine their aging experience. Findings have implications for research on adaption, proactivity, and the future-self, and suggest that pedagogy incorporates realistic expectations of aging.

Meeting Challenges of Late Life Disability Proactively

Discussions of disability in the gerontological and the disability studies literatures have seldom considered unique perspectives and needs of older adults. Disability has often been stigmatized and viewed as antithetical to successful aging. We call for expansion of prevailing paradigms of disability to address the resilience and continuing human potential of older adults living with disabilities. In addition to recognizing the environmental context of disability, we propose greater attention to adaptive potential of disabled older adults. We discuss 6 types of proactive adaptations that can contribute to empowerment, meaning, enhanced quality of life and psychological well-being among persons living with late-life onset disabilities. These include: (a) helping others, (b) planning for future care, (c) marshaling intergenerational support, (d) self-advocacy for responsive health care, (e) making environmental modifications to improve safety and comfort of the home, and (f) finding strength in spiritual pursuits. Enacting proactive adaptations can contribute to resilience in facing late life impairments and functional limitations. Such efforts can complement utilization of services and obtaining accommodations. Maintaining life satisfaction among older adults living with disabilities also involves focus on transcendent personal goals and acceptance of an altered self. We note how a more integrative view of medical and social dimensions of disability, infused with concepts of human agency, contributes to rapprochement between alternative disciplinary orientations to late life disability. Without negating society’s important responsibilities for accommodating to needs of older adults living with disability, we reaffirm their potential for greater control and self-determination through proactive adaptations.

Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?

Purpose

The purpose of this article was to examine the relative importance of patients’ self-advocacy and perceived physicians’ advocacy for impacting patients’ satisfaction in terms of physician communication and physician–patient relationship. We also examine the influence of physicians’ emotional support and patients’ demographic as well as health characteristics on patients’ satisfaction.

Sample

Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA.

Methods and results

Using multiple hierarchical regression analyses, we found that patients’ age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients’ self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients’ perception of physicians’ readiness to act as patient advocates was a significant predictor of patients’ satisfaction. Emotional support of physicians was also associated with patients’ satisfaction.

Conclusion

These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians’ advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors.

Development and evaluation of the Dignity Talk question framework for palliative patients and their families: A mixed-methods study

BACKGROUND

Effective patient-family communication can reduce patients' psychosocial distress and relieve family members' current suffering and their subsequent grief. However, terminally ill patients and their family members often experience great difficulty in communicating their true feelings, concerns, and needs to each other.

AIM

To develop a novel means of facilitating meaningful conversations for palliative patients and family members, coined Dignity Talk, explore anticipated benefits and challenges of using Dignity Talk, and solicit suggestions for protocol improvement.

DESIGN

A convergent parallel mixed-methods design. Dignity Talk, a self-administered question list, was designed to prompt end-of-life conversations, adapted from the Dignity Therapy question framework. Participants were surveyed to evaluate the Dignity Talk question framework. Data were analyzed using qualitative and quantitative methods.

SETTING/PARTICIPANTS

A total of 20 palliative patients, 20 family members, and 34 healthcare providers were recruited from two inpatient palliative care units in Winnipeg, Canada.

RESULTS

Most Dignity Talk questions were endorsed by the majority of patients and families (>70%). Dignity Talk was revised to be convenient and flexible to use, broadly accessible, clearly stated, and sensitively worded. Participants felt Dignity Talk would be valuable in promoting conversations, enhancing family connections and relationships, enhancing patient sense of value and dignity, promoting effective interaction, and attending to unfinished business. Participants suggested that patients and family members be given latitude to respond only to questions that are meaningful to them and within their emotional capacity to broach.

CONCLUSION

Dignity Talk may provide a gentle means of facilitating important end-of-life conversations.

Information provision and attentive listening as determinants of patient perceptions of shared decision-making around chronic illnesses

Background

While chronic illnesses are a major concern of the health system worldwide, little is known about patients–physicians communication. Growing demand for patient-centered care and shared decision-making have increased the interest for patients–physicians communication. Based on previous literature, we propose a model in which the effect of information provision and attentive listening over patients’ perceptions of shared decision-making (PPSDM) is mediated by the variables self-efficacy and proactivity. Primary data were collected between April and August 2014 through an online survey of patients with haemophilia. Haemophilia is a chronic disease in which many options of treatment are available. The right option depends, to some extent, on patient’s preferences. In this context, great uncertainty exists when choosing treatment option and shared decision-making plays an essential role.

