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Kachimanga C, McGlashan J, Cunningham N, Hoyle L. Communication to adult patients undergoing cancer care by non-specialist nurses: a scoping review protocol. BMJ Open 2024; 14:e081326. [PMID: 38508653 PMCID: PMC10961544 DOI: 10.1136/bmjopen-2023-081326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Little is known regarding how non-specialist nurses communicate with patients living with cancer when the patients are receiving care outside of their cancer units/teams. This scoping review aims to identify, examine and report on the currently available evidence about communication by non-specialist nurses when caring for adults living with cancer outside of their cancer care unit/teams. METHODS AND ANALYSIS A scoping review following the JBI methodology for scoping reviews will be conducted. We will search for empirical studies that meet the inclusion criteria in six databases (MEDLINE, PubMed, CINAHL, Embase, Scopus and PsycINFO). Handsearching in references of included articles will be performed to find additional articles. The population of interest will be non-specialist nurses. Three concepts will be explored, namely (1) all adult patients living with cancer, (2) a focus on three stages of the cancer continuum of care (cancer diagnosis, treatment and survivorship) and (3) a focus on communication between non-specialist nurses and patients living with cancer. We will include studies describing all healthcare settings outside patients' specialised cancer units or oncology teams. After article selection, two reviewers will independently screen titles and abstracts and perform a full-text article review, risk of bias assessments and data extraction. A third reviewer will resolve all disagreements. A narrative summary will provide an overview of how the results relate to the research aims and questions. The included articles will be limited to English and published between 2012 and 2023. ETHICS AND DISSEMINATION No ethical approval is required since we will use publicly available empirical research sources. This review will provide current research on communication by non-specialist nurses with patients with a cancer diagnosis outside of an oncology setting, evidence that will support effective communication. As such, we aim to disseminate the findings in academic conferences and peer-reviewed journals.
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Wang H, Pathak M, Takami T, Wiener RC, Shen C, Sambamoorthi U. Ethnic Disparities in Patient-Centered Communication with Healthcare Providers: A Comparison of Non-Hispanic Asians and Non-Hispanic Whites. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01898-7. [PMID: 38228862 DOI: 10.1007/s40615-023-01898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population. METHODS This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC. RESULTS We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001). CONCLUSIONS High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Trevor Takami
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
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Sardessai-Nadkarni AA, Street RL. Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal. J Cancer Surviv 2023; 17:1266-1275. [PMID: 35167049 DOI: 10.1007/s11764-022-01170-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors. METHODS The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal. RESULTS The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal. CONCLUSIONS Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects. IMPLICATIONS FOR CANCER SURVIVORS Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.
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Affiliation(s)
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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4
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Annis IE, deJong NA, Christian RB, Davis SA, Hughes PM, Thomas KC. Neighborhood context and children's health care utilization and health outcomes: a comprehensive descriptive analysis of national survey data. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad038. [PMID: 38756672 PMCID: PMC10986298 DOI: 10.1093/haschl/qxad038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 05/18/2024]
Abstract
While child health and health care disparities arising from unequal distribution of resources are well documented, a nationally representative inventory of health and well-being for children across the spectrum of opportunity is lacking. Using the nationally representative sample of children from pooled 2013-2017 Medical Expenditure Panel Survey data linked to the census-tract-level Child Opportunity Index 2.0, a composite measure of neighborhood health, education, and socioeconomic conditions, we describe US children's socioeconomic characteristics, health care utilization and expenditures across the spectrum of child neighborhood opportunity levels. We found that neighborhood level of child opportunity was associated with almost all of children's health status, health care utilization, expenditures, access to care, and satisfaction with care outcomes. Children living in lower-opportunity neighborhoods had the highest rates of poor physical and mental health status and fewest ambulatory care visits but accounted for the highest share of emergency department visits. Their parents were also least likely to report having positive experiences with health care, good communication with providers, and easy access to care. Our findings underscore the myriad harms to children of gaps in health, education, and financial resources at the community level and provide targets for public investments to improve child-focused outcomes.
