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Shalata W, Gothelf I, Bernstine T, Michlin R, Tourkey L, Shalata S, Yakobson A. Mental Health Challenges in Cancer Patients: A Cross-Sectional Analysis of Depression and Anxiety. Cancers (Basel) 2024; 16:2827. [PMID: 39199598 PMCID: PMC11352929 DOI: 10.3390/cancers16162827] [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: 07/30/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
Advancements in cancer treatment and early detection have extended survival rates, transforming many cancers into chronic conditions. However, cancer diagnosis and treatment can trigger significant psychological distress, including depression and anxiety, impacting patient outcomes and care. This study aimed to examine the prevalence of and identify the risk factors for depression and anxiety among cancer patients. A cross-sectional study was conducted, including patients under the care of the oncology department at a tertiary medical center between June 2021 and October 2023. Depression and anxiety were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. Logistic regression analysis identified risk factors for depression and anxiety. The study population included 159 patients, with 40.3% reporting worsening mental health, but only about half of them received therapy. Among the study participants, 22.6% experienced symptoms of depression and 30.2% experienced symptoms of anxiety. Single-cancer patients and those with metastases were at increased risk for depression, while those with a disease duration of more than a year and patients with female-specific cancer were more likely to experience anxiety. Given the high prevalence of mental health deterioration in cancer patients, closer monitoring and validated assessment tools are essential to improve depression and anxiety diagnosis and facilitate early interventions.
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Affiliation(s)
- Walid Shalata
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Itamar Gothelf
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Tomer Bernstine
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 13115, Israel
| | - Regina Michlin
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Lena Tourkey
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Sondos Shalata
- Nutrition Unit, Galilee Medical Center, Nahariya 22000, Israel
| | - Alexander Yakobson
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva 84105, Israel
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Lanocha N, Taub S, Webb JA, Wood M, Tate T. It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations. J Palliat Med 2024. [PMID: 38968377 DOI: 10.1089/jpm.2024.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.
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Affiliation(s)
| | - Sara Taub
- Knight Cancer Institute, Portland, Oregon, USA
| | - Jason A Webb
- Oregon Health and Science University, Portland, Oregon, USA
- University of Oregon, Eugene, Oregon, USA
| | - Mary Wood
- University of Oregon, Eugene, Oregon, USA
| | - Tyler Tate
- Stanford University School of Medicine, Palo Alto, California, USA
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Banerjee SC, Parker PA, Staley JM, Manna R, Mahoney C, Liberman L. Mentor communication skills training: development, feasibility, and preliminary efficacy. BMC MEDICAL EDUCATION 2024; 24:646. [PMID: 38858656 PMCID: PMC11165731 DOI: 10.1186/s12909-024-05616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Mentoring is vital to career development in academic medicine, and communication underlies all aspects of the mentoring relationship. Although training research mentors has been shown to be effective, few academic medicine faculties have received training in how to mentor. The investigators developed a novel intervention, the Mentor Communication Skills Training for Oncology Faculty ("Comskil Mentor Training") and examined feasibility and preliminary efficacy. METHODS The study was a single arm pre-post intervention design. The intervention (Comskil Mentor Training) was offered in one virtual 3-hour session and included a didactic lecture with exemplary skill demonstration videos, facilitator-led small group role plays with trained actors, and evaluation. 19 faculty members from 12 departments participated in the training. RESULTS All participants completed the training. Overall, the training was rated favorably, with more than 80% of participants indicating that they "agreed" or "strongly agreed" with training evaluation. From pre- to post-training, significant improvement was seen in participants' overall self-efficacy to communicate with mentees, as well as participants' overall use of communication skills and mentoring-specific language. CONCLUSIONS Our findings support the feasibility and preliminary efficacy of a virtually delivered experiential mentor communication skills training program for multidisciplinary clinical and research faculty in oncology.
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Affiliation(s)
- Smita C Banerjee
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA.
| | - Patricia A Parker
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA
| | - Jessica M Staley
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA
| | - Ruth Manna
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA
| | - Cassidy Mahoney
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA
| | - Laura Liberman
- Associate Attending Behavioral Scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, 4th Floor, New York, 10017, USA
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Hoffmann C, Avery K, Macefield R, Dvořák T, Snelgrove V, Blazeby J, Hopkins D, Hickey S, Gibbison B, Rooshenas L, Williams A, Aning J, Bekker HL, McNair AG. Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation. JMIR Hum Factors 2024; 11:e46698. [PMID: 38598276 PMCID: PMC11043934 DOI: 10.2196/46698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/02/2023] [Accepted: 03/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. OBJECTIVE This study examined the usability of an electronic real-time measurement system to monitor surgical patients' experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. METHODS We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients' experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). RESULTS A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8%) and the survey response rate was good (2254/5794, 38.9%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. CONCLUSIONS A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients' experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2023-079155.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kerry Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tadeáš Dvořák
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Jane Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Shireen Hickey
- Improvement Academy, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ben Gibbison
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Leila Rooshenas
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | | | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
- The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Central Denmark Region, Denmark
| | - Angus Gk McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- North Bristol NHS Trust, Bristol, United Kingdom
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Fattahi Ardakani M, Sotoudeh A, Asadian A, Heydari S, Zareipour M. The Effect of an Educational Intervention Based on the Health Action Process Approach on Nurses' Communication Skills. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e13. [PMID: 39083825 PMCID: PMC11290895 DOI: 10.17533/udea.iee.v42n1e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/06/2024] [Indexed: 08/02/2024]
Abstract
Objective This study aimed to the effects of the Health Action Process Approach (HAPA) in promoting the quality of nurses' communication skills among nurses. Methods The present quasi-experimental research was conducted on 148 nurses (76 in the intervention and 72 in the control group) in Yazd province (Iran). In this study, the total number of nurses in one hospital was selected as the intervention group, while the nurses from another hospital were chosen as the control group. The participants were recruited from public hospitals in Ardakan and Meibod cities. The data collection instrument was a questionnaire based on the Health Action Process Approach (HAPA) Constructs and a communicative skill questionnaire. The data were collected from the two groups before, one month after, and four months after the intervention. The control group did not receive any educational training during the course of the study. Results In the pretest, no statistically significant difference was found between the intervention and control groups regarding the behavioral stages of effective communication with patients. In the posttest, the mean task self-efficacy score was significantly increased in the intervention group compared to the control (p<0.001). The mean coping self-efficacy score was also significantly higher in the intervention group than the control in the posttest (p<0.001). Moreover, the mean coping planning score was significantly increased in the post-test intervention group(p < 0.001). The mean communicative skill score was also significantly increased in the intervention group compared to the post-test control (p=0.03). Conclusion The intervention used in the present study based on the target model (HAPA) significantly affected nurses' self-efficacy and communicative skills in the experimental group.
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Affiliation(s)
| | - Ahmad Sotoudeh
- Department of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Ali Asadian
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Sara Heydari
- Assistant Professor of Medical Education, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Moradali Zareipour
- Department of public Health, Khoy University of Medical Sciences, Khoy, Iran.
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Martinez Leal I, Acquati C, Rogova A, Chen TA, Connors SK, Agrawal P, McNeill LH, Reitzel LR. Negotiating cancer alone: A qualitative study exploring care experiences of racially and ethnically diverse women diagnosed with breast cancer during COVID-19. J Health Psychol 2024; 29:367-381. [PMID: 38009435 PMCID: PMC11005304 DOI: 10.1177/13591053231214517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors (N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the core category "negotiating cancer alone," that included: (1) psychological distress, negotiating the cancer trajectory in isolation; (2) provider/healthcare system diagnostic and treatment delays; (3) heightened anxiety about treatment delays causing cancer progression; (4) supportive care limitations; and (5) disparate experiences of cancer care disruptions. Black and Latina/x women described greater delays in care, financial challenges, treatment complications, and insurance limitations than White women. The study identifies cancer patients' pandemic-related psychological, healthcare system, and health equity challenges and suggests recommendations to support their increased psychological needs during oncologic care disruptions.