Results

A total of 181 patients with haemophilia participated in the survey. The psychometric properties of the measurement scales were evaluated by means of a confirmatory factor analysis. A structural equation model was designed. Results show that provision of information and attentive listening determine PPSDM through patients’ self-efficacy and proactivity in requesting information.

Conclusions

It is important to incorporate communication training in medical education, particularly provision of information and attentive listening. These skills help the healthcare professional to gain a deeper understanding of the patient. Furthermore, provision of information and attentive listening are fundamental in helping patients not to undervalue their personal knowledge and expertise in relation to their doctors. These strategies encourage them to adopt a more active position in requesting information. Encouraging a proactive behaviour of patients and their relatives helps them to realize the need to participate and to make them feel that they are part of the decision-making process.

Proposing an Interdisciplinary, Communication-Focused Agenda for Cancer and Aging Researchers

Cancer is mainly a disease of older people. Costs for cancer prevention and control are rising due to increased life expectancy and the large cohort of aging “baby boomers.” An effective strategy for better understanding processes related to cancer and aging across the entire cancer continuum (i.e., from prevention through to end-of-life care) is to approach this challenge collaboratively. Communication-focused research is an area of collaborative study for cancer and aging researchers that would provide evidence regarding the most effective means for reaching older adults with messages about cancer prevention, control, and quality of life issues. Specifically we recommend research that is guided by multidisciplinary communication frameworks, involves health care providers, incorporates an intergenerational and family-centered approach into designing and implementing empirical studies, and creates culturally appropriate messaging through community-engaged research.

Health information on the web and consumers' perspectives on health professionals' responses to information exchange

BACKGROUND

Health information technology, which is sometimes referred to as informaticization of medicine, is changing the extent to which patients become competent producers of their own health by enabling them access to health information anytime and anywhere.

OBJECTIVE

This research provides preliminary information on users' perceptions of the extent to which use of the Internet for health information impacts medical encounters. We specifically explored the following questions: (1) To what extent perceptions of positive or negative changes in medical encounters are associated with sociodemographic background of online health information seekers, and how often the Internet information is discussed with providers? (2) To what extent is there an association between perceived changes in medical encounters and frequency of referring to the Internet during medical encounters? (3) To what extent is there an association between sociodemographic background of online health information users and frequency of discussing of the Internet information with providers?

METHODS

The data for this study was derived from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace-Survey of User Perceptions (N=710). This study used a nationally representative online research panel of the US adults maintained by the Knowledge Networks. Analysis of variance (ANOVA), chi-square, and t tests were performed to examine the data.

RESULTS

Although Internet sources allow people the opportunity to gather health or medical information, discussion of this information was not a very common activity. It is noteworthy that half of the sample never or rarely discussed health/medical information obtained from Internet sources with health professionals. Chi-square analyses revealed that discussion of online health information with providers were associated with education, income, and marital status. We also found that discussion of the Internet information mostly promotes better physician-patient interactions. Analyses with post-hoc tests identified that perceived changes in medical encounters were associated with age, education, and income. However, 9.1% (64/703) of our respondents strongly agreed that the interactions with their providers have been strained. T test analyses showed that marital status, race, and gender were not significant.

CONCLUSIONS

Embracing new technologies, and adapting to changing roles and relationships in delivery of medical care are critical to effective delivery of patient-centered care. Health professionals could also guide patients on how to evaluate information and where to access to reliable and accurate information.

Proactive approaches to successful aging: one clear path through the forest

The importance of successful aging is increasingly acknowledged in the field of gerontology. In this paper we contribute to ongoing efforts to clarify and operationalize this concept by presenting our revised Comprehensive Preventive Corrective Proactive (PCP) model that builds on relevant research traditions, our prior formulations and accumulating research evidence based on testing this model. Recognizing biopsychosocial challenges and contextual stressors that are normative for older individuals, we emphasize the critical role of proactive behavioral adaptations in ameliorating the adverse effects of stressors. We argue that competent actions to address age-related changes and stressors are necessary to achieve positive quality-of-life outcomes. We propose that future research may benefit from employing more complex methodological approaches and data analytic tools.

Relatives' perspectives on the quality of care in an Intensive Care Unit: the theoretical concept of a new tool

OBJECTIVE

To examine the potential of a questionnaire (CQI 'R-ICU') to measure the quality of care from the perspective of relatives in the Intensive Care Unit (ICU).

METHODS

A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical structure.

RESULTS

Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely 'Communication' and 'Involvement', were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC.

CONCLUSIONS

The CQI 'R-ICU' seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication.