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Affiliation(s)
- Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, United States
| | - Robert B Christian
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, United States
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27599, United States
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27599, United States
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Alpert JM, Hampton CN, Markham MJ, Bylund CL. Clinicians' Attitudes and Behaviors Towards Communicating Electronically with Patients: A Grounded Practical Theory Approach. JOURNAL OF HEALTH COMMUNICATION 2022; 27:103-114. [PMID: 35380099 DOI: 10.1080/10810730.2022.2059723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Secure messaging (SM), asynchronous communication between patients and clinicians, is an increasingly popular tool among patients to contact clinicians about their care. Despite patients' enthusiasm, clinicians have been hesitant to embrace the technology to communicate with patients. Using the theoretical and methodological framework of Grounded Practical Theory (GPT), we analyzed and interpreted clinicians' perceptions, attitudes, and approaches toward SM to communicate with patients. Twenty clinicians in medical oncology and radiation oncology participated in audio-recorded, semi-structured interviews. Findings revealed the problems with using SM, such as difficulty interpreting low-quality messages, the amount of time needed to devote to responding, and its potential to negatively affect the patient-clinician relationship. Techniques employed to manage such problems consisted of using different forms of communication and utilizing messaging to expedite workloads. The philosophical rationale of clinicians toward SM was that it can improve patient care and this form of communication is already embedded within existing patient care. Overall, this article clarifies how clinicians can re-conceptualize how they think about SM so that it becomes a productive, informative, and useful aspect of patient care.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, Florida, USA
| | - Chelsea N Hampton
- Department of Advertising, University of Florida, Gainesville, Florida, USA
| | | | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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6
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Wang W, Li H, Li Y, Fang S, Zhang S, Zhang X, Meng X, Su J, Sun J. Colorectal cancer survivors' experience of continuity of care provided by different health professionals: A qualitative evidence synthesis. J Clin Nurs 2022; 31:2985-2999. [PMID: 34985169 DOI: 10.1111/jocn.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, synthesise and characterise the available qualitative evidence on the experience of adult colorectal cancer survivors with continuity of care led by different health professionals. BACKGROUND The limited evidence base for effective continuity of care led by different medical staff who assist colorectal cancer survivors with their unique survivorship care hampers the development of effective interventions. Synthesising the data on survivors' experience of care led by different health professionals is critical to develop such interventions. DESIGN A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. METHODS PubMed, Web of Science, Embase, Cochrane, CINAHL and PsycINFO were searched through November 2020 for qualitative and mixed methods studies in English. JBI-QARI was used to undertake a quality review of the identified studies. The review findings were synthesised by a team of researchers, and the level of confidence was evaluated using GRADE-CERQual. RESULTS Eleven studies met the criteria for inclusion in the review. The identified analytical themes included experience of diversity, preference for health professionals and space for enhancement to facilitate improved medical care delivery. Colorectal cancer survivors report diverse experiences regarding continuity of care led by different providers. Specifically, they attach substantial importance to trusted relationships with providers that are closely associated with their overall care experience. CONCLUSION Effective communication and good rapport among stakeholders are cornerstones for addressing the complexity of ongoing care. Future interventions should include adjusting the percentage of care from different providers to deliver cost-effective and personalised continuity of care. RELEVANCE TO CLINICAL PRACTICE Synthesising data on survivors' experience facilitates the development of practical approaches to increase the quality of continuity of care and may also foster the integration of providers' advantages to enable more cost-effective intervention. The limited capacity of primary care providers may be enhanced by better cooperation and communication with specialists and by additional professional cancer-related training.
