The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play

The Pursuit of Positive Impacts: Translating Longitudinal Cancer Studies into Successful Health Communication Interventions

Over a decade ago, in the 100th issue of Health Communication (Volume 25, issues 6-7); 2010), 30 "impact" articles addressed how our collective research findings had been translated to make a positive difference for persons across diverse communities. It is laudable to develop projects helping others to enhance their awareness about healthy living, refine practical communication skills to promote behavioral change, and rely on findings to enact important practices and policies giving priority to how well and long we live in contemporary society. As a preview, however, an article entitled "Why is it so difficult to talk about impact?" raised a series of inherent challenges faced whenever we conduct our research to advance basic knowledge by pursuing meaningful translation opportunities. These efforts are constrained in various ways: A lack of motivation, ability, and training to envision and implement protocols beneficial for the public good; the need to procure adequate resources (e.g., time and money) for sustaining longitudinal investigations; dealing with misconceptions that "applied" communication research has less value than "basic" studies; and creating and managing cross-disciplinary collaborations necessary to achieve project goals. When designing interventions to change others' lives in meaningful ways, attention must also be given to balancing community outreach while avoiding unnecessary self-promotion and imposition of social scientific priorities.

The sexuality experience of stoma patients: a meta-ethnography of qualitative research

BACKGROUND

As the quality of life of stoma patients has become a research hotspot, sexual health as an integral part of patients' lives has received more and more attention. However, there is a lack of comprehensive reviews on the sexual experiences of patients with stomas. This study aims to synthesize the qualitative literature on the subjective experience of stoma patients' sexual life, to identify their sexual needs, and to provide evidence for the content and methods of sexual health interventions for healthcare professionals.

METHODS

PubMed, Embase, Web of Science, CINAHL, and Scopus were searched for qualitative studies on the sexual experience of stoma patients (from the inception to January 2023). Titles, abstracts, and full texts were reviewed by two researchers. We used the Critical Appraisal Program (CASP) checklist to assess the quality of included articles.

RESULTS

A total of 1388 articles were retrieved, and eight studies were included. Data was extracted, including three main themes: 1) sexual problems due to changes in physical function and psychological disorders; 2) the relationship with spouse changes; 3) the cognition of sexual life and the need for sexual knowledge.

CONCLUSION

Healthcare professionals should pay attention to the sexual life status and sexual health needs of stoma patients and their partners, and give professional guidance and support in treatment and nursing to improve the quality of sexual life of stoma patients.

Defining Moments, Revisited

'Defining moments' are revealed by weaving three strands together in this essay. First, by reenacting stories as 'tell-aboutables,' 'defining moments' are achieved through participants' methods for drawing attention to significant events. Occasioned reconstructions are designed by speakers as timely and worthy to be heard, responded to, and appreciated by recipients. In turn, 'defining moments' of shared existence emerge through next stories, serial orderings of storytelling achievements exposing (in Goffman's terms) less about people and their moments than moments and their people. Second, numerous examples are provided of how stories about cancer comprise altogether routine everyday life activities for patients, family members, and providers. 'Defining moments' can and do become radically re-defined when landscapes of wellness give way to progressive entanglements and forfeitures of sickness. When 'health' comes into play, it is not uncommon for priorities to be given less to self-promotion (e.g. blaming and boasting), and more to efforts designed to optimize mental, emotional, spiritual, and physical well-being. Third, personal stories about 'defining moments' are shared from my long-term investigations of family cancer and patient-oncologist interactions. A vibrant reflexivity is cultivated when we recognize that, and how, our basic research can be successfully translated to advance the public good.

A White Family's Oral Storytelling About Cancer Generates More Favorable Evaluations From Black American Audiences

One proposition of Entertainment Education (EE) suggests that actors communicating messages should be ethnically and culturally homogenous with targeted audiences. The present study challenges this assumption by investigating audience evaluations of When Cancer Calls... (WCC), a unique 80-minute theatrical production based on actual phone conversations between family members dealing with a loved one's cancer diagnosis, treatment, and eventual death. In WCC, the family is White and all interactions are drawn verbatim from 61 recorded phone calls made over 13 months. This study addresses whether authentic family storytelling about cancer minimizes differences between the White family in WCC, diverse Persons of Color (POC), and specifically how WCC resonates with Black Americans' cancer experiences. Data collected (n=483) from audiences in four U.S. cities confirmed overall positive audience reactions to viewings of WCC. Blacks were significantly more likely to evaluate WCC favorably than Whites or other POC. Rooted in the prominence of oral communication traditions, these findings confirm the power of family storytelling as a vehicle for designing health communication campaigns for Black American audiences. For example, when Blacks were forbidden to learn how to read and write during American slavery, family storytelling was a powerful tool for preserving history, sharing news, resisting racism in hostile environments, and sustaining resilience necessary for survival. These WCC findings provide innovative strategies for facilitating communication among cancer patients and family members, especially Black Americans who are deeply affected and face ongoing challenges talking about cancer.

