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Ho EY, Karliner LS, Leung G, Harb R, Aguayo Ramirez G, Garcia ME. "How's your mood": Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits. PATIENT EDUCATION AND COUNSELING 2023; 114:107850. [PMID: 37364381 PMCID: PMC10528172 DOI: 10.1016/j.pec.2023.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Patient-physician communication patterns may influence discussions around depressive symptoms and contribute to engagement in depression care among racial/ethnic minority adults. We examined patient-physician communication about depressive symptoms during routine primary care visits with Chinese and Latino patients with and without language barriers. METHODS We examined 17 audio-recorded conversations between primary care physicians and Chinese (N = 7) and Latino (N = 10) patients who discussed mental health during their visit and reported depressive symptoms on a post-visit survey. Conversations (in English, Cantonese, Mandarin, Hoisan-wa, Spanish) were transcribed and translated by bilingual/bicultural research assistants and analyzed using inductive and deductive thematic and discourse analysis. RESULTS Patients initiated mental health discussion in eleven visits. Physicians demonstrated care in word choice and sometimes avoided openly mentioning depression; this could contribute to miscommunication around symptoms and treatment goals. Interpreters had difficulty finding single words to convey terms used by either patients or physicians. CONCLUSION Patients and doctors appeared willing to discuss mental health; however, variability in terminology presented challenges in mental health discussions in this culturally and linguistically diverse sample. PRACTICE IMPLICATIONS Further understanding patient preferred terminology about mental health symptoms and interpreter training in these terms could improve patient-physician communication about depressive symptoms and treatment preferences.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Leah S Karliner
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, CA, USA
| | - Raneem Harb
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA
| | - Giselle Aguayo Ramirez
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Tay DL, Ellington L, Towsley GL, Supiano K, Berg CA. Emotional expression in conversations about advance care planning among older adult home health patients and their caregivers. PATIENT EDUCATION AND COUNSELING 2021; 104:2232-2239. [PMID: 33658140 DOI: 10.1016/j.pec.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine patient and caregivers' differences in emotional expression and explore topics associated with emotional expression during advance care planning (ACP) discussions. METHODS Older adult home health patient-caregiver dyads participated in video-recorded ACP conversations as part of a collaboration-focused intervention study. Recordings were coded in Noldus Observer XT, analyzed with descriptive statistics, Cochran-Mantel-Haenszel and Breslow-Day test, and integrated with qualitative content analysis. RESULTS Eighteen patient-caregiver dyads were purposively recruited. Participants were mostly female (11 patients; 13 caregivers). Mean ages were 68.22 (SD = 9.64) for patients and 61.28 (SD = 13.60) for caregivers. Emotional expression (depth of emotion, positive and negative valence) was similar across patients and caregivers. Conversations centered on positive and negative decisional, relational, and existential topics. CONCLUSIONS This study explored emotional expression and identified topics associated with emotion for patients and caregivers during collaborative ACP. Findings suggest that collaboration in ACP can have positive relational aspects for patient-caregiver dyads, while negative emotions can also be distressing. PRACTICE IMPLICATIONS This study describes the range of emotions that are common during patient and caregiver ACP discussions. Clinical implications for the assessment of caregiver support and awareness of the interdependent nature of decision making is discussed.
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Affiliation(s)
- Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Gail L Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Katherine Supiano
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA.