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Affiliation(s)
| | - Chiara Acquati
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | - Anastasia Rogova
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | | | | | | | | | - Lorraine R Reitzel
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
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Moezzi M, Rasekh S, Zare E, Karimi M. Evaluating clinical communication skills of medical students, assistants, and professors. BMC MEDICAL EDUCATION 2024; 24:19. [PMID: 38172832 PMCID: PMC10765785 DOI: 10.1186/s12909-023-05015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The skill of communicating with the patient is one of the basic clinical skills and part of the necessary competencies for medical doctors. The present study aimed to evaluate the knowledge, attitude, and performance (KAP) of medical students, assistants, and professors of Shahrekord University of Medical Sciences regarding clinical communication skills with patients. METHOD This cross-sectional study was conducted at the hospitals of Shahrekord University of Medical Sciences in Iran. The study included a total of 289 participants, consisting of 51 professors, 72 assistants, 90 external staff, and 76 interns who work at these hospitals. The participants were selected through a convenience sampling method. The data-gathering tools used included a questionnaire to collect demographic characteristics, a researcher-made questionnaire to assess knowledge, a communication skills attitude questionnaire, and a communication skills survey questionnaire. The data were analyzed using descriptive statistics such as mean, standard deviation, and frequency, as well as statistical tests that included one-way ANOVA and Pearson's correlation test. The significance level for the study was considered to be 0.05. RESULTS The mean scores of knowledge of professors were higher compared to other groups (P = 0.002). All participating groups had a positive attitude toward learning communication skills. There were statistically significant differences between the mean scores of the communication performance of the study groups (P < 0.001). There was a positive relationship between positive attitude and communication performance, and a significant negative relationship was observed between negative attitude and communication performance. CONCLUSION The results indicate the relatively favorable attitude and performance of the groups and their low knowledge. It is suggested that the doctor-patient communication skills courses be included as one of the necessary courses in the medical education curriculum.
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Affiliation(s)
- Masoumeh Moezzi
- Department of Community Medicine, School of Medicine, Social Health Determinate, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sara Rasekh
- Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elahe Zare
- Department of Health, Promotion, School of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Karimi
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, POBox: 71645-111, Iran.
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Epner DE, Reddy SK, Hui D, Fellman B, Bruera E. Doing the hard work of learning: oncologists' enduring impressions of a year-long communication skills training program. Support Care Cancer 2023; 32:71. [PMID: 38158427 DOI: 10.1007/s00520-023-08285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Few studies have examined the long-term impact of communication skills training for oncologists. We developed a year-long communication skills curriculum for medical oncology fellows with the primary goals of fostering life-long learning of patient-centered communication skills and internalization of associated attitudes and beliefs. We engaged learners through reflection, narrative methods, and action methods, thereby creating a non-threatening, team-based environment. The purpose of the current study was to determine whether learners perceived that they had acquired enduring skills, attitudes, and knowledge years after they participated. METHODS Former fellows completed an online cross-sectional survey from June to July 2019 that included demographic information, 21 items on a numerical scale, and 3 narrative prompts. Survey items pertained to 4 domains, including skills, attitudes, confidence with specific scenarios, and overall impressions. The numerical scale ranged from "strongly agree" = 1 to "strongly disagree" = 5. RESULTS A total of 114 fellows, including 27 teaching assistants, participated in the communication skills training over 8 years. The average time between the end of the training program and completion of the survey was 5.2 years. The response rate was 68/114 (64%). Forty-one (60%, 95% CI: 49.3-73.8) fellows agreed or strongly agreed that the curriculum profoundly impacted their practice of medicine. Forty-three (64%, 95% CI: 51.5-75.5) fellows strongly agreed or agreed that they often found themselves informally sharing lessons they learned during the series. Overall average domain scores were 1.89 (SD = 0.84) for skills, 2.16 (0.79) for attitudes, 2.05 (0.81) for confidence with specific challenges, and 2.38 (0.94) for lasting impressions. Results were significantly more favorable for teaching assistants than for others. CONCLUSION Engaging, interactive, safe, and learner-centered communication skills training has an enduring and favorable impact on oncologists' self-perceived skills, confidence with specific challenges, and attitudes.
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Affiliation(s)
- Daniel E Epner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1414, Houston, TX, 77030, USA.
| | - Suresh K Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1414, Houston, TX, 77030, USA
| | - David Hui
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1414, Houston, TX, 77030, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. / Unit 1411, Houston, TX, 77030, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1414, Houston, TX, 77030, USA
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Mindlis I, Kop M, Teng MS, Revenson TA. "Your cancer is no longer considered cancer": Psychological reactions to reclassification information and communication preferences. PEC INNOVATION 2023; 2:100165. [PMID: 37384160 PMCID: PMC10294108 DOI: 10.1016/j.pecinn.2023.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
Objective In 2016, the encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This reclassification removed the word "carcinoma" and the definition of cancer from the diagnosis. While the nomenclature change was expected to psychologically impact patients, that question has not been systematically explored. Using qualitative methods, we aimed to explore the psychological impact of reclassification on thyroid cancer patients and their preferences for receiving reclassification information. Methods Semi-structured interviews with nine non-EFVPTC thyroid cancer survivors were conducted. Participants were presented with a hypothetical reclassification scenario, and interview transcripts were analyzed using a thematic content analytic approach. Results Participants expressed a range of psychological reactions to reclassification information, primarily negative, including anger, mistrust, and uncertainty, but also relief. All participants expressed difficulty understanding the concept of reclassification. Communication preferences favored conversation with an established medical provider over written materials, such as a letter. Discussion and conclusion Communication must align with patient preferences. Being mindful of potential negative psychological reactions when providing information on cancer reclassification is vital. Innovation This study examines reactions to cancer reclassification information and preferences for how this information should be communicated.
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Affiliation(s)
- Irina Mindlis
- Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Mariska Kop
- Psychology Department, Hunter College, City University of New York, New York, NY, USA
| | - Marita S. Teng
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tracey A. Revenson
- Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Psychology Department, Hunter College, City University of New York, New York, NY, USA
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Laughlin BS, Langley N, Patel SH, Kough K, Ernst B, Ashman JB, Rule WG, Vern-Gross TZ. Attitudes and Perception of the REFLECT Communication Curriculum for Clinical Oncology Graduate Medical Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1786-1791. [PMID: 37349641 PMCID: PMC10656312 DOI: 10.1007/s13187-023-02333-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
Communication and interpersonal skills are essential components of oncology patient care. The REFLECT (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) curriculum is a novel framework to improve and refine physician/patient interactions for oncology graduate medical trainees. We seek to evaluate the attitudes and perceptions of the REFLECT communication curriculum among oncology trainees. Seven-question and 8-question Likert scale surveys (1 = not beneficial and 5 = beneficial) were distributed to resident/fellow participants and faculty mentors, respectively. Questions asked trainees and faculty about their perceptions of improvement in communication, handling of stressful situations, the value of the curriculum, and overall impression of the curriculum. Descriptive statistics determined the survey's baseline characteristics and response rates. Kruskal-Wallis rank sum tests were used to compare the distribution of continuous variables. Thirteen resident/fellow participants completed the participant survey. Six (43.6%) Radiation Oncology trainees and 7 (58.3%) Hematology/Oncology fellows completed the trainee survey. Eight (88.9%) Radiation Oncologists and 1 (11.1%) Medical Oncologist completed the observer survey. Faculty and trainees generally felt that the curriculum increased communication skills. Faculty responded more favorably to the program's impact on communication skills (median 5.0 vs. 4.0, p = 0.008). Faculty were more assertive about the curriculum's capabilities to improve a learner's ability to handle stressful situations (median 5.0 vs. 4.0, p = 0.003). Additionally, faculty had a more favorable overall impression of the REFLECT curriculum than the residents/fellows (median 5.0 vs. 4.0, p < 0.001). Radiation Oncology residents felt more strongly that the curriculum enhanced their ability to handle stressful topics, compared to Heme/Onc fellows (median 4.5 vs. 3.0, range 1-5, p = 0.379). Radiation Oncology trainees felt more consistently that the workshops improved their communication skills, compared to Heme/Onc fellows (median 4.5 vs. 3.5, range 1-5, p = 0.410). The overall impression between Rad Onc resident and Heme/Onc fellows was similar (median 4.0, p = 0.586). Conclusions: Overall, the REFLECT curriculum enhanced communication skills of trainees. Oncology trainees and faculty physicians feel that the curriculum was beneficial. As interactive skills and communication is critical to build positive interactions, further work is needed to improve the REFLECT curriculum.