PRACTICE IMPLICATIONS

The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.

Altruism, helping, and volunteering: pathways to well-being in late life

OBJECTIVE

We examined the influence of prosocial orientations including altruism, volunteering, and informal helping on positive and negative well-being outcomes among retirement community dwelling elders.

METHOD

We utilize data from 2 waves, 3 years apart, of a panel study of successful aging (N = 585). Psychosocial well-being outcomes measured include life satisfaction, positive affect, negative affect, and depressive symptomatology.

RESULTS

Ordinal logistic regression results indicate that altruistic attitudes, volunteering, and informal helping behaviors make unique contributions to the maintenance of life satisfaction, positive affect and other well being outcomes considered in this research. Predictors explain variance primarily in the positive indicators of psychological well-being, but are not significantly associated with the negative outcomes. Female gender and functional limitations are also associated with diminished psychological well-being.

DISCUSSION

Our findings underscore the value of altruistic attitudes as important additional predictors, along with prosocial behaviors in fostering life satisfaction and positive affect in old age.

Patient perspectives regarding communication about prognosis and end-of-life issues: how can it be optimised?

OBJECTIVE

To explore patients' perspectives across two cultures (Australia and USA) regarding communication about prognosis and end-of-life care issues and to consider the ways in which these discussions can be optimised.

METHODS

Fifteen Australian and 11 US patients completed individual semi-structured qualitative interviews. A further 8 US patients participated in a focus group. Interviews and focus group recordings were transcribed verbatim and interpreted using thematic text analysis with an inductive, data-driven approach.

RESULTS

Global themes identified included readiness for and outcomes of discussions of prognosis and end-of-life issues. Contributing to readiness were sub themes including patients' adjustment to and acceptance of their condition (together with seven factors promoting this), doctor and patient communication skills, mutual understandings and therapeutic relationship elements. Outcomes included sub themes of achievement of control and ability to move on. A model of the relationships between these factors, emergent cross cultural differences, and how factors may help to optimise these discussions are presented.

CONCLUSION

Identified optimising factors illustrate Australian and US patients' perspectives regarding how prognosis and end-of-life issues can be discussed with minimised negative impact.

PRACTICE IMPLICATIONS

Recognition of factors promoting adjustment, acceptance and readiness and use of the communication skills and therapeutic relationship elements identified may assist in optimising discussions and help patients plan care, achieve more control of their situation and enjoy an optimal quality-of-life.

Self-compassionate responses to aging

PURPOSE

Evidence suggests that self-compassion may be beneficial to older adults who are struggling to cope with the aging process. The purpose of this study was to assess the thoughts of self-compassionate older adults and to determine whether self-compassionate thoughts relate to positive responses to aging.

DESIGN AND METHODS

Participants (n = 121, M = 76.2 years, approximately 65% female) completed measures of self-compassion and self-esteem; were randomly assigned to write about a positive, negative, or neutral age-related event; and completed questions about the event and their reactions. Responses were coded for self-compassionate themes and emotional tone.

RESULTS

Analyses indicated that self-compassion predicted positive responses to aging and that self-compassionate thoughts explained the relationship between trait self-compassion and emotional tone as well as the belief that one's attitude helped them cope with age-related events.

IMPLICATIONS

Although older adults who were low versus high in self-compassion experienced similar age-related events, participants high in self-compassion thought about these events in ways that predicted positive outcomes. Encouraging older adults to be more self-compassionate may improve well-being in old age.

Oncologists' assessments of lung cancer patient and family disagreements regarding treatment decision making

BACKGROUND

Disagreements between cancer patients and their caregivers about treatment and care can affect the patient's physical and mental well-being. Therefore it is important to understand if oncologists can accurately identify the presence of patient-caregiver decisional conflict. This study examined assessments made by lung cancer patients, their caregivers, and their oncologists regarding patient-caregiver disagreements concerning treatment and care decisions.

PARTICIPANTS AND METHODS

We assessed the extent to which the patient, caregiver, and oncologist reported disagreement between the patient and the family member regarding treatment decisions in 134 patient-caregiver-oncologist triads. Descriptive statistics were used to explore rates of concordance amongst all possible combinations of raters. Loglinear models were tested for 3-way agreement.

RESULTS

Most patient-caregiver pairs, 82.1% (n = 110), reported agreement concerning presence or absence of decisional conflict. Oncologists were more successful in detecting absence of conflict than the presence of conflict. When the caregiver and the oncologist agreed, it was regarding the absence of conflict (64.9%), rather than the presence of conflict. In 10.6% (n = 15) of cases, oncologists reported that conflictual relationships negatively impacted their ability to provide patient care.