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Affiliation(s)
- Wenxia Wang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Huanhuan Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Yijing Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuyan Fang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuang Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xu Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xiangfei Meng
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jianping Su
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
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Austin JD, Allicock M, Fernandez ME, Balasubramanian BA, Lee SC. Understanding the Delivery of Patient-Centered Survivorship Care Planning: An Exploratory Interview Study With Complex Cancer Survivors. Cancer Control 2021; 28:10732748211011957. [PMID: 34689577 PMCID: PMC8718161 DOI: 10.1177/10732748211011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Understanding key elements of the survivorship care planning process, such as patient-centered communication (PCC) and health self-efficacy, are critical for delivering patient-centered survivorship care to cancer survivors with multiple chronic conditions (“complex cancer survivors”). Building upon our team’s recent research efforts to examine the survivorship care planning process from a patient-centered lens, this exploratory study leveraged an ongoing quasi-experimental trial to elucidate the experience of complex cancer survivors with survivorship care planning and post-treatment management. Methods: We conducted a hypothesis-generating thematic content analysis on 8 interview transcripts. Results: Survivors reported positive experiences communicating with their oncology care team but the presence of multiple chronic conditions in addition to cancer creates additional barriers to patient-centered survivorship care. Conclusion: These findings support the need for further in-depth research aimed at improving PCC across all care teams and enabling self-management by delivering more personalized survivorship care planning that aligns with survivor’s needs, values, and preferences.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zou W. How Do Patient-Centered Communication, Emotional Well-Being, Confidence in Health Information-Seeking, and Future Time Perspective Influence Health Self-Efficacy? AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1902887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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9
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Vena JA, Copel LC. A concept analysis of remission within the domain of cancer survivorship. Nurs Forum 2021; 56:421-428. [PMID: 33634534 DOI: 10.1111/nuf.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
AIM This concept analysis aims to formulate a unique theoretical definition of the term remission as used in cancer survivorship. BACKGROUND Inadequate communication between healthcare providers and cancer survivors is a shared burden affecting survivor well-being. Healthcare providers regularly use the term remission in cancer prognosis, treatment, and long-term cancer management; yet, how healthcare providers and cancer survivors define and interpret the concept of remission is less understood. DESIGN The Walker and Avant method of concept analysis was applied to define the term remission within the domain of cancer survivorship. DATA SOURCE: Three health sciences databases were chosen for the literature search, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline. REVIEW METHODS: Included research articles were evaluated to define the antecedents, attributes, consequences, and empirical referents of the term remission. RESULTS A cancer diagnosis is the most commonly cited antecedent to cancer remission. During remission, most cancer patients are free of measurable or symptomatic disease; however, the remission milestone is complemented by multiple physical and psychological symptoms. More specific cancer remission attributes include anxiety, recurrence fears, self-perseverance, and loss of social support. Both positive and negative outcomes accompany cancer remission, including acceptance of the treatment journey, appreciation for life, hope, persistent anxiety, personal relief, and triggered memories. CONCLUSIONS This concept analysis reviewed numerous publications to understand remission in the context of cancer survivorship. Advanced practice and registered nurses have a continued opportunity to improve the communication methods of patient-centered teaching and care planning for cancer patients in remission.
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Affiliation(s)
- Joseph A Vena
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Linda C Copel
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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10
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Dommershuijsen LJ, Dedding CWM, Van Bruchem-Visser RL. Consultation Recording: What Is the Added Value for Patients Aged 50 Years and Over? A Systematic Review. HEALTH COMMUNICATION 2021; 36:168-178. [PMID: 31556750 DOI: 10.1080/10410236.2019.1669270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This systematic review aimed to provide medical professionals with insight into beneficial and harmful effects of consultation recording for patients aged 50 years and over. This insight could enable medical professionals to decide on whether or not to promote consultation recording in their practice. The systematic literature search was performed in six databases; additional relevant articles were sought using the snowball method. Studies were included that investigated the value of consultation recording for patients aged 50 years and over. The selected studies were analyzed on affective cognitive outcomes, behavioral outcomes, and health outcomes. Twenty-five studies of both qualitative and quantitative design were included. Consultation recordings mainly improved patient satisfaction, recall, fulfillment of information needs, and decision-making. Both positive and negative effects were reported on anxiety. The recordings did not distinctly affect functional outcomes or quality of life. In conclusion, consultation recording positively influenced patients' affective cognitive and behavioral outcomes, and the negative effects of consultation recording were minor. Because of the positive effects of consultation replay, we recommend that doctors promote consultation recording among their patients of 50 years and over. However, more studies are necessary among older patients because this patient population is underrepresented in the current literature.
