Perceptions of health care provider communication activity among American cancer survivors and Adults Without Cancer Histories: an analysis of the 2003 Health Information Trends Survey (HINTS) Data

Patients' perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020

OBJECTIVE

To describe patients' perceptions of the patient-centeredness of their communication with healthcare providers in Japan, and to examine factors associated with these perceptions.

METHODS

We analyzed the cross-sectional data from the INFORM Study 2020, which is a nationwide survey on health information access in Japan. A total of 3605 respondents completed the survey. Our primary outcome was the nine elements of the patient-centered communication scale (PCCS), which was compiled from 2703 respondents (75.0%) reporting at least one provider visit within 12 months. It was rated on a four-point Likert scale: always, usually, sometimes, and never. We used binary logistic regression to examine the association between sociodemographic and health-related variables, and each element of the PCCS.

RESULTS

For all elements, the percentage of respondents who agreed that their healthcare providers always communicated in a patient-centered way was low (17-31%). Patients with higher age, higher education, poorer general health status and a larger number of visits to providers in the previous 12 months were more likely to have positive perception.

CONCLUSION

Patient-centered communication as reported in a national sample in Japan was low.

CLINICAL IMPLICATIONS

Efforts are needed to improve the patient-centeredness of patient-provider communication in Japan to optimize health outcomes.

Migrant and native women's perceptions of prenatal care communication quality: the role of host-country language proficiency

BACKGROUND

Despite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women's perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women.

METHODS

We aimed to examine the effect of women's host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants' language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27.

RESULTS

A high percentage of women (29%) rated communication quality as "optimal". Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives.

CONCLUSIONS

Facilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes.

Trends and differences in perceptions of patient-centered communication among adults in the US

OBJECTIVE

Patient-centered communication (PCC) is a key indicator of healthcare quality and is critical to patient-centered care. The purpose of this study is to examine the trends in PCC over the past decade and determine if differences in PCC by subpopulation remain METHODS: We used nationally representative survey data from the Health Information National Trends Study (HINTS) to examine PCC. We conducted trend and multivariate regression analyses to understand the changes of PCC scores and differences in PCC by key sociodemographic groups.

RESULTS

PCC reported among adults minimally increased with the largest increases in participants involved in making decisions regarding their healthcare. Participants who were non-Hispanic Black, older, had less than a high school education, or rural residents reported more positive perceptions of PCC CONCLUSION: Our findings indicate improvements to PCC over time. These findings also indicate that differences in patients' perceptions of PCC continue to persist and it's possible that personal expectations may influence a person's perception of the quality of PCC experienced PRACTICE IMPLICATIONS: This study highlights the continued need for provider education in patient emotional support and providing patients with the skills and resources to engage in high quality PCC.

Association of Pneumococcal and Influenza Vaccination With Patient-Physician Communication in Older Adults: A Nationwide Cross-sectional Study From the JAGES 2016

BACKGROUND

Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination.

METHODS

We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination.

RESULTS

Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians' listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients' questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination.

CONCLUSION

The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

Correlates of the perceived quality of patient-provider communication among German adults

BACKGROUND

Since a higher perceived quality of patient-provider communication is known to be associated with improved health outcomes, it is essential to analyze determinants influencing patients' perceived quality of patient-provider communication. Due to the limited knowledge about patient-related influencing factors of quality perception available so far, the objective of this study is to explore and assess determinants of the perceived quality of patient-provider communication with regards to sociodemographic, health-related, healthcare-specific and information-related factors.

METHODS

Linear regression of cross-sectional data from the first wave of Health Information National Trends Survey Germany (n = 2902) was conducted. Independent variables were sociodemographic, health-, healthcare- and information-related factors; the dependent variable was the perceived quality of patient-provider communication.

RESULTS

Results show that age, migration background, the perceived quality of healthcare, health-related self-efficacy and trust in health information from health professionals are significantly associated with the perceived quality of patient-provider communication.

CONCLUSIONS

Sociodemographic, healthcare- and health information-related factors influence the perceived quality of patient-provider communication. In particular, patients having a migration background and patients reporting low self-efficacy showed significant lower levels of their perceived patient-provider communication quality. With the aim to improve quality issues, patients of both target groups should be empowered and supported.

Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults

LAY ABSTRACT

Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.

