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van der Velden NCA, Smets EMA, van Vliet LM, Brom L, van Laarhoven HWM, Henselmans I. Effects of Prognostic Communication Strategies on Prognostic Perceptions, Treatment Decisions and End-Of-Life Anticipation in Advanced Cancer: An Experimental Study among Analogue Patients. J Pain Symptom Manage 2024; 67:478-489.e13. [PMID: 38428696 DOI: 10.1016/j.jpainsymman.2024.02.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
CONTEXT Evidence-based guidance for oncologists on how to communicate prognosis is scarce. OBJECTIVES To investigate the effects of prognostic communication strategies (prognostic disclosure vs. communication of unpredictability vs. non-disclosure; standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on prognostic perceptions, treatment decision-making and end-of-life anticipation in advanced cancer. METHODS This experimental study used eight videos of a scripted oncological consultation, varying only in prognostic communication strategies. Cancer-naive individuals, who imagined being the depicted patient, completed surveys before and after watching one video (n = 1036). RESULTS Individuals generally perceived dying within 1 year as more likely after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001), and after numerical versus word-based estimates (P < 0.001). Individuals felt better informed about prognosis to decide about treatment after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001); after communication of unpredictability versus non-disclosure (P < 0.001); and after numerical versus word-based estimates (P = 0.017). Chemotherapy was more often favored after prognostic disclosure versus non-disclosure (P = 0.010), but less often after numerical versus word-based estimates (P < 0.001). Individuals felt more certain about the treatment decision after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001). Effects of different survival scenarios were absent. No effects on end-of-life anticipation were observed. Evidence for moderating individual characteristics was limited. CONCLUSION If and how oncologists discuss prognosis can influence how individuals perceive prognosis, which treatment they prefer, and how they feel about treatment decisions. Communicating numerical estimates may stimulate prognostic understanding and informed treatment decision-making.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Ellen M A Smets
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology (L.M.V.), University of Leiden, Leiden, The Netherlands
| | - Linda Brom
- Department of Research and Development (L.B.), Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Netherlands Association for Palliative Care (PZNL) (L.B.), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands; Department of Medical Oncology (H.W.M.L.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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van der Velden NCA, Smets EMA, van Vliet LM, Brom L, van Laarhoven HWM, Henselmans I. Effects of prognostic communication strategies on emotions, coping, and appreciation of consultations: An experimental study in advanced cancer. Palliat Support Care 2024:1-13. [PMID: 38533613 DOI: 10.1017/s1478951524000403] [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: 03/28/2024]
Abstract
OBJECTIVES We aimed to investigate effects of prognostic communication strategies on emotions, coping, and appreciation of consultations in advanced cancer. METHODS For this experimental study, we created 8 videos of a scripted oncological consultation, only varying in prognostic communication strategies. Disease-naive individuals (n = 1036) completed surveys before and after watching 1 video, while imagining being the depicted cancer patient. We investigated effects of the type of disclosure (prognostic disclosure vs. communication of unpredictability vs. non-disclosure) and content of disclosure (standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on emotions, coping, and appreciation of consultations. Moderating effects of individual characteristics were tested. RESULTS Participants generally reported more satisfaction (p < .001) after prognostic disclosure versus communication of unpredictability and less uncertainty (p = .042), more satisfaction (p = .005), and more desirability (p = .016) regarding prognostic information after numerical versus word-based estimates. Effects of different survival scenarios were absent. Prognostic communication strategies lacked effects on emotions and coping. Significant moderators included prognostic information preference and uncertainty tolerance. SIGNIFICANCE OF RESULTS In an experimental setting, prognostic disclosure does not cause more negative emotions than non-disclosure and numerical estimates are more strongly appreciated than words. Oncologists' worries about harming patients should not preclude disclosing (precise) prognostic information, yet sensitivity to individual preferences and characteristics remains pivotal.