BRIGHTLIGHT researchers as 'dramaturgs': creating There is a Light from complex research data

BACKGROUND

BRIGHTLIGHT is a national evaluation of cancer services for young people aged 13-24 years in England. It is a mixed methods study with six interlinked studies aiming to answer the question: do specialist cancer services for teenagers and young adults add value? http://www.brightlightstudy.com/. Young people have been integral to study development and management, working as co-researchers, consultants and collaborators throughout. We aimed to share results in a way that was meaningful to young people, the public, and multidisciplinary professionals. This paper reports the development of 'There is a Light: BRIGHTLIGHT', a theatrical interpretation of study results by young people, and offers insight into the impact on the cast, researchers and audiences.

METHODS

The BRIGHTLIGHT team collaborated with Contact Young Company, a youth theatre group in Manchester. Twenty members of Contact Young Company and four young people with cancer worked together over an eight-week period during which BRIGHTLIGHT results were shared along with explanations of cancer, healthcare policy and models of care in interactive workshops. Through their interpretation, the cast developed the script for the performance. The impact of the process and performance on the cast was evaluated through video diaries. The research team completed reflective diaries and audiences completed a survey.

RESULTS

'There is a Light' contained five acts and lasted just over an hour. It played 11 performances in six cities in the United Kingdom, to approximately 1377 people. After nine performances, a 30-min talk-back between members of the cast, creative team, an expert healthcare professional, and the audience was conducted, which was attended by at least half the audience. Analysis of cast diaries identified six themes: initial anxieties; personal development; connections; cancer in young people; personal impact; interacting with professionals. The cast developed strong trusting relationships with the team. Professionals stated they felt part of the process rather than sitting on the periphery sharing results. Both professional and lay audiences described the performance as meaningful and understandable. Feedback was particularly positive from those who had experienced cancer themselves.

CONCLUSIONS

Using theatre to present research enabled BRIGHTLIGHT results to be accessible to a larger, more diverse audience.

Confessions of a Reluctant Caregiver Palliative Educational Program: Using Readers' Theater to Teach End-of-Life Communication in Undergraduate Medical Education

End-of-life care can be stressful for patients, caregivers, and providers. Caregivers often experience high levels of burden from caregiving duties such as performing medical tasks, communicating with providers, and making decisions. Similarly, many physicians feel unprepared to provide end-of-life care or communicate with patients and families about sensitive issues associated with death and dying. Physicians often attribute their lack of preparation to inadequate training in medical school. Previous research suggests that drama-based learning opportunities are valuable supplements to existing end-of-life curricula. The current study evaluates the success of the Confessions of a Reluctant Caregiver Palliative Educational Program - a drama-based educational program that depicts patient and caregiver experiences. A total of 477 osteopathic medical students participated in the program, which includes viewing a play, engaging in a facilitated post-performance talkback session, and completing an evaluation survey. The results suggest the program is a valuable learning experience that is positively associated with important facets of experiential learning using narratives such as perceived realism, increased reflection, strong emotions, and increased comfort with difficult behaviors. The program offers a safe environment for medical students to identify, understand, and process the sensitive and complex issues associated with end-of-life care. Moreover, the play offers insight into the often-overlooked experiences of family caregivers who are at risk of experiencing high caregiver burden while managing health-related communication and decision-making.