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Heyman RE, Otto AK, Reblin M, Wojda AK, Xu S. The lump-versus-split dilemma in couple observational coding: A multisite analysis of rapid marital interaction coding system data. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2021; 35:559-565. [PMID: 33180516 PMCID: PMC8113338 DOI: 10.1037/fam0000754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Historically, observational couple communication researchers have oscillated between splitting behaviors into narrowly defined discrete codes and grouping behaviors into broader codes-sometimes within the same study. We label this the "lump-versus-split dilemma." Coding across a decade and 11 investigators were used to recommend the most meaningful number of codes to use when observing couples' conflict. We combined data from 14 studies that used the Rapid Marital Interaction Coding System (RMICS) to score communication behavior during different-sex couples' conflict interactions. In each study, couples completed at least one 10-min, video-recorded conflict discussion. Communication during these interactions was coded by trained research staff using RMICS; all codes were compiled into a single data set for descriptive analysis and exploratory factor analyses (EFAs). The final sample comprised N = 2,011 couples. Several RMICS codes were extremely infrequent-specifically, distress-maintaining attributions, psychological abuse, withdrawal, dysphoric affect, and relationship-enhancing attributions. By far, the most frequent code was constructive problem discussion. EFAs yielded two factors for both women and men. Factor 1 (Negative) contained two items: distress-maintaining attributions and hostility. Factor 2 (Nonnegative) contained constructive problem discussion and humor (and, for women only, acceptance). Results side heavily with the "lump" camp in the lump-versus-split dilemma in couple observational coding. These RMICS factor analysis results converge with those from other systems and imply that the microanalytic "splitting" era in couples coding should draw to a close, with future studies instead focused on negative, neutral, and positive codes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Amy K Otto
- Department of Health Outcomes and Behavior
| | | | | | - Shu Xu
- School of Global Public Health
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Tjia J, Clayton M, Chiriboga G, Staples B, Puerto G, Rappaport L, DeSanto-Madeya S. Stakeholder-engaged process for refining the design of a clinical trial in home hospice. BMC Med Res Methodol 2021; 21:92. [PMID: 33941089 PMCID: PMC8091786 DOI: 10.1186/s12874-021-01275-0] [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: 08/14/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Clinical trials in home hospice settings are important to build the evidence base for practice, but balancing the burden and benefit of clinical trial conduct for clinicians, patients, and family caregivers is challenging. A stakeholder-engaged process can help inform and refine key aspects of home hospice clinical trials. The aim of this study was to describe a stakeholder-engaged process to refine, design, and implement aspects of an educational intervention trial in home hospice, including recommendations for refining intervention content and delivery, recruitment and enrollment strategies, and content and frequency of outcome measurement. Methods A panel of interprofessional (1 hospice administrator, 3 nurses, 2 physicians, 2 pharmacists) and 2 former family caregiver stakeholders was systematically selected and invited to participate based on expertise, representing 2 geographically distinct hospices who were participating in the clinical trial. Teleconferences followed a predetermined procedural sequence: 1. pre-meeting materials distribution and review; 2. pre-meeting email solicitation of concerns in response to materials; 3. teleconference with structured and guided discussion; and 4. documentation and distribution of minutes for accuracy review and future meeting guidance. Discussion topics were distinct for each panel meeting. Written reflections on the stakeholder engagement process were collected from panel members to further refine our process. Results Five initial biweekly teleconferences resulted in recommendations for recruitment strategy, enrollment process, measurement frequency, patient inclusion, and primary care physician notification of the patient’s trial involvement. The panel continues to participate in quarterly teleconferences to review progress and unexpected questions and concerns. Panelist reflections reveal personal and professional benefit from participation. Conclusions An interprofessional stakeholder process is feasible and invaluable for developing home hospice intervention studies, contributing to better science, successful trial implementation, and relevant, valid outcomes. Trial registration Clinicaltrials.gov, NCT03972163, Registered June 3, 2019.
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Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA.
| | | | - Germán Chiriboga
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Brooke Staples
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Geraldine Puerto
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Lynley Rappaport
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
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Addressing cancer patient and caregiver role transitions during home hospice nursing care. Palliat Support Care 2020; 17:523-530. [PMID: 29761752 DOI: 10.1017/s1478951518000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life. METHOD A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits. RESULT Nineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance. SIGNIFICANCE OF RESULTS Our findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.