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology, University of Leiden, Leiden, The Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Labrie N, Kunneman M, van Veenendaal N, van Kempen A, van Vliet L. Using expert opinion rounds to develop valid and realistic manipulations for experimental video-vignette research: Results from a study on clinicians' (un)reasonable argumentative support for treatment decisions in neonatal care. PATIENT EDUCATION AND COUNSELING 2023; 112:107715. [PMID: 36996589 DOI: 10.1016/j.pec.2023.107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To develop valid and realistic manipulations for video-vignette research using expert opinion rounds, in preparation of an experimental study on clinicians' (un)reasonable argumentative support for treatment decisions in neonatal care. METHODS In three rounds, N = 37 participants (parents/clinicians/researchers) provided feedback on four video-vignette scripts and completed listing, ranking, and rating exercises to determine which (un)reasonable arguments clinicians may provide to support treatment decisions. RESULTS Round 1: participants deemed the scripts realistic. They judged that, on average, clinicians should provide two arguments for a treatment decision. They listed 13-20 reasonable arguments, depending on the script. Round 2: participants ranked the two most salient, reasonable arguments per script. Round 3: participants rated the most plausible, unreasonable arguments from a predefined list. These results guided the design of 12 experimental conditions. CONCLUSION Expert opinion rounds are an effective method to develop video-vignettes that are theoretically sound and ecologically realistic and offer a powerful means to include stakeholders in experimental research design. Our study yielded some preliminary insights into what are considered prevalent (un)reasonable arguments for clinicians' treatment plans. PRACTICE IMPLICATIONS We provide hands-on guidelines on involving stakeholders in the design of video-vignette experiments and the development of video-based health communication interventions - both for research and practice.
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Affiliation(s)
- Nanon Labrie
- Department of Language, Literature & Communication, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Nicole van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Anne van Kempen
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands
| | - Liesbeth van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
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Fieke Linskens FG, van der Scheer ES, Stortenbeker I, Das E, Staal JB, van Lankveld W. Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents. PATIENT EDUCATION AND COUNSELING 2023; 110:107649. [PMID: 36764063 DOI: 10.1016/j.pec.2023.107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study aimed to determine the effect of physiotherapists' negative language use on nocebo effects of state anxiety and illness beliefs. METHODS A web-based randomised controlled trial included adults without recent musculoskeletal pain. The intervention was a short educational video about low back pain using negative language (nocebo condition: n = 87) versus a video using neutral or positive language (control condition: n = 82). State anxiety was assessed using the State-Trait Anxiety Inventory. Illness beliefs were assessed using the Illness Perception Questionnaire. RESULTS Nocebo and control groups differed in outcome measures (MANOVA Pillai's trace = 0.22, F = 4.98; df = (9,159), p < 0.001). Post-hoc analyses showed a medium to large effect for the nocebo condition on anxiety (d = 0.71, 95% CI 0.4 -1.0). The nocebo group also had higher scores in three illness beliefs: beliefs on timeline (d = 0.45, 95% CI 0.14 - 0.75), treatment control (d = 0.43, 95% CI 0.12 - 0.74) and concern (d = 0.47, 95% CI 0.16 - 0.78). CONCLUSION Physiotherapists' use of negative language contributes directly to a higher state anxiety and illness beliefs that can trigger the nocebo effects in the recipient PRACTICE IMPLICATIONS: Negative language use should be avoided.
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Affiliation(s)
- F G Fieke Linskens
- Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, the Netherlands.
| | - E S van der Scheer
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, the Netherlands.
| | - I Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - E Das
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - J B Staal
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, the Netherlands.
| | - W van Lankveld
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, the Netherlands.