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11
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A structural equation modeling approach to understanding pathways linking survivorship care plans to survivor-level outcomes. J Cancer Surviv 2020; 14:834-846. [PMID: 32474862 DOI: 10.1007/s11764-020-00896-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Several high-profile organizations have mandated the delivery of survivorship care plans (SCPs) despite mixed evidence regarding the effectiveness of SCPs on key survivor-level outcomes. There is a need to understand the types of survivor-level outcomes the SCPs are likely to change. Informed by existing frameworks and the literature, the objective of this study was to understand the pathways linking the receipt of a SCP to key survivor-level outcomes including patient-centered communication (PCC), health self-efficacy, changes in health behaviors, and improvements in overall health. METHODS We used structural equation modeling to test the direct and indirect pathways linking the receipt of an SCP to patient-centered communication (PCC), health self-efficacy, and latent measures of health behaviors and physical health in a nationally representative sample of breast and colorectal cancer survivors from the Health Information National Trends Survey. RESULTS The receipt of an SCP did not have a significant effect on key survivor-level outcomes and was removed from the final structural model. The final structural model fit the data adequately well (Chi-square p value = 0.03, RMSEA = 0.07, CFI = .88, and WRMR = 0.73). PCC had a significant direct effect on physical health but not on health behaviors. Health self-efficacy had a significant direct effect on physical health and health behaviors. CONCLUSION The receipt of an SCP alone is unlikely to facilitate changes in PCC, health self-efficacy, health behaviors, or physical health. IMPLICATION FOR CANCER SURVIVORS A SCP is a single component of a larger model of survivorship care and should be accompanied by ongoing efforts that promote PCC, health self-efficacy, and changes in health behaviors resulting in improvements to physical health.
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12
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Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions: results from the Health Information National Trends Survey. J Cancer Surviv 2019; 13:663-672. [PMID: 31309416 DOI: 10.1007/s11764-019-00785-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/03/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Cancer survivors with multiple chronic conditions experience significant challenges managing their health. The six core functions of patient-centered communication (PCC)-fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management-represent a central component to facilitating a survivor's confidence to manage their health that has not been investigated in cancer survivors with multiple chronic conditions. METHOD Nationally representative data across two iterations of the Health Information National Trends Survey (HINTS) were merged with combined replicate weights using the jackknife replication method. Adjusted linear regression examined the association between PCC and health self-efficacy in a sample of breast, colorectal, and prostate cancer survivors and by multiple chronic conditions. RESULTS 53.9% reported that providers did not always respond to their emotions and 48.9% reported that they could not always rely on their providers to help them manage uncertainty. In the adjusted linear regression models, there was a significant positive association between PCC and health self-efficacy (β = 0.2, p = 0.01) for the entire sample. However, the association between PCC and health self-efficacy was attenuated in cancer survivors with multiple chronic conditions (β = 0.1, p = 0.53). CONCLUSION PCC alone is not enough to improve a cancer survivor's confidence in their ability to manage their health in the presence of multiple chronic conditions. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors with multiple chronic conditions need ongoing support, in addition to PCC, that render them prepared to manage their health after cancer.
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13
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Nevin PE, Blas M, Bayer A, Gutierrez MAC, Rao D, Molina Y. Positive cancer care in Peru: Patient and provider perspectives. Health Care Women Int 2019; 41:510-523. [PMID: 31090496 DOI: 10.1080/07399332.2019.1608206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.