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Clayton MF, Iacob E, Reblin M, Ellington L. Hospice nurse identification of comfortable and difficult discussion topics: Associations among self-perceived communication effectiveness, nursing stress, life events, and burnout. PATIENT EDUCATION AND COUNSELING 2019; 102:1793-1801. [PMID: 31227332 PMCID: PMC6717031 DOI: 10.1016/j.pec.2019.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To assess hospice nurses' self-perceived communication effectiveness, identify comfortable and difficult discussion topics, and explore associations between self-perceived communication effectiveness, burnout, nursing stress, and life events. METHODS 181 nurses completed self-report measures, then listed comfortable and/or difficult patient and caregiver discussion topics. RESULTS Nurses were generally experienced (median 9 years, range <1-46 as a registered nurse; median 3 years, range <1-23 as a hospice nurse), reporting overall Effective/Very Effective communication skills (85.6%); 70% desired more communication training. As nursing stress increased perceived overall communication effectiveness decreased (rs = -0.198; p 0.012). As burnout increased overall effectiveness (rs = -0.233; p 0.002) and effectiveness with difficult topics (rs = -0.225; p 0.003) decreased. Content analysis revealed 9 categories considered both comfortable and difficult to discuss; contextual comments provided fuller explanation (e.g. providing general information on the Dying Process was comfortable, discussing Dying process during patient death was difficult). Seven additional categories (e.g. Denial) were deemed uniquely difficult. CONCLUSION Hospice nurses perceive themselves as effective communicators, yet want additional training. Perceived communication effectiveness is associated with burnout and stress. PRACTICE IMPLICATIONS Communication training that focuses on contextually grounded topics identified by participants may optimize communication between hospice nurses, patients and caregivers.
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Affiliation(s)
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Measuring Communication Similarity Between Hospice Nurses and Cancer Caregivers Using Latent Semantic Analysis. Cancer Nurs 2019; 43:506-513. [PMID: 31356461 DOI: 10.1097/ncc.0000000000000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Optimal end-of-life care requires effective communication between hospice nurses, caregivers, and patients, yet defining and evaluating effective communication are challenging. Latent semantic analysis (LSA) measures the degree of communication similarity (talking about the same topic) without relying on specific word choices or matching of communication behaviors (question-answer), thus more comprehensively evaluating communication interactions. OBJECTIVE Guided by the Communication Accommodation Theory, we evaluated communication similarity, indicating theoretical convergence, between hospice nurses and caregivers of cancer patients, identifying nurse attributes and communication skills that were associated with greater communication similarity. METHODS A descriptive secondary analysis of self-reported nurse data and 31 audio-recorded cancer patient home hospice nursing visits across 2 states and 7 hospices. RESULTS The average LSA score was 0.83 (possible range, 0-1). A nurse preference for greater patient-oriented visits, use of more Nurse Partnering statements, and less Conversation Dominance (ratio of total nurse to total caregiver talk) were associated with higher LSA scores. CONCLUSIONS Effective communication is essential to optimal end-of-life care. Latent semantic analysis is a feasible and promising approach for assessing communication similarity during home hospice care. IMPLICATIONS FOR PRACTICE Hospice nurses are at the forefront of family caregiver communication, playing a vital role in empowering caregivers to assume required patient care tasks. Communication strategies such as the use of partnering statements that increase LSA scores can be taught to hospice nurses and other members of the hospice interdisciplinary team as a way to enrich communication skills and improve communication confidence and can be translated into other oncology nursing contexts.
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Behind the doors of home hospice patients: A secondary qualitative analysis of hospice nurse communication with patients and families. Palliat Support Care 2019; 17:579-583. [PMID: 30841945 DOI: 10.1017/s1478951518001098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hospice nurses frequently encounter patients and families under tremendous emotional distress, yet the communication techniques they use in emotionally charged situations have rarely been investigated. In this study, researchers sought to examine hospice nurses' use of validation communication techniques, which have been shown in prior research to be effective in supporting individuals experiencing emotional distress. METHOD Researchers performed a directed content analysis of audiorecordings of 65 hospice nurses' home visits by identifying instances when nurses used validation communication techniques and rating the level of complexity of those techniques. RESULT All nurses used validation communication techniques at least once during their home visits. Use of lower level (i.e., more basic) techniques was more common than use of higher level (i.e., more complex) techniques. SIGNIFICANCE OF RESULTS Although hospice nurses appear to use basic validation techniques naturally, benefit may be found in the use of higher level techniques, which have been shown to result in improved clinical outcomes in other settings.