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Visser LNC, van der Velden NCA, Smets EMA, van der Lelie S, Nieuwenbroek E, van Vliet LM, Hillen MA. Methodological choices in experimental research on medical communication using vignettes: The impact of gender congruence and vignette modality. PATIENT EDUCATION AND COUNSELING 2022; 105:1634-1641. [PMID: 34686382 DOI: 10.1016/j.pec.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Experimental vignette designs are used to systematically test the effects of medical communication. We tested the impact of two methodological choices -gender congruence and vignette modality- on analogue patient reported outcomes. METHODS In an online experiment using a vignette portraying an oncological bad news consultation, we manipulated (1) gender congruence between the analogue and the vignette patient, and (2) vignette modality, i.e., text, audio, or video. Cancer-naïve students acting as analogue patients (N = 209, 22 ± 3 years old, 75% F) were assigned one randomly-selected vignette variant and completed questionnaires. Using 3 × 2 (repeated-measures) ANOVAs, we tested main and interaction effects of gender congruence and modality on self-reported engagement, recall, trust, satisfaction and anxiety. RESULTS We found no main effects of gender congruence or modality on any of the outcomes, nor any interaction effects between modality and congruence. CONCLUSION Our results indicate that researchers may needlessly create gender-congruent vignettes at considerable cost and effort. Also, the currently assumed superiority of videos over other modalities for experimental vignette-based research may be inaccurate. PRACTICE IMPLICATIONS Although further testing in an offline format and among different populations is warranted, decisions regarding gender congruence and modality for future vignette-based studies should be based primarily on their specific aims.
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Affiliation(s)
- Leonie N C Visser
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Samantha van der Lelie
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Eva Nieuwenbroek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, PO Box 9600, 2300 RB Leiden, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Kühne F, Fauth H, Ay-Bryson DS, Visser LNC, Weck F. Communicating the diagnosis of cancer or depression: Results of a randomized controlled online study using video vignettes. Cancer Med 2021; 10:9012-9021. [PMID: 34747132 PMCID: PMC8683534 DOI: 10.1002/cam4.4396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/06/2021] [Accepted: 10/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study. Methods Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied. Results Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, ηpartial2 = 0.08) and trustworthy practitioner (p = 0.014, ηpartial2 = 0.04) with better communication skills (p = 0.013, ηpartial2 = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, ηpartial2 = 0.15) and a larger increase in negative affect (p < 0.001, ηpartial2 = 0.14) from pre‐ to post‐video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06). Conclusions The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.
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Affiliation(s)
- Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Henriette Fauth
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Destina S Ay-Bryson
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Leonie N C Visser
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Solna, Sweden.,Department of Medical Psychology, Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Florian Weck
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
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Pieterse AH, Brandes K, de Graaf J, de Boer JE, Labrie NHM, Knops A, Allaart CF, Portielje JEA, Bos WJW, Stiggelbout AM. Fostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making. Med Decis Making 2021; 42:375-386. [PMID: 34727753 PMCID: PMC8918871 DOI: 10.1177/0272989x211056334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment. Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance. Results A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (Mpresent = 5.2 v. Mabsent = 5.0, P = 0.042, η2partial = 0.006) and physician preference communication had no (Mpresent = 5.0 v. Mabsent = 5.1, P = 0.144, η2partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (Mpresent = 4.7 v. Mabsent = 5.3, P = 0.006, η2partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust. Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Kim Brandes
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Jessica de Graaf
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Knops
- Dutch Federation of Patients' Organizations, Quality of Care Department, BM, Utrecht, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
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Medendorp NM, Hillen MA, Visser LNC, Aalfs CM, Duijkers FAM, van Engelen K, Ausems MGEM, Verhoef S, Stiggelbout AM, Smets EMA. A randomized experimental study to test the effects of discussing uncertainty during cancer genetic counseling: different strategies, different outcomes? Eur J Hum Genet 2021; 29:789-799. [PMID: 33437034 PMCID: PMC8110589 DOI: 10.1038/s41431-020-00799-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 01/29/2023] Open
Abstract
