Decoding the Role of Companions in Supporting the Health Communication of Older African-American Men With Cancer

Banal nationalisms in medicine and prostate onco-practice in Japan: A urological viewpoint

Cancer has the highest mortality and morbidity rates, and kills more men than women in Japan. Culturally and medically constructed as a 'lifestyle-related disease', prostate cancer incidence is directly proportional to the 'Westernisation of eating habits', and societal ageing. Nevertheless, campaigns to advocate routine testing for prostate cancer remain non-existent. Based on an adaptation of the 'sexual scripts' theorising (Gagnon and Simon, 2005), 21 Japanese urologists from Osaka, Kobe and Tokyo, recruited through snowball sampling, were interviewed from 2021 to 2022, to explore how banal nationalisms in medicine-daily medical practice grounded in cultural scripts concerning the Japanese ethnic-self, rather than in medical 'biological causation to explain illness' (Barry and Yuill, 2008, 20), influence their onco-practice. 'Systemic networks' (Bliss et al., 1983) underpinned the analysis of interviews, which indicates that the physicians tend to (re)produce banal nationalisms in medicine through an understanding of an onco-self, who embodies an 'essentialised' version of the Japanese-self concerning rational-thinking, medical-compliancy, and a dependency on familialism and the feminisation of care to cope with cancer. In grappling with prostate cancer, onco-biopedagogy built on the consumption of traditional Japanese food comprehends banal nationalisms in medicine entrenched in prostate onco-practice. Lastly, endorsing and subsidising Traditional Japanese Medicine encompass an element of onco-economics that involves banal nationalisms in medicine. Nonetheless, emotionality underneath decision-making processes, and an onco-self demanding a robotic surgery challenge the validity of banal nationalisms in medicine when grasping onco-practice.

Development and evaluation of novel tool to assess communication skills in adult triadic interviews

OBJECTIVE

Develop and evaluate the reliability and validity of a novel assessment tool for triadic communication.

METHODS

We developed the tool using published opinions of patients and companions regarding effective communication, and used it in a four-station Objective Standardized Clinical Examination (OSCE) with 140 medical students, including one triadic interview station. We conducted multitrait-multimethod (MTMM) and generalizability (G) analyses to assess its performance.

RESULTS

MTMM analyses demonstrated the validity of the instrument in assessing two separate communication traits (with patient and companion), as showed by the high covariation of both traits based on patient and companion's ratings (average r = 0.78) compared to the inter-traits covariation within (average r = 0.50) and across raters (average r = 0.45). G analyses showed that the communication assessment of the single triadic station functioned similar to two independent stations, revealing the novel tool's ability to reliably measure medical students' ability to communicate with patient and companion.

CONCLUSION

Triadic communication skills with patient and companion can be individually assessed within a single OSCE station using this novel tool.

PRACTICE IMPLICATIONS

This tool fills a gap in communication assessments, allowing for reliable evaluation of triadic communication.

Being in Place: A Multimodal Analysis of the Contribution of the Patient's Companion to "First Time" Oncological Visits

Companions to medical visits have been alternatively viewed as members who “support” or “inhibit” and “interfere” with the doctor-patient interaction. One way of looking at the companions' contribution to medical visits is by coding roles or functions of their communicative behavior. Our paper aims at reconsidering these findings and analyzing how the companion participation is a local and sequential accomplishment, changing from time to time in the consultation. The paper relies upon an overall collection of 58 videorecordings of first oncological visits. Visits were conducted in two different hospitals, one of which a University hospital, and by different oncologists, including both senior professionals and (in the second setting) medical students in oncology. Visits were fully transcribed according to the Jeffersonian conventions and authors examined the transcripts and video according to the methodology of Conversation Analysis. The aim of the paper focused on how patient's companions orient and contribute to the accomplishment of the different aims and activities at different stages of the visit as an institutional speech event. The multimodal analysis of turns and actions (such as, gaze shifts, prosodic modulation, bodily arrangements), and the close examination of the sequential and temporal arrangements of companions' and their co-participants' turns revealed that companions finely attune to the multiparty framework of the encounter and the institutional constraints that govern the oncological first visit. Overall, results show two relevant features: that companions act as to preserve the doctor-patient interaction and to maintain the patient as the most responsible and legitimate agent in the interaction; that companions' contributions are relevant to the activities that sequentially unfold at different stages in the consultation (e.g., history taking, problem presentation, treatment recommendation etc.). The study complements earlier findings on the companion's roles, showing how these are highly mobile, multimodal and multiparty accomplishments, and they are tied to the specific contingencies of the visit. The results solicit to consider the value of multimodal analysis in understanding the complexity of multiparty communication in medical setting, and make it usable also in medical education.

Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study

BACKGROUND

A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS

We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS

Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS

Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

"You Have to Be Part of the Process": A Qualitative Analysis of Older African American Men's Primary Care Communication and Participation

The objective of the current study was to understand older African American men's perceptions of and experiences with patient-provider communication during primary care medical visits. Fifteen African American men age 50 and older participated in individual semistructured interviews. Open-ended questions focused on their primary care therapeutic alliance, preferences for decision-making, self-efficacy, patient satisfaction, communication, and companion participation during primary care medical visits. Emergent themes included the perception of rushed and inattentive care related to low socioeconomic status, inadequate information exchange about medical testing and follow-up care, welcoming the help of highly engaged companions, and proactively preparing for medical visits. Participants' assertiveness, confidence, and persistence with health providers regarding agenda setting for their care were most prevalent and contradict extant literature portraying African American men as less engaged or informed patients. Older African American men, particularly those with low socioeconomic status, may benefit from additional support and advocacy to consistently receive patient centered care and communication.