The Influence of Patient-Provider Communication on Cancer Screening

Few studies have examined how different qualities and modes (face-to-face vs electronic) of patient-provider communication (PPC) influence cancer screening uptake. Our objective was to determine whether receiving a breast, cervical, and colorectal cancer screening is influenced by (1) qualities of face-to-face and (2) the use of e-mail PPC. We analyzed Health Information National Trends Survey 4, cycles 1 to 4 data. To assess qualities of face-to-face PPC, adults reported how often physicians spent enough time with them, explained so they understood, gave them a chance to ask questions, addressed feelings and emotions, involved them in decisions, confirmed understanding, and helped them with uncertainty. Adults reported whether they used e-mail PPC. We used multivariable logistic regression to evaluate the odds of receiving cancer screenings based on face-to-face and e-mail PPC. Adults whose health-care providers involved them in decision-making had highest odds of receiving breast (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.11-1.71), cervical (OR = 1.30; 95% CI = 1.06-1.60), and colorectal (OR = 1.25; 95% CI = 1.03-1.51) cancer screenings. No significant associations were observed between e-mail PPC and cancer screenings. More research is needed to explore this association.

Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians

Importance

How patients' mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions.

Objective

To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians.

Design, Setting, and Participants

This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder).

Main Outcomes and Measures

Patient satisfaction with physician, measured by the patient-physician communication composite score.

Results

A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001).

Conclusions and Relevance

This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.

Positive aspects of having had cancer: A mixed-methods analysis of responses from the American Cancer Society Study of Cancer Survivors-II (SCS-II)

OBJECTIVE

This study focused on understanding positive aspects of cancer among a large, national sample of survivors, 2, 5, and 10 years' postcancer diagnosis, who responded to the American Cancer Society Study of Cancer Survivors - II (SCS-II) survey "Please tell us about any positive aspects of having cancer."

METHODS

A sequential mixed methods approach examined (1) thematic categories of positive aspects from cancer survivors (n = 5149) and (2) variation in themes by sociodemographics, cancer type, stage of disease, and length of survivorship.

RESULTS

Themes comprised 21 positive aspects within Thornton's typology of benefits that cancer survivors attribute to their illness: life perspectives, self, and relationships. New themes pertaining to gratitude and medical support during diagnosis and treatment, health-related changes, follow-up/surveillance, and helping others emerged that are not otherwise included in widely used existing benefit finding cancer scales. Gratitude and appreciation for life were the most frequently endorsed themes. Sociodemographics and stage of disease were associated with positive aspect themes. Themes were not associated with survivor cohorts.

CONCLUSIONS

No differences in perceived positive aspects across survivor cohorts suggest that positive aspects of cancer may exist long after diagnosis for many survivors. However, variation across sociodemographics and clinical variables suggests cancer survivors differentially experience positive aspects from their cancer diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS

This analysis provides new information about cancer survivors' perceptions of positive aspects from their cancer and factors associated with benefit finding and personal growth. This information can be useful in further refining quality-of-life measures and interventions for cancer survivors.

The Development and Evaluation of an Online Healthcare Toolkit for Autistic Adults and their Primary Care Providers

BACKGROUND

The healthcare system is ill-equipped to meet the needs of adults on the autism spectrum.

OBJECTIVE

Our goal was to use a community-based participatory research (CBPR) approach to develop and evaluate tools to facilitate the primary healthcare of autistic adults.

DESIGN

Toolkit development included cognitive interviewing and test-retest reliability studies. Evaluation consisted of a mixed-methods, single-arm pre/post-intervention comparison.

PARTICIPANTS

A total of 259 autistic adults and 51 primary care providers (PCPs) residing in the United States.

INTERVENTIONS

The AASPIRE Healthcare toolkit includes the Autism Healthcare Accommodations Tool (AHAT)-a tool that allows patients to create a personalized accommodations report for their PCP-and general healthcare- and autism-related information, worksheets, checklists, and resources for patients and healthcare providers.

MAIN MEASURES

Satisfaction with patient-provider communication, healthcare self-efficacy, barriers to healthcare, and satisfaction with the toolkit's usability and utility; responses to open-ended questions.