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Affiliation(s)
- Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
| | - Natalie Langley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | | | - Brenda Ernst
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Tamara Z Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
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Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Prins S, Linn AJ, van Kaam AHLC, van de Loo M, van Woensel JBM, van Heerde M, Dijk PH, Kneyber MCJ, de Hoog M, Simons SHP, Akkermans AA, Smets EMA, de Vos MA. Diversity of Parent Emotions and Physician Responses During End-of-Life Conversations. Pediatrics 2023; 152:e2022061050. [PMID: 37575087 DOI: 10.1542/peds.2022-061050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To provide support to parents of critically ill children, it is important that physicians adequately respond to parents' emotions. In this study, we investigated emotions expressed by parents, physicians' responses to these expressions, and parents' emotions after the physicians' responses in conversations in which crucial decisions regarding the child's life-sustaining treatment had to be made. METHODS Forty-nine audio-recorded conversations between parents of 12 critically ill children and physicians working in the neonatal and pediatric intensive care units of 3 Dutch university medical centers were coded and analyzed by using a qualitative inductive approach. RESULTS Forty-six physicians and 22 parents of 12 children participated. In all 49 conversations, parents expressed a broad range of emotions, often intertwining, including anxiety, anger, devotion, grief, relief, hope, and guilt. Both implicit and explicit expressions of anxiety were prevalent. Physicians predominantly responded to parental emotions with cognition-oriented approaches, thereby limiting opportunities for parents. This appeared to intensify parents' expressions of anger and protectiveness, although their anxiety remained under the surface. In response to more tangible emotional expressions, for instance, grief when the child's death was imminent, physicians provided parents helpful support in both affect- and cognition-oriented ways. CONCLUSIONS Our findings illustrate the diversity of emotions expressed by parents during end-of-life conversations. Moreover, they offer insight into the more and less helpful ways in which physicians may respond to these emotions. More training is needed to help physicians in recognizing parents' emotions, particularly implicit expressions of anxiety, and to choose helpful combinations of responses.
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Affiliation(s)
- Sanne Prins
- Department of Pediatrics, Emma Children's Hospital
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Moniek van de Loo
- Department of Pediatrics, Division of Neonatology, Emma Children's Hospital
| | - Job B M van Woensel
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | - Marc van Heerde
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | | | - Martin C J Kneyber
- Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sinno H P Simons
- Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aranka A Akkermans
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Taheri Z, Javadinia SA, Ghahramani-Asl R. Breaking Bad News in Cancer Patients: Voicing the Training Requirement. Cancer Invest 2023; 41:568-570. [PMID: 37115731 DOI: 10.1080/07357907.2023.2209182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/27/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Zahra Taheri
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Seyed Alireza Javadinia
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ruhollah Ghahramani-Asl
- Department of Medical Physics and Radiological Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Parker PA, Staley J, Rosa WE, Weiner R, Banerjee SC. Development of a Communication Skills Training to Enhance Effective Team Communication in Oncology. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:71-74. [PMID: 37141164 PMCID: PMC10624640 DOI: 10.1097/ceh.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Effective communication among members of health care teams is essential to provide quality and patient-centered care, yet many people identify this as a challenge. We developed, implemented, and conducted a preliminary evaluation of a training to enhance communication within oncology teams. METHODS This training identifies key strategies, communication skills, and process tasks recommended to achieve the goal of using a collaborative approach to navigate communication interactions across members of the hospital team to enhance patient care outcomes and increase team effectiveness. Forty-six advanced practice providers (APPs) participated and completed an evaluation of the module. RESULTS Eighty-three percent of participants identified as female and 61% were White. Eighty-three percent of participants were nurse practitioners and 17% were physician assistants. The module was highly rated. Participants responded that they were satisfied ("agree" or "strongly agree") on 16 of 17 evaluation items (80% or higher). DISCUSSION APPs were satisfied with the course and found many aspects useful in learning and practicing skills to improve their communication with other team members to enhance their care of patients. Training with this module and other communication approaches are needed for health care professionals of all types to encourage more consistent and meaningful communication with their colleagues to improve patient care.
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Affiliation(s)
- Patricia A Parker
- Dr. Parker: Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY. Ms. Staley: Memorial Sloan Kettering Cancer Center, New York, NY. Dr. Rosa: Memorial Sloan Kettering Cancer Center, New York, NY. Mr. Weiner: Memorial Sloan Kettering Cancer Center, New York, NY. Dr. Banerjee: Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
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Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
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Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
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The Acknowledge-Normalize-Partner (ANP) Framework: A novel empathic communication tool for oncology nurses. Palliat Support Care 2023; 21:12-19. [PMID: 35236541 DOI: 10.1017/s1478951522000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the development and implementation of a novel tool designed to enhance nurse-patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience. METHOD An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires. RESULTS Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001). SIGNIFICANCE OF RESULTS Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.
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PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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Chen W, Chung JOK, Lam KKW, Molassiotis A. End-of-life communication strategies for healthcare professionals: A scoping review. Palliat Med 2023; 37:61-74. [PMID: 36349371 DOI: 10.1177/02692163221133670] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. AIM To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. DESIGN A scoping review performed in accordance with the Arksey and O'Malley framework. DATA SOURCES A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. RESULTS Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. CONCLUSIONS The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.
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Affiliation(s)
- Weilin Chen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Katherine Ka Wai Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.,Health and Social Care Research Centre, University of Derby, Derby, UK
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Karger A, Petermann-Meyer A, Vitinius F, Geiser F, Kraus D, Ernsten L, Mayers AJ, Heuser C, Hiltrop K, Bremen R, Marx A, Ernstmann N. Effectiveness of interprofessional communication skills training for oncology teams: study protocol for a three-arm cluster randomised trial (KommRhein Interpro). BMJ Open 2022; 12:e062073. [PMID: 36581438 PMCID: PMC9806046 DOI: 10.1136/bmjopen-2022-062073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Patient-provider communication is an important factor influencing the quality of care in oncology. The study examines the comparative effectiveness of a 10-hour interprofessional communication skills training (CST) programme for physicians and nurses in cancer centres. METHODS AND ANALYSIS KommRhein Interpro is a cluster-randomised trial sponsored by the German Cancer Aid (Deutsche Krebshilfe, DKH) and conducted at the cancer centres of the university hospitals of Aachen, Bonn, Cologne and Düsseldorf. Thirty oncology teams of four cancer centres are randomly assigned to three study arms, providing healthcare professionals with either (a) only written information on patient-centred communication or (b) written information plus CST for physicians or (c) written information plus interprofessional CST for physicians and nurses. For summative evaluation, standardised surveys from three measurement points for patients (T0pat: study enrollment; T1pat: after discharge; T2pat: 3 months' follow-up) and two measurement points for physicians and nurses (T0hcp: before the intervention; T1hcp: after the intervention) are used. N=1320 valid patient cases are needed for data evaluation. The primary endpoint is fear of progression in patients with cancer after discharge. Data will be analysed according to the intention-to-treat principle using a mixed model for repeated measurement. Secondary outcome is the providers' self-efficacy in patient centeredness. Individual confounders and possible moderating effects of organisational factors will be considered. Secondary analysis will be performed by means of multilevel analysis and structural equation modelling. ETHICS AND DISSEMINATION A vote of approval has been obtained from the ethics committees of the medical faculties of RWTH Aachen University (EK325/20), University of Bonn (391/20), University of Cologne (20-1332) and Heinrich Heine University Düsseldorf (2019-796). Data protection regulations are adhered to for all processed data. The conduct of the study will be monitored. Dissemination strategies include a transfer workshop with cancer teams and distribution of the final study report to participants. TRIAL REGISTRATION NUMBER DRKS00022563; DRKS (German Clinical Trials Register).
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Affiliation(s)
- Andre Karger
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Petermann-Meyer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Center for Integrated Oncology Aachen, RWTH Aachen University, Medical Faculty and University Hospital, Aachen, Germany
| | - Frank Vitinius
- Department for Psychosomatics and Psychotherapy, University Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Franziska Geiser
- Psychosomatic Medicine and Psychotherapy, University Bonn, Medical Faculty and University Hospital, Bonn, Germany
| | - Daria Kraus
- Clinical Trials Center Cologne, University of Cologne, Cologne, Germany
| | - Luisa Ernsten
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Antonia J Mayers
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
| | - Kati Hiltrop
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
| | - Rebecca Bremen
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Center for Integrated Oncology Aachen, RWTH Aachen University, Medical Faculty and University Hospital, Aachen, Germany
| | - Ambra Marx
- Psychosomatic Medicine and Psychotherapy, University Bonn, Medical Faculty and University Hospital, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
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Song EY, Chuang J, Frakes JM, Dilling T, Quinn JF, Rosenberg S, Johnstone P, Harrison L, Hoffe SE. Developing a Dedicated Leadership Curriculum for Radiation Oncology Residents. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1446-1453. [PMID: 33619686 DOI: 10.1007/s13187-021-01980-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
The increasing complexity of healthcare emphasizes the need for continued physician leadership and leadership training. This study aims to determine baseline attitudes toward the perceptions and utility of a leadership development curriculum (LDC) for radiation oncology (RO) residents. A novel longitudinal LDC was implemented for RO residents at our institution from 2018 to 2019. Prior to the curriculum, current and past residents in our institution's RO residency program were surveyed on their attitudes towards leadership in healthcare, emotional intelligence competencies, and leadership training interests. After the completion of the LDC, a post-curriculum survey was forwarded to current residents. The response rate was 84% (21 of 24) for the baseline survey and 90% (9 of 10) for the post-curriculum survey. Having a leadership training curriculum during residency was rated as extremely useful, with top training interests involving leading clinical teams, effective communication strategies, and conflict management. After the LDC, the residents reported high satisfaction with the curriculum and utilization of leadership training into their daily work. Our LDC demonstrates significant potential to engage trainees and improve their leadership skills at the graduate medical education level.