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9
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Xu J, Yang R, Wilson A, Reblin M, Clayton MF, Ellington L. Using Social Network Analysis to Investigate Positive EOL Communication. J Pain Symptom Manage 2018; 56:273-280. [PMID: 29723565 PMCID: PMC6086370 DOI: 10.1016/j.jpainsymman.2018.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/23/2022]
Abstract
CONTEXT End-of-life (EOL) communication is a complex process involving the whole family and multiple care providers. Applications of analysis techniques that account for communication beyond the patient and patient/provider will improve clinical understanding of EOL communication. OBJECTIVES The objectives of the study were to introduce the use of social network analysis to EOL communication data and to provide an example of applying social network analysis to home hospice interactions. METHODS We provide a description of social network analysis to model communication patterns during home hospice nursing visits. We describe three social network attributes (i.e., magnitude, directionality, and reciprocity) in the expression of positive emotion among hospice nurses, family caregivers, and hospice cancer patients. Differences in communication structure by primary family caregiver across gender and time were also examined. RESULTS Magnitude (frequency) in the expression of positive emotion occurred most often between nurses and caregivers or between nurses and patients. Female caregivers directed more positive emotion to nurses, and nurses directed more positive emotion to other family caregivers when the primary family caregiver was male. Reciprocity (mutuality) in positive emotion declined toward day of death but increased on day of actual patient death. There was a variation in reciprocity by the type of positive emotion expressed. CONCLUSION Our example demonstrates that social network analysis can be used to better understand the process of EOL communication. Social network analysis can be expanded to other areas of EOL research, such as EOL decision making and health care teamwork.
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Affiliation(s)
- Jiayun Xu
- School of Nursing, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA.
| | - Rumei Yang
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Andrew Wilson
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Terrill AL, Ellington L, John KK, Latimer S, Xu J, Reblin M, Clayton MF. Positive emotion communication: Fostering well-being at end of life. PATIENT EDUCATION AND COUNSELING 2018; 101:631-638. [PMID: 29241975 PMCID: PMC5878994 DOI: 10.1016/j.pec.2017.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. METHODS A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. RESULTS Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. CONCLUSION We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. PRACTICE IMPLICATION This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research.
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Affiliation(s)
- Alexandra L Terrill
- University of Utah, Department of Occupational & Recreational Therapies, Salt Lake City, USA.
| | - Lee Ellington
- University of Utah, College of Nursing, Salt Lake City, USA
| | - Kevin K John
- Brigham Young University, School of Communication, Provo, USA
| | - Seth Latimer
- University of Utah, College of Nursing, Salt Lake City, USA
| | - Jiayun Xu
- Purdue University School of Nursing, West Lafayette, USA
| | - Maija Reblin
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, USA
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Oliver DP, Washington K, Demiris G, Wallace A, Propst MR, Uraizee AM, Craig K, Clayton MF, Reblin M, Ellington L. Shared Decision Making in Home Hospice Nursing Visits: A Qualitative Study. J Pain Symptom Manage 2018; 55:922-929. [PMID: 29128433 PMCID: PMC6335643 DOI: 10.1016/j.jpainsymman.2017.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT Shared decisions between health care providers and patients and families are replacing the traditional physician-driven plans of care. Hospice philosophy recognizes the patient and family as a unit of care and embraces their role in decision making. OBJECTIVE The goal of this study was to evaluate the shared decisions between hospice nurses and patients and family members. METHODS A secondary analysis of audio recordings of 65 home hospice nurse visits from 65 home hospice nurse visits in 11 different U.S. hospice programs. RESULTS To varying degrees, hospice nurses used all the recommended elements of shared decision making during home visits with patients and families; however, not all elements were used in every visit. The most commonly used element was defining a problem, and the least used element was the assessment of patient and family understanding. CONCLUSIONS Hospice staff can benefit from a more purposeful shared decision-making process and a greater focus on assessment of patient and family understanding and ability to implement plans of care.