KEY RESULTS

Preliminary testing of the AHAT demonstrated strong content validity and adequate test-retest stability. Almost all patient participants (>94 %) felt that the AHAT and the toolkit were easy to use, important, and useful. In pre/post-intervention comparisons, the mean number of barriers decreased (from 4.07 to 2.82, p < 0.0001), healthcare self-efficacy increased (from 37.9 to 39.4, p = 0.02), and satisfaction with PCP communication improved (from 30.9 to 32.6, p = 0.03). Patients stated that the toolkit helped clarify their needs, enabled them to self-advocate and prepare for visits more effectively, and positively influenced provider behavior. Most of the PCPs surveyed read the AHAT (97 %), rated it as moderately or very useful (82 %), and would recommend it to other patients (87 %).

CONCLUSIONS

The CBPR process resulted in a reliable healthcare accommodation tool and a highly accessible healthcare toolkit. Patients and providers indicated that the tools positively impacted healthcare interactions. The toolkit has the potential to reduce barriers to healthcare and improve healthcare self-efficacy and patient-provider communication.

Disparities in perceived patient-provider communication quality in the United States: Trends and correlates

OBJECTIVE

This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ.

METHODS

A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations.

RESULTS

PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors.

CONCLUSIONS

Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health.

PRACTICE IMPLICATIONS

These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities.

The potential for health-related uses of mobile phones and internet with homeless veterans: results from a multisite survey

BACKGROUND

Addressing the health needs of homeless veterans is a priority in the United States, and, although information technologies can potentially improve access to and engagement in care, little is known about this population's use of information technologies or their willingness to use technologies to communicate with healthcare providers and systems.

MATERIALS AND METHODS

This study fills this gap through a survey of homeless veterans' use of information technologies and their attitudes about using these technologies to assist with accessing needed healthcare services.

RESULTS

Among the 106 homeless veterans surveyed, 89% had a mobile phone (one-third were smartphones), and 76% used the Internet. Among those with a mobile phone, 71% used text messaging. Nearly all respondents (93%) were interested in receiving mobile phone reminders (text message or phone call) about upcoming medical appointments, and a similar proportion (88%) wanted mobile phone outreach asking if they would like to schedule an appointment if they had not been seen by a health provider in over a year. In addition, respondents already used these technologies for information and communication related to health, housing, and jobs.

CONCLUSIONS

These findings suggest new avenues for communication and health interventions for hard-to-reach homeless veterans.

Factors associated with perceived patient-provider communication quality among Puerto Ricans

Patient-provider communication is an important factor influencing patients' health outcomes. This study examined the relationship between patient-provider communication quality and sociodemographic, health care access, trusted information sources, and health status variables. Data were from a representative sample of 450 Puerto Rican adults who participated in the Health Information National Trends Survey. A composite score rating perceived patient-provider communication quality was created from five items (Cronbach's alpha = 0.87). A multivariate linear regression analysis was conducted. Patient-provider communication ratings were lower among the unemployed (p = 0.049), those who do not trust a lot in the information provided by their providers (p = 0.003), and respondents with higher depressive symptoms scores (p = 0.036). Perceived patient-provider communication quality, however, was higher among respondents who visited their providers five or more times in the last year (p = 0.023). Understanding patient perceptions of provider communication may serve to develop system-level interventions aimed at eliminating communication disparities and improving patients' health outcomes.

Favorable ratings of providers' communication behaviors among U.S. women with depression: a population-based study applying the behavioral model of health services use

BACKGROUND

Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient-provider communication in women with depression.

METHODS

The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers' communication behavior measures.

FINDINGS

Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01-1.94), explained so they understood (OR, 1.53; 95% CI, 1.10-2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01-1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences.

CONCLUSIONS

Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences.

IMPLICATIONS FOR PRACTICE AND/OR POLICY

Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient-provider communication in this population.

Comparison of healthcare experiences in autistic and non-autistic adults: a cross-sectional online survey facilitated by an academic-community partnership

BACKGROUND

Little is known about the healthcare experiences of adults on the autism spectrum. Moreover, autistic adults have rarely been included as partners in autism research.

OBJECTIVE

To compare the healthcare experiences of autistic and non-autistic adults via an online survey.

METHODS

We used a community-based participatory research (CBPR) approach to adapt survey instruments to be accessible to autistic adults and to conduct an online cross-sectional survey. We assessed preliminary psychometric data on the adapted scales. We used multivariate analyses to compare healthcare experiences of autistic and non-autistic participants.