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Affiliation(s)
- Ethan Y Song
- USF Health Morsani College of Medicine, Tampa, FL, USA.
| | | | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Thomas Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Joann F Quinn
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stephen Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Louis Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Banerjee SC, Staley JM, Howell F, Malling C, Moreno A, Kotsen C, Parikh D, Parker PA. Communicating Effectively via Tele-oncology (Comskil TeleOnc): a Guide for Best Practices for Communication Skills in Virtual Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1343-1348. [PMID: 33544315 PMCID: PMC7862043 DOI: 10.1007/s13187-021-01959-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 05/07/2023]
Abstract
The emergence of a novel coronavirus (SARS-CoV-2, causing coronavirus disease 2019 or COVID-19) has disrupted the US medical care system. Telemedicine has rapidly emerged as a critical technology enabling health care visits to continue while supporting social distancing to reduce the risk of COVID-19 transmission among patients, families, and clinicians. This model of patient care is being utilized at major cancer centers around the USA-and tele-oncology (telemedicine in oncology) has rapidly become the primary method of providing cancer care. However, most clinicians have little experience and inadequate training in this new form of care delivery. Because many practicing oncology clinicians are not familiar with telemedicine technology and the best practices for virtual communication, we strongly believe that training in this field is essential. Utilizing best practices of communication skills training, this paper presents a brief tele-oncology communication guide (Comskil TeleOnc) to address the timely need to maximize high-quality care to patients with cancer. The goal of the Comskil TeleOnc Guide is to recognize, elicit, and effectively respond to patients' medical needs and concerns while utilizing empathic responses to communicate understanding, alleviate distress, and provide support via videoconferencing. We recommend five strategies to achieve the communication goal outlined above: (1) Establish the clinician-patient relationship/create rapport, (2) set the agenda, (3) respond empathically to emotions, (4) deliver the information, and (5) effectively end the tele-oncology visit. The guide proposed in this paper is not all-encompassing and may not be applicable to all health care institutions; however, it provides a practical, patient-centered framework to conduct a tele-oncology visit.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Jessica M Staley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Frances Howell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Charlotte Malling
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Aimee Moreno
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chris Kotsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Dhwani Parikh
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 136 Mountain View Blvd, Basking Ridge, NJ, 07920, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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23
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Applebaum AJ, Gebert R, Behrens M, Loschiavo M, Parker PA, Shaffer KM, Carver A, Diamond EL. Development and feasibility of a communication training to assist caregivers with advanced care planning. Palliat Support Care 2022; 21:1-8. [PMID: 36102339 PMCID: PMC10011009 DOI: 10.1017/s1478951522001080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Caregivers are critical in advanced care planning (ACP) discussions, which are difficult but necessary to carry out patients' goals of care. We developed and evaluated the feasibility and acceptability of a communication training to equip caregivers of patients with malignant brain tumors with skills to navigate ACP conversations. METHOD Caregivers completed a 2-h virtual training addressing ACP Discussions with Your Loved One and ACP Discussions with the Medical Team. A pre-training assessment was completed at baseline and a training evaluation was completed one day post-training. A subset of participants completed semi-structured interviews 2 months post-training. RESULTS Of 15 caregivers recruited, 9 attended the training and 4 completed qualitative interviews. Post-training, 40% felt confident in discussing ACP with loved ones and 67% felt confident doing so with healthcare professionals; 100% reported feeling confident in using skills learned in the training to facilitate these conversations. Data from qualitative interviews highlighted additional benefits of the training in empathic communication skills and fostering social support. SIGNIFICANCE OF RESULTS Our communication skills training shows promise in supporting caregivers' skills and confidence in engaging in ACP discussions with patients and healthcare providers. A future randomized controlled trial with a larger and more diverse caregiving sample is needed to determine training efficacy.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia Behrens
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan Loschiavo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kelly M Shaffer
- University of Virginia School of Medicine, Charlottesville, VA
| | - Alan Carver
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
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24
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Ayou C, Vabres N, Poullaouec C, Lemesle M, Gras-le Guen C, Launay E, Balençon M. Information préoccupante ou signalement dans les violences intrafamiliales : construction, validation et mise en application d’une grille d’annonce par technique de simulation en santé avec patients standardisés. Encephale 2022; 48 Suppl 1:S34-S38. [DOI: 10.1016/j.encep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
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25
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Arad M, Alilu L, Habibzadeh H, Khalkhali H, Goli R. Effect of spiritual intelligence training on nurses' skills for communicating with patients - an experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:127. [PMID: 35677273 PMCID: PMC9170219 DOI: 10.4103/jehp.jehp_1483_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/31/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Since poor communication with the patient has a negative impact on the quality of nursing care, taking the necessary measures to strengthen the relationship with the patient seems necessary. This study was conducted to determine the effect of spiritual intelligence training on nurses' skills for communicating with patients. MATERIALS AND METHODS This experimental study with the control group and the pretest-posttest design was conducted on 70 nurses working in Imam Khomeini Hospital, Mahabad, in 2019. Randomized stratified sampling was used to recruit participants. Then, participants were randomly assigned to the two groups of control and intervention. The demographic information form and the patient-nurse communication skill questionnaire were used to collect the data. For the intervention group, 7 spiritual intelligence training sessions were held as a workshop in 2 months. Two weeks and a month after the intervention, both groups completed the questionnaires. Data were analyzed with the SPSS software version 17.0. RESULTS The findings showed that the mean communication skill scores in the intervention group before training were 44.71 ± 7.62, which significantly increased to 66.22 ± 8.43 2 weeks after training. Bonferroni multiple comparisons showed the mean communication skill scores significantly increased before, 2 weeks later and in the follow-up phase in the intervention group (P < 0.001). CONCLUSION Spiritual intelligence training is effective in improving the communication skills of nurses. It is recommended that the prepared content can be provided to in-service training units; consequently, nurses can improve their communication skills by individual and group learning.
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Affiliation(s)
- Mansour Arad
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Leyla Alilu
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Hosein Habibzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamidreza Khalkhali
- Department of Biostatistics and Epidemiology, Inpatient's Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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26
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Eggly S, Manning M, Senft N, Moore TF, Albrecht TL, Penner LA, Heath E, Carducci MA, Lansey DG, Hamel LM. Development and pilot test of a physician-focused cancer clinical trials communication training intervention. PEC INNOVATION 2021; 1:100012. [PMCID: PMC10194245 DOI: 10.1016/j.pecinn.2021.100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 05/30/2023]
Abstract
Objective We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population. Methods Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module. Results Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable. Conclusions This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings. Innovation This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions. Trial Registration Number: NCT02906241
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Mark Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Tanina Foster Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Michael A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Dina G. Lansey
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
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27
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'Bad news consultations' with oncology nurses: Impact on perceived stress and patient experience. Eur J Oncol Nurs 2021; 56:102085. [PMID: 34990998 DOI: 10.1016/j.ejon.2021.102085] [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: 03/22/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE 'Bad News Consultations' (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC. METHOD This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC). RESULTS Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = -1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = -0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares. CONCLUSION Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway.
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28
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Iversen ED, Wolderslund M, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S, Ammentorp J. Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice. J Patient Cent Res Rev 2021; 8:307-314. [PMID: 34722798 DOI: 10.17294/2330-0698.1782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. Methods This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Results Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Conclusions Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.