Making Cancer Visible: Unmasking Patients' Subjective Experiences

The Face of Cancer, an article and patient's painting published nearly 15 years ago, has contributed in significant ways to a body of research focusing on communication during oncology interviews. Impacts from this painting helped to create a sensitivity for analyzing naturally occurring video recordings, including moments when patients' subjective experiences are raised and responded to. Analysis begins with how a melanoma patient's facial expression bears striking resemblance to the painting, vocal and other visible social actions (e.g., gaze, gesture), and how patient's story about a friend's metastatic cancer reveals her primal fears and hopes about cancer. Actions displayed by other patients (breast, testicular, abdominal, and leukemia) are also examined to unmask how their faces and bodies make cancer visible, doctors' responses, and the complexities of how patients' stressful stories get constructed. Implications are raised for improving patient-provider relationships by offering more personalized care. Understanding how patients display their concerns and emotions, through spoken and embodied actions, enhances discernment about how best to provide tailored and supportive responses to patients' life-world experiences especially, but not exclusively, when dealing with the stresses and angst of cancer.

Communication skills training for healthcare professionals working with people who have cancer

BACKGROUND

This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective.

OBJECTIVES

To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction.

SEARCH METHODS

For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies.

SELECTION CRITERIA

The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs).

MAIN RESULTS

We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias.

AUTHORS' CONCLUSIONS

Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.

Arts-based palliative care training, education and staff development: A scoping review

BACKGROUND

The experience of art offers an emerging field in healthcare staff development, much of which is appropriate to the practice of palliative care. The workings of aesthetic learning interventions such as interactive theatre in relation to palliative and end-of-life care staff development programmes are widely uncharted.

AIM

To investigate the use of aesthetic learning interventions used in palliative and end-of-life care staff development programmes.

DESIGN

Scoping review.

DATA SOURCES

Published literature from 1997 to 2015, MEDLINE, CINAHL and Applied Social Sciences Index and Abstracts, key journals and citation tracking.

RESULTS

The review included 138 studies containing 60 types of art. Studies explored palliative care scenarios from a safe distance. Learning from art as experience involved the amalgamation of action, emotion and meaning. Art forms were used to transport healthcare professionals into an aesthetic learning experience that could be reflected in the lived experience of healthcare practice. The proposed learning included the development of practical and technical skills; empathy and compassion; awareness of self; awareness of others and the wider narrative of illness; and personal development.

CONCLUSION

Aesthetic learning interventions might be helpful in the delivery of palliative care staff development programmes by offering another dimension to the learning experience. As researchers continue to find solutions to understanding the efficacy of such interventions, we argue that evaluating the contextual factors, including the interplay between the experience of the programme and its impact on the healthcare professional, will help identify how the programmes work and thus how they can contribute to improvements in palliative care.

The Transformative Power of Authentic Conversations About Cancer

Entertainment-education (E-E) assumes that actors performing content should be ethnically and culturally homogeneous with targeted audiences. The present study challenges this basic E-E assumption. Findings are presented from audience members who viewed When Cancer Calls… This theatrical production was constructed from verbatim transcriptions of naturally occurring telephone conversations between White family members as they communicated about and through their cancer journey. Non-White audience members were significantly more likely than White audience members to (a) regard the performance as authentic, (b) find it would influence "people like me," and (c) recommend the production to others. These findings suggest that all people must rely on communication when facing health challenges together. Such interactions that are fundamental to family membership are thus primal for the human social condition, regardless of differences in race and ethnicity. These findings also suggest innovative approaches to E-E health interventions that may contradict traditional market segmentation theories based on cultural differences and the principle of homophily.

The Conversations About Cancer (CAC) Project-Phase II: National findings from viewing When Cancer Calls…and implications for Entertainment-Education (E-E)

OBJECTIVE

We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls…(WCC…), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone.

METHODS

A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members. Comparisons were made with a control video on cancer nutrition and diet. Pretest-posttest sample size was 1006, and 669 participants completed a 30-day follow-up impacts assessment.

RESULTS

All five family and communication indices increased significantly for WCC…. When compared to the placebo, average pretest-posttest change scores were higher for self-efficacy (775%), family fabric (665%), outside support (189%), and family communication (97%). One month following viewings, WCC…participants reported 30% more conversations about cancer among patients and family members about cancer.

CONCLUSION

A new genre of Entertainment-Education (E-E) was created that triggers positive reactions from audience members. Managing delicate and often complex communication about the trials, tribulations, hopes, and triumphs of cancer journeys is fundamentally important for everyday living.

PRACTICE IMPLICATIONS

Unique opportunities exist to make WCC… available to national and global audiences, create tailored curricula, and integrate these viewings into educational programs for patients, family members, and care-provider teams across diverse health, corporate, and governmental systems.