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Affiliation(s)
- Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA.
| | - Karla Washington
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - George Demiris
- Biobehavioral Health Sciences, School of Nursing & Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Marc R Propst
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aisha M Uraizee
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kevin Craig
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Reblin M, Heyman RE, Ellington L, Baucom BRW, Georgiou PG, Vadaparampil ST. Everyday couples' communication research: Overcoming methodological barriers with technology. PATIENT EDUCATION AND COUNSELING 2018; 101:551-556. [PMID: 29111310 DOI: 10.1016/j.pec.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Abstract
Relationship behaviors contribute to compromised health or resilience. Everyday communication between intimate partners represents the vast majority of their interactions. When intimate partners take on new roles as patients and caregivers, everyday communication takes on a new and important role in managing both the transition and the adaptation to the change in health status. However, everyday communication and its relation to health has been little studied, likely due to barriers in collecting and processing this kind of data. The goal of this paper is to describe deterrents to capturing naturalistic, day-in-the-life communication data and share how technological advances have helped surmount them. We provide examples from a current study and describe how we anticipate technology will further change research capabilities.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, USA.
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Panayiotis G Georgiou
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, USA
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Reblin M, Clayton MF, Xu J, Hulett JM, Latimer S, Donaldson GW, Ellington L. Caregiver, patient, and nurse visit communication patterns in cancer home hospice. Psychooncology 2017; 26:2285-2293. [PMID: 28029712 PMCID: PMC5489378 DOI: 10.1002/pon.4361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have examined the triadic communication between patients, spouse caregivers, and nurses in the home hospice setting. Thus, little is known about the types of communication patterns that unfold. The goals of the study were to, first, identify common patterns of communication in nurse-patient-caregiver home hospice visits and, second, to identify nurse, caregiver-patient dyad, and visit characteristics that predict visit communication patterns. METHOD Nurses (N = 58) and hospice cancer patient and spouse caregiver dyads (N = 101; 202 individuals) were recruited from 10 hospice agencies. Nurses audio recorded visits to patient/caregiver homes from study enrollment until patient death. All patient, caregiver, and nurse utterances from the audio recordings were coded using an adapted Roter interaction analysis system. Using identified codes, cluster analysis was conducted to identify communication patterns within hospice visits. Logistic regression was used with demographic variables to predict visit communication patterns. RESULTS Six visit communication patterns were identified and were defined largely by 2 dimensions: (1) either the patient, the caregiver, or the patient and caregiver dyad interacting with the nurse and (2) the relatively high or low expression of distress during the visit. Time until death significantly predicted several clusters. CONCLUSION This study leads the way in outlining triadic communication patterns in cancer home hospice visits. Our findings have implications for nursing education, letting future nurses know what to expect, and lays the foundation for future research to determine effectiveness and interventions to improve health care communication.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center,
Tampa, FL, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
| | | | - Seth Latimer
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
| | - Gary W. Donaldson
- Pain Research Center, Department of Anesthesiology, University of
Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
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Abstract
BACKGROUND Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. OBJECTIVE We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. METHODS We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. RESULTS Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. CONCLUSIONS Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. IMPLICATIONS FOR PRACTICE Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.
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Tabler J, Utz RL, Ellington L, Reblin M, Caserta M, Clayton M, Lund D. Missed Opportunity: Hospice Care and the Family. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:224-243. [PMID: 26654059 PMCID: PMC4741375 DOI: 10.1080/15524256.2015.1108896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partner's needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers' high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements.
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Affiliation(s)
| | | | | | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center
| | | | | | - Dale Lund
- Department of Sociology, California State San Bernardino
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