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Affiliation(s)
- Else Dalsgaard Iversen
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Helle Poulsen
- Department of Gastrointestinal Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
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29
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Jabbarian LJ, Rietjens JAC, Mols F, Oude Groeniger J, van der Heide A, Korfage IJ. Untangling the relationship between negative illness perceptions and worse quality of life in patients with advanced cancer-a study from the population-based PROFILES registry. Support Care Cancer 2021; 29:6411-6419. [PMID: 33891204 PMCID: PMC8464557 DOI: 10.1007/s00520-021-06179-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Quality of life (QoL) is an important yet complex outcome of care in patients with advanced cancer. QoL is associated with physical and psychosocial symptoms and with patients' illness perceptions (IPs). IPs are modifiable cognitive constructs developed to make sense of one's illness. It is unclear how IPs influence patients' QoL. A better understanding of this relationship can inform and direct high quality care aimed at improving patients' QoL. We therefore investigated the mediating role of anxiety and depression in the association of IPs with QoL. METHODS Data from 377 patients with advanced cancer were used from the PROFILES registry. Patients completed measures on IPs (BIPQ), QoL (EORTC QLQ-C30), and symptoms of anxiety and depression (HADS). Mediation analyses were conducted to decompose the total effect of IPs on QoL into a direct effect and indirect effect. RESULTS All IPs but one ("Comprehensibility") were negatively associated with QoL (p<0.001); patients with more negative IPs tended to have worse QoL. The effect was strongest for patients who felt that their illness affected their life more severely ("Consequences"), patients who were more concerned about their illness ("Concern"), and patients who thought that their illness strongly affected them emotionally ("Emotions"). Anxiety mediated 41-87% and depression mediated 39-69% of the total effect of patients' IPs on QoL. CONCLUSION Negative IPs are associated with worse QoL. Anxiety and depression mediate this association. Targeting symptoms of anxiety and depression, through the modification of IPs, has the potential to improve QoL of patients with advanced cancer.
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Affiliation(s)
- Lea J. Jabbarian
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, the Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
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30
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Hamilton JG, Banerjee SC, Carlsson SV, Vera J, Lynch KA, Sar-Graycar L, Martin CM, Parker PA, Hay JL. Clinician perspectives on communication and implementation challenges in precision oncology. Per Med 2021; 18:559-572. [PMID: 34674550 DOI: 10.2217/pme-2021-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To describe patient communication challenges encountered by oncology clinicians, which represent a fundamental barrier to implementing precision oncology. Materials & methods: We conducted three focus groups including breast, melanoma and thoracic oncology clinicians regarding their precision oncology communication experiences. Transcripts were reviewed and coded using inductive thematic text analysis. Results: We identified four themes: varied definitions of precision oncology exist, clinicians and patients face unique challenges to precision oncology implementation, patient communication challenges engendered or heightened by precision oncology implementation and clinician communication solutions and training needs. Conclusion: This study elucidated clinicians' perspectives on implementing precision oncology and related communication challenges. Understanding these challenges and developing strategies to help clinicians navigate these discussions are critical for ensuring that patients reap the full benefits of precision oncology.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Smita C Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Sigrid V Carlsson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jacqueline Vera
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Kathleen A Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Lili Sar-Graycar
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Chloé M Martin
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Patricia A Parker
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
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Ernstmann N, Nakata H, Meurer L, Weiß J, Geiser F, Vitinius F, Petermann-Meyer A, Burgmer M, Sonntag B, Teufel M, Karger A. Participative development and evaluation of a communication skills-training program for oncologists-patient perspectives on training content and teaching methods. Support Care Cancer 2021; 30:1957-1966. [PMID: 34626250 PMCID: PMC8794992 DOI: 10.1007/s00520-021-06610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022]
Abstract
Background Using the 6-step approach to curriculum development for medical education, we developed a communication skills training (CST) curriculum for oncology and evaluated this curriculum from the perspective of cancer patients. Methods We conducted a qualitative interview study with cancer patients, collecting data using semi-structured face-to-face or telephone interviews with a short standardized survey. We fully transcribed the audiotaped interviews and conducted the content analysis using MAXQDA 2020. We analyzed the quantitative sociodemographic data descriptively. Results A total of 22 cancer patients participated, having a mean age of 60.6 (SD, 13.2) years and being predominantly female (55%). The patients believed that the CST curriculum addressed important aspects of patient-centered communication in cancer care. They emphasized the importance of physicians acquiring communication skills to establish a trusting relationship between doctor and patient, show empathy, inform patients, and involve them in treatment decisions. The patients had some doubts concerning the usefulness of strict protocols or checklists (e.g., they feared that protocol adherence might disturb the conversation flow). Discussion Although it was a challenge for some participants to take the perspective of a trainer and comment on the CST content and teaching methods, the patients provided a valuable perspective that can help overcome blind spots in CST concepts.
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Affiliation(s)
- Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany. .,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.
| | - Hannah Nakata
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Lena Meurer
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Johanna Weiß
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Franziska Geiser
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Frank Vitinius
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrea Petermann-Meyer
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Münster and University Hospital of Münster, Münster, Germany
| | - Bernd Sonntag
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - André Karger
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Platas A, Cruz-Ramos M, Mesa-Chavez F, Jasqui-Bucay A, de la Rosa-Pacheco S, Rivera F, Mohar A, Villarreal-Garza C. Communication Challenges Among Oncologists in Mexico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1098-1104. [PMID: 32030611 DOI: 10.1007/s13187-020-01703-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Communication challenges related to the delivery of bad news are present in oncologists' daily practice. Hence, communication skills are essential for clinicians to handle these situations as appropriately and compassionately as possible. The aim of this study was to identify Mexican oncologists' perceptions on the most important and hardest issues to discuss with patients and their families, as well as the challenges they most commonly encounter when communicating bad news. Physicians from various oncology centers were invited to anonymously complete an electronical survey designed by our multidisciplinary oncology team. Statistical analysis was performed with the SPSS software v25; descriptive statistics were used for the analysis of the survey's answers. In total, 115 physicians were included; most were medical oncologists. Treatment objectives and prognosis were the topics most of them considered relevant to address; while end-of-life care and treatment objectives were the hardest ones to discuss. The most difficult challenges they faced when breaking bad news were being honest without taking away hope and dealing with patients' emotions. Remarkably, we detected a lack of training in delivering bad news to patients among our participants, as a minority of them had formal training in the matter. However, most desired to receive communication skills training and believed a session of 2-5 h would be sufficient. Mexican oncologists face diverse communication challenges when disclosing bad news to patients. Our findings reveal an opportunity to develop formal training programs tailored for Mexican oncologists and to ultimately improve outcomes and patient-centered care.
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Affiliation(s)
- Alejandra Platas
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Marlid Cruz-Ramos
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Fernanda Mesa-Chavez
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Centro de Cancer de Mama, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Ariel Jasqui-Bucay
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | | | - Fernanda Rivera
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Alejandro Mohar
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico
| | - Cynthia Villarreal-Garza
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Ciudad de Mexico, Mexico.
- Departamento de Tumores Mamarios y Departamento de Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico.
- Centro de Cancer de Mama, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Banerjee SC, Haque N, Bylund CL, Shen MJ, Rigney M, Hamann HA, Parker PA, Ostroff JS. Responding empathically to patients: a communication skills training module to reduce lung cancer stigma. Transl Behav Med 2021; 11:613-618. [PMID: 32080736 PMCID: PMC7963287 DOI: 10.1093/tbm/ibaa011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Noshin Haque
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carma L Bylund
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sokas C, Kelly M, Sheu C, Song J, Welch HG, Bergmark R, Minami C, Trinh QD. Cancer in the Shadow of COVID: Early-Stage Breast and Prostate Cancer Patient Perspectives on Surgical Delays Due to COVID-19. Ann Surg Oncol 2021; 28:8688-8696. [PMID: 34170430 PMCID: PMC8231084 DOI: 10.1245/s10434-021-10319-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022]
Abstract
Background During the height of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries, including oncologic surgeries, were delayed. Little prospective data existed to guide practice, and professional surgical societies issued recommendations grounded mainly in common sense and expert consensus, such as medical therapy for early-stage breast and prostate cancer patients. To understand the patient experience of delay in cancer surgery during the pandemic, we interviewed breast and prostate cancer patients whose surgeries were delayed due to the pandemic. Patients and Methods Patients with early-stage breast or prostate cancer who suffered surgical postponement at Brigham and Women’s Hospital (BWH) were invited to participate. Semi-structured telephone interviews were conducted with 21 breast and prostate cancer patients. Interviews were transcribed, and qualitative analysis using ground-theory approach was performed. Results Most patients reported significant distress due to cancer and COVID. Key themes that emerged included the lack of surprise and acceptance of the surgical delays but endorsed persistent cancer- and delay-related worries. Satisfaction with patient–physician communication and the availability of a delay strategy were key factors in patients’ acceptance of the situation; perceived lack of communication prompted a few patients to seek care elsewhere. Discussion The clinical effect of delay in cancer surgery will take years to fully understand, but there are immediate steps that can be taken to improve the patient experience of delays in care, including elicitation of individual patient perspectives and ongoing communication. More work is needed to understand the wider experiences of patients, especially minority, socioeconomically disadvantaged, and uninsured patients, who encounter delays in oncologic care. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10319-0.