Uncertainty is increasingly discussed during genetic counseling due to innovative techniques, e.g., multigene panel testing. Discussions about uncertainty may impact counselees variably, depending on counselors' communication styles. Ideally, the discussion of uncertainty enables counselees to cope with uncertainty and make well-informed decisions about testing. We examined the impact of how counselors convey uncertainty and address counselees' uncertainty, and explored the role of individual characteristics. Therefore, a randomized controlled experiment using videos was conducted. Former counselees (N = 224) viewed one video depicting a genetic consultation about multigene panel testing. The extent of counselors' communication of uncertainty (comprehensive vs. the essence) and their response to counselees' uncertainty expressions (providing information vs. providing space for emotions vs. normalizing and counterbalancing uncertainty) were systematically manipulated. Individual characteristics, e.g., uncertainty tolerance, were assessed, as well as outcome variables (primary outcomes: feelings of uncertainty and information recall). No effects were found on primary outcomes. Participants were most satisfied when the essence was communicated, combined with providing information or providing space responses (p = 0.002). Comprehensive information resulted in less perceived steering toward testing (p = 0.005). Participants with lower uncertainty tolerance or higher trait anxiety were less confident about their understanding when receiving comprehensive information (p = 0.025). Participants seeking information experienced less uncertainty (p = 0.003), and trusted their counselor more (p = 0.028), when the counselor used information providing responses. In sum, the impact of discussing uncertainty primarily depends on individual characteristics. Practical guidelines should address how to tailor the discussion of uncertainty.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor A M Duijkers
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Physiological Correlates of Processing Health-Related Information: An Idea for the Adoption of a Foreign Field. NURSING REPORTS 2021; 11:175-186. [PMID: 34968322 PMCID: PMC8608086 DOI: 10.3390/nursrep11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Measuring health may refer to the measurement of general health status through measures of physical function, pain, social health, psychological aspects, and specific disease. Almost no evidence is available on the possible interaction of physiological measures and correlating emotional–affective states that are triggered by dealing with individual health-relevant issues and their specific processing modes. Public health research has long been concerned with the processing of health-related information. However, it is not yet clear which factors influence access and the handling of health-related information in detail. One way to close this research gap could be adopting methods from neurocognitive experiments to add psychophysiological data to existing approaches in health-related research. In this article, we present some of these methods and give a narrative overview and description of their usefulness for enlarged research in public health.
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10
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Schwaegermann MK, Schranz M, Moehler M, Labenz C, Moringlane A, Schmidt M, Theobald M, Hess G. Any progress in informed consenting for cancer treatment? Results from a cross sectional analysis at a comprehensive cancer center. J Cancer Res Clin Oncol 2021; 147:2117-2126. [PMID: 33420813 PMCID: PMC8164598 DOI: 10.1007/s00432-020-03495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
Purpose Informed consent is required prior to any medical procedure. In the context of cancer treatment, special efforts are needed to inform cancer patients properly about treatment, potential sequelae and alternative therapies. Little is known about the effectiveness of current informed consent strategies and patients’ individual satisfaction. Given the heterogeneity in terms of age, education, sex and other factors, detailed understanding of patients’ comprehension and perception is the basis for further optimization of the informed consent process, which was the aim of the current investigation. Methods Patients with a new cancer diagnosis and recent informed consent were asked to complete a questionnaire about satisfaction, comprehension, time management, physician–patient relationship and other items of the informed consent process. Patients were followed for 6 months and invited to complete a follow-up questionnaire. Results In total, 89 patients completed the first questionnaire and 52 the follow-up questionnaire. Subjective understanding was assumed high, however, this did not correlate with objective understanding. Age and education were identified as influencing factors for comprehension. 85% of the patients were satisfied with the information provided. A major gap was the information on alternative therapies. Moreover, not all patients perceived the consent dialog as such, and particularly the individual treatment intention partially remained unclear for some patients. Conclusions To ensure that informed consent is based on solid understanding, informed consenting must be patient-centered and consider the individual expectations, needs and abilities of cancer patients. Further studies are required to develop tailored informed consent strategies.