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Affiliation(s)
- Paul E Nevin
- University of Washington, Seattle, Washington, USA
| | - Magaly Blas
- University of Washington, Seattle, Washington, USA.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angela Bayer
- Univeristy of California Los Angeles, Los Angeles, California, USA
| | | | - Deepa Rao
- University of Washington, Seattle, Washington, USA
| | - Yamilé Molina
- University of Illinois at Chicago, Chicago, Illinois, USA
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14
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Gornick MC, Ryan KA, Scherer AM, Roberts JS, De Vries RG, Uhlmann WR. Interpretations of the Term "Actionable" when Discussing Genetic Test Results: What you Mean Is Not What I Heard. J Genet Couns 2019; 28:334-342. [PMID: 30964581 PMCID: PMC10558004 DOI: 10.1007/s10897-018-0289-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
In genomic medicine, the familiarity and inexactness of the term "actionable" can lead to multiple interpretations and mistaken beliefs about realistic treatment options. As part of a larger study focusing on public attitudes toward policies for the return of secondary genomic results, we looked at how members of the lay public interpret the term "medically actionable" in the context of genetic testing. We also surveyed a convenience sample of oncologists as part of a separate study and asked them to define the term "medically actionable." After being provided with a definition of the term, 21 out of 60 (35%) layperson respondents wrote an additional action not specified in the provided definition (12 mentioned "cure" and 9 mentioned environment or behavioral change) and 17 (28%) indicated "something can be done" with no action specified. In contrast, 52 surveyed oncologists did not mention environment, behavioral change, or cure. Based on our findings, we propose that rather than using the term "actionable" alone, providers should also say "what they mean" to reduce miscommunication and confusion that could negatively impact medical decision-making. Lastly, to guide clinicians during patient- provider discussion about genetic test results, we provide examples of phrasing to facilitate clearer communication and understanding of the term "actionable."
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Affiliation(s)
- Michele C. Gornick
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kerry A. Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Aaron M. Scherer
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA
| | - J. Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Raymond G. De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Wendy R. Uhlmann
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI
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15
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Abu Sharour L. Lived experience of Jordanian colorectal cancer patients with recurrence: an interpretative phenomenological analysis. PSYCHOL HEALTH MED 2019; 24:827-835. [DOI: 10.1080/13548506.2019.1587481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Loai. Abu Sharour
- Faculty of nursing, AL-Zaytoonah University of Jordan, Amman, Jordan
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16
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Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas J, Black N. How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. J Patient Rep Outcomes 2018; 2:42. [PMID: 30294712 PMCID: PMC6153194 DOI: 10.1186/s41687-018-0061-6] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians' awareness of patients' problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. RESULTS PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. CONCLUSIONS This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making.
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Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
| | - Kate Gooding
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
- Present address: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
| | - Sonia Dalkin
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
- Present address: Department of Social Work, Education & Community Wellbeing, Northumbria University, H005, Coach Lane Campus East, Newcastle upon Tyne, NE7 7XA England
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL England
| | - Jose Valderas
- Health Services and Policy Research, Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU England
| | - Nick Black
- Health Services Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH England
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Han J, Jungsuwadee P, Abraham O, Ko D. Shared Decision-Making and Women's Adherence to Breast and Cervical Cancer Screenings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071509. [PMID: 30018244 PMCID: PMC6068979 DOI: 10.3390/ijerph15071509] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 12/11/2022]
Abstract
We examined the effect of shared decision-making (SDM) on women’s adherence to breast and cervical cancer screenings and estimated the prevalence and adherence rate of screenings. The study used a descriptive cross-sectional design using the 2017 Health Information National Trends Survey (HINTS) data collected by the National Cancer Institute. Adherence was defined based on the guidelines from the American Cancer Society and the composite measure of shared decision-making was constructed using three items in the data. Multivariable logistic regression was performed to examine the association between the SDM and adherence, controlling for cancer beliefs and socio-demographic variables. The analysis included 742 responses. Weighted to represent the U.S. population, 68.1% adhered to both breast and cervical cancer screening guidelines. The composite measure of SDM was reliable (α = 0.85), and a higher SDM score was associated with women’s screening adherence (b = 0.17; p = 0.009). There were still women who did not receive cancer screenings as recommended. The results suggest that the use of the SDM approach for healthcare professionals’ communication with patients can improve screening adherence.