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Affiliation(s)
- Claire Sokas
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.
| | - Masami Kelly
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | - Christina Sheu
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | | | - H Gilbert Welch
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | - Regan Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christina Minami
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
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Ostroff JS, Bolutayo Gaffney KL, O'Brien M, deLeon-Sanchez ST, Whitlock CW, Kotsen CS, Carter-Harris L, Banerjee SC, Schofield E. Training oncology care providers in the assessment and treatment of tobacco use and dependence. Cancer 2021; 127:3010-3018. [PMID: 33914922 DOI: 10.1002/cncr.33545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinical practice guidelines for promoting smoking cessation in cancer care exist; however, most oncology settings have not established tobacco use assessment and treatment as standard care. Inadequate staff training and other implementation challenges have been identified as barriers for delivery of evidence-based tobacco treatment. Providing training in tobacco treatment tailored to the unique needs of tobacco-dependent patients with cancer is one strategy to improve adoption of best practices to promote smoking cessation in cancer care. METHODS A tobacco treatment training program for oncology care providers (tobacco treatment training-oncology [TTT-O]) consisting of a 2-day didactic and experiential workshop followed by 6 monthly, collaboratory videoconference calls supporting participants in their efforts to implement National Comprehensive Cancer Network guidelines in their oncology settings was developed and implemented. This article presents preliminary results on program evaluation, changes in participants' self-efficacy, and progress in implementing tobacco treatment. RESULTS Data have been obtained from the first 5 cohorts of TTT-O participants (n = 110) who completed training, course evaluations, baseline and follow-up surveys. Participants rated the training as highly favorable and reported significant gains in self-efficacy in their ability to assess and treat tobacco dependence. Participants also demonstrated significant improvements in tobacco treatment skills and implementation of several indicators of improved adoption of best practices for tobacco treatment in their cancer care settings. CONCLUSIONS Implementation of tobacco treatment training for cancer care providers is feasible, acceptable, and can have a significant positive impact on participants' tobacco treatment skills, self-efficacy, and greater adoption of tobacco treatment delivery in cancer care.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kemi L Bolutayo Gaffney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maureen O'Brien
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suhana T deLeon-Sanchez
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Will Whitlock
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chris S Kotsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa Carter-Harris
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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Berg MN, Ngune I, Schofield P, Grech L, Juraskova I, Strasser M, Butt Z, Halkett GKB. Effectiveness of online communication skills training for cancer and palliative care health professionals: A systematic review. Psychooncology 2021; 30:1405-1419. [PMID: 33909328 DOI: 10.1002/pon.5702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the reported effect of online communication skills training (CST) on health professional (HP) communication skills and patient care outcomes in cancer and palliative care. METHODS Primary research published in English between January 2003 and April 2019 was identified in bibliographic databases including Medline, Embase and Proquest (Prospero: CRD42018088681). An integrated mixed-method approach included studies describing a CST intervention and its effect, for cancer or palliative care HPs, delivered online or blended with an online component. Included studies' outcomes were categorised then findings were stratified by an evaluation framework and synthesised in an effect direction plot. Risk of bias was assessed using Joanna Briggs Institute's tools. RESULTS Nineteen included studies (five randomised controlled trials, 11 pre-post, two post-test and one qualitative study) evaluated a CST intervention (median duration = 3.75 h; range 0.66-96 h) involving 1116 HPs, 422 students and 732 patients. Most interventions taught communication skills for specific scenarios and approximately half were delivered solely online and did not involve role plays. Online CST improved HPs' self-assessed communication skills (three studies, 215 participants), confidence (four studies, 533 participants), and objective knowledge (five studies, 753 participants). While few studies evaluated patient outcomes, CST may benefit observed communication skills in care settings (two studies, 595 participants). CONCLUSIONS Online CST benefits oncology HPs' subjectively-reported communication skills and confidence, and objective knowledge. Translation to patient outcomes requires further investigation. The quality of research varied and few studies had a control group. We recommend improvements to study design, evaluation and implementation.
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Affiliation(s)
- Melissa N Berg
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Irene Ngune
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Penelope Schofield
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Grech
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ilona Juraskova
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Strasser
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Zoe Butt
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, Sydney, New South Wales, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Rogge AA, Helmer SM, King R, Canella C, Icke K, Pach D, Witt CM. Effects of training oncology physicians advising patients on complementary and integrative therapies on patient-reported outcomes: A multicenter, cluster-randomized trial. Cancer 2021; 127:2683-2692. [PMID: 33905536 DOI: 10.1002/cncr.33562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many patients with cancer do not disclose complementary medicine use but want their physician's advice on this matter. This study evaluated whether using blended learning (e-learning plus a workshop) to train oncology physicians in providing advice on complementary and integrative medicine (CIM) therapies to their patients with cancer, in addition to distributing an information leaflet on reputable CIM websites, had different effects on patient-reported outcomes for the consultation than only distributing the leaflet. METHODS In this multicenter, cluster-randomized trial, patients from private practices/hospital departments, recruited by 48 oncology physicians randomly allocated to an intervention group (CIM consultation plus information leaflet) or a control group (information leaflet), received CIM information. Patient-reported outcomes included satisfaction (Patient Satisfaction With Information on Cancer Treatment), readiness to make a decision (Preparation for Decision Making), and physician-patient communication (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and Communication 26 [EORTC QLQ-COMU26]) for the consultation. Qualitative interviews were conducted with a physician subsample. RESULTS A total of 291 patients (128 in the intervention group and 169 in the control group) advised by 41 physicians participated. Patients in the intervention group rated physician-patient communication higher on all EORTC QLQ-COMU26 scales (mean total score, 84.3 [95% CI, 79.5-89.2] vs 73.6 [95% CI, 69.3-78.0]; P = .002), were more satisfied with the advice (mean, 4.2 [95% CI, 4.0-4.4] vs 3.7 [95% CI, 3.5-3.8]; P < .001), and were readier to make a decision (mean, 63.5 [95% CI, 57.4-69.6] vs 53.2 [95% CI, 47.8-58.7]; P = .016) than the control group. Physicians who reported patients in both settings seemed satisfied with the advice given. CONCLUSIONS This study evaluated a novel education intervention for training oncology physicians in providing CIM advice in routine care. Providing structured CIM consultations had positive effects on patient satisfaction, readiness to make decisions, and physician-patient communication.
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Affiliation(s)
- Alizé A Rogge
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefanie M Helmer
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Health and Nursing Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ryan King
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Canella
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Katja Icke
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pach
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Gebhardt C, Mehnert-Theuerkauf A, Hartung T, Zimmermann A, Glaesmer H, Götze H. COMSKIL: a communication skills training program for medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc83. [PMID: 34056072 PMCID: PMC8136352 DOI: 10.3205/zma001479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/30/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
Objectives: Training communication skills has come to be recognized as a vital aspect of medical school education. A medical communication course based on the COMSKIL Communication Skills Training (CST) Program was developed, integrated into the core curriculum, and evaluated at the Leipzig University Medical School. Methods: Between October 2016 and July 2017, 312 medical students (mean age 21.80 years; 62% male) participated in the medical communication course. Each course unit was evaluated via questionnaires specifically designed to address the theoretical and practical content of the curriculum. The items correspond to the material covered in each course unit. Students responded using a 5-point-Likert scale (1="not at all helpful", 5="extremely helpful") to rate the degree to which the course helped them learn about the subject matter and train the skills covered in the curriculum. Results: The average score for the first part of the course (theoretical foundations) was M=3.69 (SD=0.35). The second part received a similar rating (M=3.84; SD=0.73). The role play exercises with actor-patients received a score of M=4.27 (SD=0.62). In an overall evaluation at the end of the course, students rated the administration of the course (setting, etc), knowledge gained, and skills trained with a score of M=4.11 (SD=0.66). The role play exercises received an overall score of M=4.36 (SD=0.61). Conclusion: A new curriculum for teaching medical students patient-physician communication skills based on the COMSKIL CST program was established at the University of Leipzig. The goal of this course is to teach students about the kinds of communication scenarios they will encounter in their future working lives as care providers and equip them with the fundamental communication techniques and skills they need to successfully handle those situations. A formal evaluation of the program resulted in satisfactory findings, indicating that it is well suited for use in medical universities.