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Affiliation(s)
- Marie-Kristin Schwaegermann
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Melanie Schranz
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Markus Moehler
- Department of Internal Medicine I, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Labenz
- Department of Internal Medicine I, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alice Moringlane
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Theobald
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Georg Hess
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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11
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van de Water LF, van Kleef JJ, Dijksterhuis WPM, Henselmans I, van den Boorn HG, Vaarzon Morel NM, Schut KF, Daams JG, Smets EMA, van Laarhoven HWM. Communicating treatment risks and benefits to cancer patients: a systematic review of communication methods. Qual Life Res 2020; 29:1747-1766. [PMID: 32333238 PMCID: PMC7295838 DOI: 10.1007/s11136-020-02503-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients are increasingly involved in decision-making processes. Hence, clinicians need to inform patients about the risks and benefits of different treatment options in order for patients to make well informed decisions. The aim of this review is to determine the effects of methods of communicating prognostic information about (1) disease progression (survival, progression, recurrence and remission), (2) side effects and complications and (3) health-related quality of life (HRQL) on cognitive, affective and behavioral outcomes in cancer patients. METHODS A literature search was performed to select articles that were published up to November 2019 and that examined verbal and/or visual risk communication interventions in an oncological clinical setting. RESULTS The search yielded 14,875 studies; 28 studies were ultimately included. For disease progression information, we found that framing affects treatment choice. Furthermore, limiting the amount of progression information in a graphical display could benefit patients' understanding of risks and benefits. For prognostic information about side effects and complications, precise and defined risk information was better understood than information presented in words. When displaying HRQL data, no consensus was found on which graph type to use. CONCLUSION Great heterogeneity in the results and methodology and in the compared communication formats precluded us from drawing any further conclusions. Practical implications for clinicians are to consider the effects that different types of framing might have on the patient and to not rely exclusively on words to describe risks, but rather include at least some form of numbers or visualization.
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Affiliation(s)
- L F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - J J van Kleef
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - W P M Dijksterhuis
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - I Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - N M Vaarzon Morel
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - K F Schut
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - J G Daams
- Amsterdam University Medical Centers, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
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12
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Provider caring and structuring treatment information to improve cancer patients' recall: Does it help? PATIENT EDUCATION AND COUNSELING 2020; 103:55-62. [PMID: 31349965 DOI: 10.1016/j.pec.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors. METHODS In an online survey, 148 participants (Mage = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust. RESULTS Increased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = -.268) among younger participants. CONCLUSIONS Provider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed. PRACTICE IMPLICATIONS Providers may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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13
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Nguyen MH, Smets EMA, Bol N, Bronner MB, Tytgat KMAJ, Loos EF, van Weert JCM. Fear and forget: how anxiety impacts information recall in newly diagnosed cancer patients visiting a fast-track clinic. Acta Oncol 2019; 58:182-188. [PMID: 30264632 DOI: 10.1080/0284186x.2018.1512156] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION One-day fast track programs for cancer diagnostics and treatment planning are increasingly being implemented in health care. Fast-track programs are highly effective at reducing waiting times, and thus well received by patients and healthcare providers. However, these programs may also burden patients, as patients generally receive a lot of information from multiple healthcare providers within a short time span. This might increase anxiety and negatively impact recall of medical information in newly diagnosed patients. This study examines whether anxiety influences information recall at the moment of diagnosis, and whether this relation differs for younger and older patients. METHODS Data were collected from 78 colorectal cancer patients visiting a one-day fast-track multidisciplinary outpatient clinic. All consultations that took place were recorded on a video. Anxiety was measured at baseline (T1) and immediately after consultations (T2) with the STAI-6. Information recall was assessed by telephone within 36-48 hours after patients' visit (T3) using open questions. RESULTS After consultations (T2), 32% of patients experienced clinical anxiety levels. Patients recalled ∼60% of medical information (T3). Information recall was negatively impacted by anxiety (β = -.28, p = .011), and negatively related to higher age (β = -.23, p = .031), and lower education level (β = .27, p = .013). Although older patients (M = 53.99) recalled 11% less information than younger patients (M = 64.84), age was not related to anxiety and did not moderate the anxiety-recall relationship. CONCLUSION High levels of anxiety after receiving a cancer diagnosis negatively influence how much information patients remember after visiting a one-day fast-track clinic. This calls for interventions that may reduce patients' anxiety as much as reasonably possible and support patients' information recall. Researchers, practitioners, and hospitals are encouraged to continue exploring ways to optimize information provision to cancer patients in current modern healthcare.