RESULTS

Four hundred and thirty-seven participants completed the survey (209 autistic, 228 non-autistic). All adapted scales had good to excellent internal consistency reliability (alpha 0.82-0.92) and strong construct validity. In multivariate analyses, after adjustment for demographic characteristics, health insurance, and overall health status, autistic adults reported lower satisfaction with patient-provider communication (beta coefficient -1.9, CI -2.9 to -0.9), general healthcare self-efficacy (beta coefficient -11.9, CI -14.0 to -8.6), and chronic condition self-efficacy (beta coefficient -4.5, CI -7.5 to -1.6); higher odds of unmet healthcare needs related to physical health (OR 1.9 CI 1.1-3.4), mental health (OR 2.2, CI 1.3-3.7), and prescription medications (OR 2.8, CI 2.2-7.5); lower self-reported rates of tetanus vaccination (OR 0.5, CI 0.3-0.9) and Papanicolaou smears (OR 0.5, CI 0.2-0.9); and greater odds of using the emergency department (OR 2.1, CI 1.8-3.8).

CONCLUSION

A CBPR approach may facilitate the inclusion of people with disabilities in research by increasing researchers' ability to create accessible data collection instruments. Autistic adults who use the Internet report experiencing significant healthcare disparities. Efforts are needed to improve the healthcare of autistic individuals, including individuals who may be potentially perceived as having fewer disability-related needs.

The association of perceived provider-patient communication and relationship quality with colorectal cancer screening

BACKGROUND

Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior.

METHODS

The association of provider communication quality, relationship, and colorectal cancer screening was examined within data from the 2007 Health Information National Trends Survey.

RESULTS

Perceived provider communication and relationship quality were associated with both adherence to colonoscopy and with ever having been screened. Predictive margins analyses indicated that increasing perceptions from lowest to highest levels of communication and relationship quality would be associated with increases in screening rates approaching 16 percentage points.

CONCLUSION

Improving provider-patient communication and relationship quality could potentially improve colorectal cancer screening behaviors among adults aged 50 years and older. Future research and clinical practice should focus on understanding the role of these factors in screening behavior and enhance the provider-patient interaction.

The nature and timing of family-provider communication in late-stage cancer: a qualitative study of caregivers' experiences

CONTEXT

Family members of people with advanced cancer can experience intensified distress and uncertainty during the final stages of their loved one's illness. Enhanced comprehension about disease progression, symptom management, and options for care can help families adapt, cope, and plan for the future.

OBJECTIVES

Guided by concepts from the Sense of Coherence Theory, which illuminates factors that contribute to adaptation in stressful situations, the objective of this study was to explore and describe family caregivers' accounts of the nature and timing of communication they had with a loved one's health care provider(s) during the advanced stages of cancer and before hospice enrollment.

METHODS

Retrospective in-depth interviews were conducted with caregivers of 46 people who died of cancer. Interviews were audiotaped, transcribed, and submitted to an iterative process of qualitative data analysis that included 1) systematic coding, 2) the use of data matrices to display summarized results and collapse the codes into themes, 3) and axial coding to characterize the nature of the themes.

RESULTS

Overall, communication with providers was found to be either 1) satisfactory or 2) unsatisfactory. Satisfactory communication was 1) compassionate, 2) responsive, and/or 3) dedicated. Unsatisfactory communication was described as 1) sparse, 2) conflicted, 3) contradictory, and/or 4) brink of death.

CONCLUSION

Communication with health care providers is critical for helping family caregivers understand and manage the changes that accompany a life-limiting illness. Timely communication with information and meaningful discussion about disease progression can help families prepare for the advanced stages of an illness and approaching death.

Picking up the pace: changes in method and frame for the health information national trends survey (2011-2014)

Health communication and health information technology influence the ways in which health care professionals and the public seek, use, and comprehend health information. The Health Information National Trends Survey (HINTS) program was developed to assess the effect of health communication and health information technology on health-related attitudes, knowledge, and behavior. HINTS has fielded 3 national data collections with the fourth (HINTS 4) currently underway. Throughout this time, the Journal of Health Communication has been a dedicated partner in disseminating research based on HINTS data. Thus, the authors thought it the perfect venue to provide an historical overview of the HINTS program and to introduce the most recent HINTS data collection effort. This commentary describes the rationale for and structure of HINTS 4, summarizes the methodological approach applied in Cycle 1 of HINTS 4, describes the timeline for the HINTS 4 data collection, and identifies priorities for research using HINTS 4 data.