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Affiliation(s)
- Claudia Gebhardt
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Tim Hartung
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Zimmermann
- University Medical Center Leipzig, LernKlinik Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Heide Götze
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
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Suthumphong C, Tran DB, Ruiz M. Perceptions and Misperceptions of Early Palliative Care Interventions for Patients With Hematologic Malignancies Undergoing Bone Marrow Transplantation. Cureus 2021; 13:e13876. [PMID: 33868840 PMCID: PMC8043049 DOI: 10.7759/cureus.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hematopoietic stem cell or bone marrow transplantation (BMT) is one of the most promising and potentially curative therapeutic options available for eligible patients with hematologic malignancies (HMs) or leukemias. However, the nature and clinical course of HMs, specifically for patients undergoing BMT, are associated with significant morbidity, symptomatology, healthcare service utilization, psychosocial and end of life issues, and overall decreased quality of life. Early palliative care (PC) consultations and utilization for patients with HMs have been shown to improve patient outcomes, satisfaction, and autonomy as well as caregiver burden, shared-decision making, and holistic care management. Despite the complexity of care and complications for patients with HM undergoing BMT, early PC interventions are systematically underutilized and understudied in this population compared to patients with solid tumors or non-HMs. Herein, the authors reviewed the current literature and knowledge to assess and report the perceptions and barriers to early PC utilization in the care of patients with HMs undergoing BMT. Clinical and cultural aspects of PC perceptions as well as current PC care models and potential directions for PC implementation were reviewed to inform future research studies and clinical practice guidelines necessary for the improvement of care and quality of life for HM patients undergoing BMT.
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Affiliation(s)
- Corey Suthumphong
- Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Dan B Tran
- Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Marco Ruiz
- Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.,Miami Cancer Institute, Baptist Health South Florida, Miami, USA
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de Sousa Mata ÁN, de Azevedo KPM, Braga LP, de Medeiros GCBS, de Oliveira Segundo VH, Bezerra INM, Pimenta IDSF, Nicolás IM, Piuvezam G. Training in communication skills for self-efficacy of health professionals: a systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:30. [PMID: 33676515 PMCID: PMC7937280 DOI: 10.1186/s12960-021-00574-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services. OBJECTIVE To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals. METHODS Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method. RESULTS Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk. CONCLUSION Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals. PROSPERO CRD42019129384.
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Affiliation(s)
- Ádala Nayana de Sousa Mata
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | - Kesley Pablo Morais de Azevedo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Liliane Pereira Braga
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | | | - Victor Hugo de Oliveira Segundo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Isaac Newton Machado Bezerra
- Academic Center of Vitória, Federal University of Pernanmbuco, R. Aldo do reservatório, s/n, Bela Vista, Vitória de Santo Antão, PE ZIP Code: 55608-680 Brazil
| | - Isac Davidson Santiago Fernandes Pimenta
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Ismael Martinez Nicolás
- Department of Health Sciences, Catholic University San Antonio de Murcia, San Antonio de Murcia, Campus de los Jerónimos, 135, 30107 Guadalupe, Murcia Spain
| | - Grasiela Piuvezam
- Department of Public Health, Federal University of Rio Grande do Norte, University Campus, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN ZIP Code: 59.078-970 Brazil
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Banerjee SC, Staley JM, Alexander K, Parker PA, Haviland KS, Moreno A, Walters CB. Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:35-52. [PMID: 37475763 PMCID: PMC10358276 DOI: 10.1891/lgbtq-2020-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.
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Affiliation(s)
| | | | | | | | | | - Aimee Moreno
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Campbell-Salome G, Buchanan AH, Hallquist MLG, Rahm AK, Rocha H, Sturm AC. Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers. PATIENT EDUCATION AND COUNSELING 2021; 104:403-412. [PMID: 32782180 DOI: 10.1016/j.pec.2020.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine the uncertainty management process of individuals with Lynch syndrome (LS). METHODS 19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes. RESULTS Qualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support. CONCLUSION Healthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences. PRACTICE IMPLICATIONS Findings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.
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Affiliation(s)
| | | | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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Harnischfeger N, Rath HM, Ullrich A, Alt-Epping B, Letsch A, Thuss-Patience P, Bokemeyer C, Oechsle K, Bergelt C. Evaluation of a communication skills training to facilitate addressing palliative care related topics in advanced cancer patients: study protocol of a multicenter randomized controlled trial (PALLI-KOM). Palliat Care 2020; 19:67. [PMID: 32398130 PMCID: PMC7218622 DOI: 10.1186/s12904-020-00568-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early integration of palliative care concurrently to standard cancer care is associated with several benefits for patients and their caregivers. However, communication barriers on part of the caring physicians often impede a timely referral to palliative care. This study describes the protocol of the evaluation of a communication skills training aiming to strengthen the ability of physicians to address palliative care related topics adequately and early during disease trajectory. Methods We will implement a communication skills training and evaluate it within a prospective, multi-centered, two-armed randomized controlled trial (RCT), which will be conducted at four sites in Germany. Eligible subjects are all physicians treating patients with advanced cancer in their daily routine. An intervention group (IG) receiving a group training will be compared to a wait-list control group (CG) receiving the training after completion of data collection. At pre- and post-measurement points, participants will conduct videotaped conversations with standardized simulated patients (SP). Primary outcome will be the external rating of communication skills and consulting competencies addressing palliative care related topics. Secondary outcomes on core concepts of palliative care, basic knowledge, attitudes, confidence and self-efficacy will be assessed by standardized questionnaires and self-developed items. A further external assessment of the quality of physician-patient-interaction will be conducted by the SP. Longitudinal quantitative data will be analyzed using covariate-adjusted linear mixed-models. Discussion If the communication skills training proves to be effective, it will provide a feasible intervention to promote an earlier communication of palliative care related topics in the care of advanced cancer patients. This would help to further establish early integration of palliative care as it is recommended by national and international guidelines. Trial registration German Clinical Trials Register DRKS00017025 (date of registration: 4 June 2019).
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O'Connor M, Watts KJ, Kilburn WD, Vivekananda K, Johnson CE, Keesing S, Halkett GKB, Shaw J, Colgan V, Yuen K, Jolly R, Towler SC, Chauhan A, Nicoletti M, Leonard AD. A Qualitative Exploration of Seriously Ill Patients' Experiences of Goals of Care Discussions in Australian Hospital Settings. J Gen Intern Med 2020; 35:3572-3580. [PMID: 33037591 PMCID: PMC7546390 DOI: 10.1007/s11606-020-06233-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient's preferences and values. Little is known about patients' experiences of these discussions. OBJECTIVE This study explored patients' perspectives of the GOC discussion in the hospital setting. DESIGN An explorative qualitative design was used within a social constructionist framework. PARTICIPANTS Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. APPROACH Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient's home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. KEY RESULTS Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process. CONCLUSIONS Effective communication, and patients' values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions.
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Affiliation(s)
- Moira O'Connor
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Kaaren J Watts
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Warren D Kilburn
- School of Psychological Sciences, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Kitty Vivekananda
- Counselling & Psychology Programs, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Claire E Johnson
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Eastern Health, Melbourne, VIC, Australia
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sharon Keesing
- School of Occupational Therapy, Social Work, and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Josephine Shaw
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Valerie Colgan
- WA Cancer and Palliative Care Network, WA Department of Health, Perth, WA, Australia
| | - Kevin Yuen
- Palliative Care Department, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
| | - Renate Jolly
- Respiratory Medicine, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
| | - Simon C Towler
- Intensive Care Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Perth, WA, Australia
- DonateLife, WA, MHPHDS Division, North Metropolitan Health Service, Perth, WA, Australia
- End-of-Life Care, WA Department of Health, Perth, WA, Australia
| | - Anupam Chauhan
- Department of Intensive Care Medicine, Rockingham Hospital, South Metropolitan Health Service, Perth, WA, Australia
| | - Margherita Nicoletti
- Palliative Care, Rockingham Hospital, South Metropolitan Health Service, Perth, WA, Australia
| | - Anton D Leonard
- Intensive Care, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
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Matošková J, Bartók O, Tomancová L. The relation between employee characteristics and knowledge sharing. VINE JOURNAL OF INFORMATION AND KNOWLEDGE MANAGEMENT SYSTEMS 2020. [DOI: 10.1108/vjikms-05-2020-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Knowledge sharing becomes crucial in today’s competitive world to foster organizational performance. This paper aims to explore which employee characteristics facilitate knowledge sharing in the organizations and to examine the dimensions of these characteristics.