CONCLUSIONS

Recent models of cancer patient care promote including the caregiver fully in the process while respecting the primacy of the patient's perspective. However, these models assume that the oncologist will recognize when disagreements exist and be able to assist in conflict resolution. The degree to which the oncologist identified that conflict exists and implications for their ability to provide patient care when familial disagreements existed are discussed.

Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life

OBJECTIVES

Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators.

METHOD

Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N = 561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations.

RESULTS

Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future.

CONCLUSION

These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.

Promoting and measuring family caregiver self-efficacy in caregiver-physician interactions

This article describes the development of a 5-item scale that assesses family caregivers' self-efficacy in communicating with physicians about ill family members (Perceived Efficacy in Caregiver-Physician Interactions-PECPI) in the context of an evaluation study of an online training in health care communication skills for caregivers. A national sample of 197 self-identified family caregivers participated in an online webinar and completed a brief evaluation instrument before and immediately after the training. Results indicated that the webinar was effective in increasing perceived self-efficacy and self-reported knowledge about and level of preparation for medical visits. Principal component analysis indicates that the PECPI is unidimensional with a Cronbach's alpha of .91.

Toward advocacy in cancer care for older adults: survivors have cautious personal actions but bold advice for others

OBJECTIVES

To examine narratives of personal coping with the cancer experience and compare them with narratives of advice offered to other cancer patients by community-dwelling elderly cancer survivors.

DESIGN

Qualitative and quantitative mixed methods.

SETTING

Community.

PARTICIPANTS

Interviews were conducted with 100 elderly adults who had reported cancer diagnosis from among participants of a panel study of 1,107 community-dwelling elderly adults. Mean age of the sample was 78.7+/-6.8; 62% were female, and 62% were married.

MEASUREMENTS

Three raters identified consistent themes through content analyses of interviews using a staged content analysis process. Themes reporting personal coping were coded separately from advice respondents would offer to others.

RESULTS

Respondents reported themes of personal coping that corresponded well to previously established modes of problem-focused and emotion-focused coping. Themes for personal coping primarily reflected reframing, normalizing, and obtaining social support. Assertive healthcare consumerism and self-care were seldom reported as personal coping strategies but emerged as important coping approaches, along with positive attitude maintenance, in advice offered to others. Length of survivorship was unrelated to coping strategies.

CONCLUSION

Elderly cancer survivors use passive modes of coping and rely on physicians, family, or cognitive acceptance in coping with cancer, but they offer far more proactive advice to other cancer patients. These findings underscore the importance of physician encouragement of older cancer patient initiative and proactivity in expressing views and preferences. Physicians should offer reassurance that elderly patients' questions and initiatives are welcomed.

Self-Compassion, Stress, and Coping

People who are high in self-compassion treat themselves with kindness and concern when they experience negative events. The present article examines the construct of self-compassion from the standpoint of research on coping in an effort to understand the ways in which people who are high in self-compassion cope with stressful events. Self-compassionate people tend to rely heavily on positive cognitive restructuring but do not appear to differ from less self-compassionate people in the degree to which they cope through problem-solving and distraction. Existing evidence does not show clear differences in the degree to which people who are low vs. high in self-compassion seek support as a coping strategy, but more research is needed.

An assessment of the likelihood, frequency, and content of verbal communication between radiologists and women receiving screening and diagnostic mammography

RATIONALE AND OBJECTIVES

Research on communication between radiologists and women undergoing screening and diagnostic mammography is limited. We describe community radiologists' communication practices with patients regarding screening and diagnostic mammogram results and factors associated with frequency of communication.

MATERIALS AND METHODS

We received surveys from 257 radiologists (70% of those eligible) about the extent to which they talk to women as part of their health care visit for either screening or diagnostic mammograms, whether this occurs if the exam assessment is positive or negative, and how they use estimates of patient risk to convey information about an abnormal exam where the specific finding of cancer is not yet known. We also assessed characteristics of the radiologists to identify associations with more or less frequent communication at the time of the mammogram.

RESULTS

Two hundred and forty-three radiologists provided complete data (95%). Very few (<6%) reported routinely communicating with women when screening mammograms were either normal or abnormal. Fewer than half (47%) routinely communicated with women when their diagnostic mammograms were normal, whereas 77% often or always communicated with women when their diagnostic exams were abnormal. For positive diagnostic exams, female radiologists were more likely to be frequent communicators compared to males (87.1%-72.8%; P=.02) and those who spend 40%-79% of their time in breast imaging (94.6%) were more likely to be frequent communicators compared to those who spend less time (67.2%-78.9%; P=.02). Most radiologists convey risk information using general rather than numeric statements (57.7% vs. 28.5%).