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Affiliation(s)
- Minh Hao Nguyen
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Madelon B. Bronner
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Kristien M. A. J. Tytgat
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Eugène F. Loos
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
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14
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Visser LNC, Tollenaar MS, van Doornen LJP, de Haes HCJM, Smets EMA. Does silence speak louder than words? The impact of oncologists' emotion-oriented communication on analogue patients' information recall and emotional stress. PATIENT EDUCATION AND COUNSELING 2019; 102:43-52. [PMID: 30224275 DOI: 10.1016/j.pec.2018.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The impact of two types of oncologists' emotion-oriented communication on participants' recall of medical information was investigated, and the potential mediation by a reduction in emotional stress. Additionally, moderation effects by personal characteristics were explored. METHODS An oncologist's communication in response to a patient's emotional expressions was manipulated during a videotaped, scripted bad-news consultation. Three conditions were created: 1) standard communication, 2) emotion-oriented silence, and 3) emotion-oriented speech. Participants (N = 217) were randomly allocated to one of the three conditions. Measurements included information recall (free recall and recognition), emotional stress (self-reported and physiological), and personal characteristics. RESULTS Emotion-oriented silence (p = .002) and speech (p = .019) enhanced information recognition compared to standard communication. No differences in free recall were found. Emotional stress did not mediate these relations. Poorer functional health literacy predicted poorer recognition, but this was counteracted by emotion-oriented communication. CONCLUSIONS By means of acknowledging, exploring, empathic and supportive statements, and attentive silence, the oncologist's communication resulted in better information recognition. How oncologists' communication impacts patients' information recall warrants further investigation, as this could not be explained by reducing emotional stress. PRACTICE IMPLICATIONS These insights will help educators to validate the relevance of emotion-oriented strategies, and encourage oncologists to adopt them.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | | | | | - Hanneke C J M de Haes
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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15
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Danzi OP, Perlini C, Tedeschi F, Nardelli M, Greco A, Scilingo EP, Valenza G, Del Piccolo L. Affective communication during bad news consultation. Effect on analogue patients' heart rate variability and recall. PATIENT EDUCATION AND COUNSELING 2018; 101:1892-1899. [PMID: 29941309 DOI: 10.1016/j.pec.2018.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the effect of physicians' supportive communication on analogue patients' (APs) heart rate variability (HRV) and recall, while watching a video of palliative treatment being explained to a female patient. METHODS Sixty healthy women, acting as APs, were randomly assigned to watch one of two versions (standard vs. affective) of a scripted video-vignette of a bad news consultation to a female patient. The physician's communication differed only in the delivery of four supportive comments. Empathy, support and engagement perception were assessed by three questions. APs' HR was recorded during video-observation and recall was assessed immediately after. HRV was determined through measures defined in time and frequency domains. RESULTS Data of 54 APs (27 + 27) were included. The group with supportive communication perceived the physician as more empathic and supportive. Intra- and Inter-group comparisons suggested a greater sense of stress in the standard communication group. Recall did not differ in the two groups. CONCLUSION AND PRACTICE IMPLICATIONS Findings show that the use of supportive expressions contribute to the perception of the physician as more empathic, potentially buffer patients' arousal after a bad news announcement, but does not confirm a positive impact on general recall.