Design/methodology/approach
Opinion-based questionnaires among employees in Czech companies were applied. The research design in this study was cross-sectional. The hypotheses were tested by Pearson’s correlations and regression analyses.
Findings
The findings support the idea that specific individual employee characteristics increase knowledge sharing in the organization. Four categories of potentially appropriate employee individual characteristics were suggested: social and communication skills; positive work feelings; competences for problem-solving; and employee’s self-efficacy. However, only employee’s positive work feelings and self-efficacy significantly predicted the extent of knowledge sharing in the organization.
Practical implications
The findings offer a basis for future research. The results of the study can be used in recruiting new employees and managerial decision-making. The recruitment methods and the selection methods deployed should enable the firm to attract those whose values are in harmony with the organization’s values. Managers should build a work environment that promotes greater and more trusting ties among employees via organizing social activities for employees, a supervisor’s acceptance of an employee’s autonomy and responsibility and increasing employees’ confidence in their abilities.
Originality/value
This is one of the first studies to investigate dimensions of employee knowledge-oriented characteristics. It supports the idea that some individual employee characteristics boost spontaneous knowledge sharing behaviour.
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Johannsen LM, Frerichs W, Inhestern L, Bergelt C. Assessing competencies of healthcare professionals caring for parents with cancer: The development of an innovative assessment tool. Psychooncology 2020; 29:1670-1677. [PMID: 32779287 DOI: 10.1002/pon.5507] [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: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/31/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This paper describes the development of an assessment tool capturing competencies of healthcare professionals (HCPs) in caring for cancer patients with minor children. METHODS We combined the methods of clinical case vignettes and situational judgement tests (SJTs). Scenarios were created based on literature and interviews with patients, HCPs, and experts. We pretested the instrument by conducting cognitive interviews with n = 6 HCPs, who gave feedback on realism, clarity, and difficulty of the scenarios. RESULTS The developed assessment tool measures the following competencies: HCPs' (1) application of knowledge, (2) behavioural responses to clinical scenarios, (3) attitudes regarding the relevance of integrating the parental role in cancer care, and (4) empathic behaviour towards affected parents. Results of the cognitive interviews indicate that the scenarios are perceived as realistic and clear. CONCLUSIONS We provide an innovative approach by methodologically combining clinical case vignettes and SJTs. Next, the assessment tool will be applied in the context of a pilot evaluation of a newly developed training for HCPs that aims at enhancing their competencies in caring for cancer patients with minor children.
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Affiliation(s)
- Lene M Johannsen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
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Messerotti A, Banchelli F, Ferrari S, Barbieri E, Bettelli F, Bandieri E, Giusti D, Catellani H, Borelli E, Colaci E, Pioli V, Morselli M, Forghieri F, Galeazzi GM, Marasca R, Bigi S, D'Amico R, Martin P, Efficace F, Luppi M, Potenza L. Investigating the association between physicians self-efficacy regarding communication skills and risk of "burnout". Health Qual Life Outcomes 2020; 18:271. [PMID: 32762755 PMCID: PMC7409639 DOI: 10.1186/s12955-020-01504-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians’ self-efficacy regarding communication to patients and risk of burnout. Methods We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models. Results Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout. Conclusions Our findings suggest that some physicians’ BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.
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Affiliation(s)
- Andrea Messerotti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Emiliano Barbieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bettelli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Local Health Agency, Carpi (Modena), Italy
| | - Davide Giusti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Hillary Catellani
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Borelli
- Department of Biomedic and Metabolic Science and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Colaci
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Pioli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Morselli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Forghieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Marasca
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Roberto D'Amico
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Faculty of Health, Deakin University, Melbourne, Australia
| | - Fabio Efficace
- Italian Group for Adult Hematologic Disease (GIMEMA), Health Outcomes Research Unit, Rome, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Mahal J, Amann JS, Wischmann T, Ditzen B. [The Importance of Different Topics in Medical Psychology/Sociology from Physicians' and Medical Students' View: Similarities and Differences]. Psychother Psychosom Med Psychol 2020; 71:72-80. [PMID: 32634839 DOI: 10.1055/a-1153-9262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The subject of "Medical Psychology/Sociology" is facing various content changes as a result of the currently pending study reforms within the framework of the "Master Plan Medical Studies 2020". These include the further development of the catalogues of exam-relevant topics (GK) and the National Competence-Based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM) as well as the Medical Licensing Regulations (ÄApprO). In this context, the question arises as to which training contents of "medical psychology/sociology", that medical students are confronted with, are of particular importance for their future medical work. METHODS 332 physicians and 265 students evaluated different contents of the catalogue of exam-relevant topics of medical psychology/sociology (GK-MPS) according to their importance regarding their education or respectively their daily work. In addition, the physicians indicated in free text fields of the questionnaire which situations in their daily work they would have liked to have been better prepared for during medical school. In a combined quantitative-qualitative analysis approach, differences between the 2 groups were identified by t-tests for independent samples with unequal variances (Welch test) and free text information was assigned to the various topics of the GK-MPS and evaluated in terms of content by 3 raters within the framework of a qualitatively oriented category-based text analysis. RESULTS Both physicians and students considered those topics of the GK-MPS, that involve communication between physician and patient, to be the most important. In addition, physicians rated the topics of physician-patient communication, statistics and prevention as more important than the students did. The physicians would have liked to have been better prepared for special and challenging medical situations in physician-patient interaction. DISCUSSION The topics of physician-patient communication are still considered to be of particular importance for the medical training of physicians and students, but physicians consider them to be more important than students. CONCLUSION The study results support the current study reforms towards a stronger emphasis on physician-patient communication and scientific basics as well as the linking of pre-clinical and clinical study contents.
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Affiliation(s)
- Julia Mahal
- Institut für Medizinische Psychologie, Zentrum für psychosoziale Medizin, Universität Heidelberg, UniversitätsKlinikum Heidelberg
| | - Jeanette Sophie Amann
- Institut für Medizinische Psychologie, Zentrum für psychosoziale Medizin, Universität Heidelberg, UniversitätsKlinikum Heidelberg
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Zentrum für psychosoziale Medizin, Universität Heidelberg, UniversitätsKlinikum Heidelberg
| | - Beate Ditzen
- Institut für Medizinische Psychologie, Zentrum für psychosoziale Medizin, Universität Heidelberg, UniversitätsKlinikum Heidelberg
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Lee J, Kim GB, Song MK, Lee SY, Kim MS, Bae EJ. End-of-Life Care of Hospitalized Children with Advanced Heart Disease. J Korean Med Sci 2020; 35:e107. [PMID: 32329256 PMCID: PMC7183846 DOI: 10.3346/jkms.2020.35.e107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite improvements in palliative care for critically ill children, the characteristics of end-of-life care for pediatric patients with advanced heart disease are not well-known. We investigated these characteristics among hospitalized children with advanced heart disease in a tertiary referral center in Korea. METHODS We retrospectively reviewed the records of 136 patients with advanced heart disease who died in our pediatric department from January 2006 through December 2013. RESULTS The median age of patients at death was 10.0 months (range 1 day-28.3 years). The median duration of the final hospitalization was 16.5 days (range 1-690 days). Most patients (94.1%) died in the intensive care unit and had received mechanical ventilation (89.7%) and inotropic agents (91.2%) within 24 hours of death. The parents of 74 patients (54.4%) had an end-of-life care discussion with their physician, and the length of stay of these patients in the intensive care unit and in hospital was longer. Of the 90 patients who had been hospitalized for 7 days or more, the parents of 54 patients (60%) had a documented end-of-life care discussion. The time interval from the end-of-life care discussion to death was 3 days or less for 25 patients. CONCLUSION Children dying of advanced heart disease receive intensive treatment at the end of life. Discussions regarding end-of-life issues are often postponed until immediately prior to death. A pediatric palliative care program must be implemented to improve the quality of death in pediatric patients with heart disease.
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Affiliation(s)
- Joowon Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea.
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
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