CONCLUSIONS

Radiologists are most likely to convey information about diagnostic mammographic findings when results are abnormal. Most radiologists convey risk information using general rather than numeric statements.

Marshalling Social Support: A "Care-Getting" Model for Persons Living with Cancer

This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This "Care-Getting" model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed.

How does communication heal? Pathways linking clinician-patient communication to health outcomes

OBJECTIVE

Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions.

CONCLUSION

Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway.

PRACTICE IMPLICATIONS

Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.

Community-based free prostate cancer screening program

BACKGROUND

The objective of this study was to demonstrate both the feasibility and importance of a bilingual community-based educational program that offers free prostate cancer screening to Hispanic and black men in a high-risk community.

METHODS

The East Harlem Partnership for Cancer Awareness (EHPCA) brought together an academic medical center, public hospital, and two community health centers to offer monthly free prostate cancer screening programs in neighborhood community health centers. The programs included an educational component in Spanish and English, digital rectal examinations (DRE), and blood testing for prostate-specific antigen (PSA).

RESULTS

Participant evaluations of the program demonstrated that the sessions were informative and helpful as well as successful in increasing knowledge about prostate cancer. Almost 90% of the participants chose to undergo a digital examination and PSA test; 4 of 150 participants were diagnosed as having prostate cancer.

CONCLUSION

Offering free prostate screening is a successful method of reaching men who might otherwise not be tested. We found that men were willing to be tested and follow-up with care, as needed.

Chemotherapy for elderly patients with advanced colorectal carcinoma

There is an increasing need to redefine treatment strategies in elderly patients with advanced colorectal carcinoma since they constitute more than 50% of newly diagnosed patients. Taking into account that the vast majority of clinical trials in advanced colorectal carcinoma include patients up to 75 years old, it seems reasonable to consider those patients over 75 years as elderly. In general, 20% of patients have favorable factors (fewer than four liver nodules less than 5 cm in size) and are suitable for local treatments (surgery or local-ablative therapies). Additionally, 40% of patients have poor performance status or are severely disabled owing to geriatric syndromes and/or comorbid diseases (advanced stage) that preclude any treatment strategies. The remainder of patients (fit elderly patients not suitable for radical treatments) constitute the focus of this review.

Communication analysis of BRCA1 genetic counseling

In this study, we apply an existing medical communication coding system to BRCA1 genetic counseling sessions, describe the session dynamics, and explore variation in session communication. The sample was comprised of 167 members of an identified BRCA1 kindred whose pretest counseling session was audiotaped and coded using Roter's Interaction Analysis System (RIAS). Three certified genetic counselors followed a research protocol that dictated areas to be covered in the counseling session. We found that it was feasible to code long, protocol driven BRCA1 sessions in a quantitative manner without the use of transcripts and capture the dialogue of all session participants. These findings support the use of RIAS in genetic counseling research. Our results indicate that these BRCA1 sessions were predominantly educational in nature with minimal dialogue devoted to psychosocial issues. We found that participant gender, presence of a client companion, and counselor identity influence session communication.

Measuring discord in treatment decision-making; progress toward development of a cancer communication and decision-making assessment tool

Families, as a unit, play an important role in the process of making decisions about care for and with adult cancer patients. Families often step in as the patient's advocate and primary decision-maker as the patient's condition deteriorates. How well caregivers fulfill that role may depend on the level of congruence between the family members and the patient. Disagreements may jeopardize processes of decision-making and treatment choice. To facilitate the clinical assessment process and to provide a tool for research, we are designing an instrument that can validly and reliably assess the level of family discord concerning the treatment of late stage cancer as they consider participation in clinical trials, palliative care and salvage treatment such as chemotherapy designed to decrease tumor burden without hope of cure. Development of the instrument is a four step process to develop and test the instrument: (1) formative interviewing with lung cancer patients and their family caregivers to identify and develop a comprehensive list of domains and items; (2) refinement of the items' wording with a sample of 43 patients and 67 family caregivers; (3) testing the reduced item pool to determine statistical and content validity and reliability with an initial of sample of 42 patients and their primary caregivers; (4) examination of the 30-item scale's properties with 160 lung cancer patients and their primary caregivers.