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Affiliation(s)
- Olivia Purnima Danzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Federico Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mimma Nardelli
- Department of Information Engineering, and Bioengineering and Robotics Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Alberto Greco
- Department of Information Engineering, and Bioengineering and Robotics Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Enzo Pasquale Scilingo
- Department of Information Engineering, and Bioengineering and Robotics Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Gaetano Valenza
- Department of Information Engineering, and Bioengineering and Robotics Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
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16
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Del Piccolo L, Finset A. Patients' autonomic activation during clinical interaction: A review of empirical studies. PATIENT EDUCATION AND COUNSELING 2018; 101:195-208. [PMID: 28869056 DOI: 10.1016/j.pec.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how patients' autonomic responses are related to verbal or non-verbal communication during clinical encounters. METHODS The SCOPUS database was searched to identify papers. Studies were included if measures of autonomic arousal were related to patients' emotions or patient-clinician interaction during clinical consultations such as psychotherapy, counseling or medical interviews. The search was conducted according to PRISMA criteria. The included studies were assessed using the 16 item quality assessment tool QATSDD. RESULTS A total of 24 publications were identified. The studies varied greatly in design and quality. However, a few trends could be observed across studies. Patients' expressions of emotions were associated with significant autonomic arousal. Clinician behavior affected arousal levels; and in a few studies, a patient centered way of presenting information was found to attenuate arousal level, interpreted as stress reduction. There was a general, but not consistent, trend in the reduction of arousal level over time within the consultation. Examples of individual differences in autonomic responses were found. CONCLUSION AND PRACTICE IMPLICATIONS Increased awareness of potential impact of clinician behavior on patient' arousal level may be helpful for clinicians, in particular how different communication styles may augment or attenuate arousal in response to stressors.
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Affiliation(s)
- Lidia Del Piccolo
- Section of Clinical Psychology, Faculty of Medicine, University of Verona, Italy.
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
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17
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Visser LNC, Bol N, Hillen MA, Verdam MGE, de Haes HCJM, van Weert JCM, Smets EMA. Studying medical communication with video vignettes: a randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients' engagement. BMC Med Res Methodol 2018; 18:15. [PMID: 29351736 PMCID: PMC5775584 DOI: 10.1186/s12874-018-0472-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Video vignettes are used to test the effects of physicians' communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants' engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants' engagement with a video vignette showing a bad news consultation. METHODS Introduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient's situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants' electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction. RESULTS The audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, [Formula: see text]= 0.05) and the consultation part of the vignette (p = 0.051, [Formula: see text]= 0.05), when compared to the written introduction. With respect to camera focus, results revealed that the variant focusing on the patient at emotional moments evoked a higher level of electrodermal activity (p = 0.003, [Formula: see text]= 0.06), when compared to the other two variants. Furthermore, an interaction effect was shown on self-reported emotional engagement (p = 0.045, [Formula: see text]= 0.04): the physician-only variant resulted in lower emotional engagement if the vignette was preceded by the audiovisual introduction. No effects were shown on the other dimensions of self-reported engagement. CONCLUSIONS Our findings imply that using an audiovisual introduction combined with alternating camera focus depicting patient's emotions results in the highest levels of emotional engagement in analogue patients. This evidence can inform methodological decisions during the development of video vignettes, and thereby enhance the ecological validity of future video-vignettes studies.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - Nadine Bol
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Mathilde G E Verdam
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
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18
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Medendorp NM, Visser LNC, Hillen MA, de Haes JCJM, Smets EMA. How oncologists' communication improves (analogue) patients' recall of information. A randomized video-vignettes study. PATIENT EDUCATION AND COUNSELING 2017; 100:1338-1344. [PMID: 28233585 DOI: 10.1016/j.pec.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation. METHODS An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trust-conveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations. RESULTS Free recall, assessed 24-28h after viewing, was higher (p=0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p=0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p=0.037). No mediation effect nor an effect on electrodermal activity was found. CONCLUSION These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response. PRACTICE IMPLICATIONS The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation.
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Affiliation(s)
- N M Medendorp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - L N C Visser
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
| | - M A Hillen
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - J C J M de Haes
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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