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Affiliation(s)
- Jayoung Han
- Department of Pharmacy Practice, School of Pharmacy and Health Sciences, Fairleigh Dickinson University, 230 Park Ave, Florham Park, NJ 07932, USA.
| | - Paiboon Jungsuwadee
- Department of Pharmaceutical Sciences, School of Pharmacy and Health Sciences, Fairleigh Dickinson University, 230 Park Ave, Florham Park, NJ 07932, USA.
| | - Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, WI 53705, USA.
| | - Dongwoo Ko
- Department of Marketing, College of Business, Hankuk University of Foreign Studies, 107 Imun-ro, Imun 1-dong, Dongdaemun-gu, Seoul 02450, Korea.
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Phueanpinit P, Pongwecharak J, Sumanont S, Krska J, Jarernsiripornkul N. Physicians' communication of risks from non-steroidal anti-inflammatory drugs and attitude towards providing adverse drug reaction information to patients. J Eval Clin Pract 2017; 23:1387-1394. [PMID: 28809071 DOI: 10.1111/jep.12806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for orthopaedic conditions, therefore this study aimed to explore orthopaedic physicians' perceptions of their role in NSAID-risk communication, their attitudes towards the necessity of informing patients about adverse drug reactions (ADR), and factors associated with these. METHODS Self-administered questionnaires were mailed to all 206 orthopaedic physicians working at hospitals in Northeastern Thailand. Attitudes were assessed using 17 statements and total scores classed as poor, moderate and good attitude. RESULTS Sixty-six questionnaires were returned (32.04%). The responses showed that 75% of physicians claimed to communicate NSAID ADR information, more frequently about gastrointestinal (GI) complications, than about renal and cardiovascular (CVS) complications. ADR management (36%) and monitoring (30%) were not frequently communicated. The time spent with patients was associated with provision of ADR and monitoring advice. Renal function was the risk factor of greatest concern for prescribing any NSAID, followed by history of GI complications, and allergy for non-selective NSAIDs, and history of CVS diseases and age for selective COX-2 NSAIDs. Most physicians (41) had moderate attitude towards providing information and 24 good attitude. Fewer physicians working in tertiary hospitals than general and community hospital physicians considered that time limitations prevented counseling and that patient information leaflets offered easily accessible information. Additionally, more physicians who did not inform patients about ADRs agreed that ADR communication can lead to anxiety and discontinuing treatment. CONCLUSION The study indicates that, although orthopaedic physicians had positive attitudes towards providing ADR information to patients, improvement is needed in communicating NSAID risk information.
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Affiliation(s)
- Pacharaporn Phueanpinit
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Kent, UK
| | - Narumol Jarernsiripornkul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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Lafata JE, Shay LA, Winship JM. Understanding the influences and impact of patient-clinician communication in cancer care. Health Expect 2017; 20:1385-1392. [PMID: 28636108 PMCID: PMC5689225 DOI: 10.1111/hex.12579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood. OBJECTIVE We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built. DESIGN We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use. KEY RESULTS Using this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients' perspective and affective-cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post-surgical treatment and end-of-life care decisions, and those specifying particular physician communication strategies when recommending cancer screening. CONCLUSIONS Transparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient-clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient-clinician communication impacts care outcomes in the context of cancer and health care more broadly.
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Affiliation(s)
- Jennifer Elston Lafata
- UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of PharmacyThe University of North CarolinaChapel HillNCUSA
| | | | - Jodi M. Winship
- School of MedicineVirginia Commonwealth UniversityRichmondVAUSA
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