Levels of symptom burden during chemotherapy for advanced lung cancer: differences between public hospitals and a tertiary cancer center

PURPOSE

We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non-small-cell lung cancer and in patients treated at a tertiary cancer center.

PATIENTS AND METHODS

We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership.

RESULTS

Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P = .001) and to report significantly higher symptom interference (P = .001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management.

CONCLUSION

Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.

Left hanging in the air: experiences of living with cancer as expressed through E-mail communications with oncology nurses

BACKGROUND

Cancer patients experience many physical, psychosocial, and existential problems and worries during their illness. To support patients in managing their illness, we implemented an online patient-nurse communication (OPNC) service, where breast and prostate cancer patients could ask questions and receive advice from oncology nurses.

OBJECTIVE

The aim of this study was to explore the use and content of patients' e-mail messages sent to oncology nurses and thus gain a "snapshot" of patients' experiences of living with cancer as expressed through these messages.

METHODS

Using qualitative content analysis, 276 messages from 60 breast and prostate cancer patients were analyzed. Messages were coded into categories and major themes. Both manifest and latent content was coded.

RESULTS

Four main themes emerged from patients' messages: (1) living with symptoms and side effects, (2) living with a fear of relapse, (3) concerns for everyday life, and (4) unmet information needs from health care providers.

CONCLUSIONS

Patients used the OPNC service actively to pose questions and raise concerns related to symptom experiences, fear of relapses, and uncertainty in everyday life. However, patients also expressed experiences of being "left in a void" after being discharged from hospital and living with serious unmet informational needs.

IMPLICATIONS FOR PRACTICE

The study demonstrated that online communication can provide patients with a space for otherwise unmet questions and worries and that they will seek support from nurses online when given the opportunity. Therefore, OPNC can be an important means and supplement to traditional health care in the effort to support patients to better manage their illness.

Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors

BACKGROUND

Few studies have examined risk for severe symptoms during early cancer survivorship. By using baseline data from the American Cancer Society's Study of Cancer Survivors-I, the authors examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year postdiagnosis.

METHODS

Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and were surveyed by telephone or mail. The outcomes measures used were the Modified Rotterdam Symptom Checklist and the Profile of Mood States-37 (to assess symptom burden) and the Satisfaction with Life Domains Scale-Cancer (to assess HRQoL).

RESULTS

Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two-step clustering yielded 2 subgroups, 1 with low symptom burden (n = 3113) and 1 with high symptom burden (n = 1399). Variables that were associated with high symptom burden included lung cancer (odds ratio [OR], 2.27), metastatic cancer (OR, 2.05), the number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), and being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001).

CONCLUSIONS

More than 1 in 4 cancer survivors had high symptom burden 1 year postdiagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early post-treatment survivorship, especially for the underserved.

Perceptions about collaborative decisions: perceived provider effectiveness among 2003 and 2007 Health Information National Trends Survey (HINTS) respondents

Patient-provider communication is an important element in cancer treatment and prevention. We examined the degree of concordance perceived to exist between the patient's preferences for inclusion in decision-making processes and their actual experiences among two population-based cohorts of U.S. adults with and without cancer histories who were surveyed in 2003 and 2007. Associations were examined between selected sociodemographic characteristics of respondents and the extent to which respondents perceived their health providers "always" involved them in decisions about their health to the extent desired. Data came from the Health Information National Trends Survey (HINTS), and SPSS and SAS-Callable SUDAAN statistical packages were used to analyze the data. Results showed a decrement in the proportion of favorable responses between 2003 and 2007. While there was no gender effect on the reported perceptions in either year, there was a significant effect of ethnicity (p = .001) in both years. Age, income, and employment were also independently associated (p = .001) in 2007. In contrast to 2003, higher education was significantly associated with communication satisfaction, as was having a cancer diagnosis, in 2007. There was a significant relationship between several sociodemographic variables and respondent perceptions about the consistency with which providers included patients as desired in decision-making. We conclude that communication between patient and provider remains suboptimal in cancer prevention and treatment.