A Web-based communication aid for patients with cancer: the CONNECT Study.

BACKGROUND: Cancer patients and their oncologists often report differing perceptions of consultation discussions and discordant expectations regarding treatment outcomes. CONNECT, a computer-based communication aid, was developed to improve communication between patients and oncologists. METHODS: CONNECT includes assessment of patient values, goals, and communication preferences; patient communication skills training; and a preconsultation physician summary report. CONNECT was tested in a 3-arm, prospective, randomized clinical trial. Prior to the initial medical oncology consultation, adult patients with advanced cancer were randomized to the following arms: 1) control; 2) CONNECT with physician summary; or 3) CONNECT without physician summary. Outcomes were assessed with postconsultation surveys. RESULTS: Of 743 patients randomized, 629 completed postconsultation surveys. Patients in the intervention arms (versus control) felt that the CONNECT program made treatment decisions easier to reach (P = .003) and helped them to be more satisfied with these decisions (P < .001). In addition, patients in the intervention arms reported higher levels of satisfaction with physician communication format (P = .026) and discussion regarding support services (P = .029) and quality of life concerns (P = .042). The physician summary did not impact outcomes. Patients with higher levels of education and poorer physical functioning experienced greater benefit from CONNECT. CONCLUSIONS: This prospective randomized clinical trial demonstrates that computer-based communication skills training can positively affect patient satisfaction with communication and decision-making. Measurable patient characteristics may be used to identify subgroups most likely to benefit from an intervention such as CONNECT.

An exploration of factors promoting patient participation in primary care medical interviews.

Street's (2003) ecological model of communication in medical encounters was used to select and examine factors that potentially promote or retard patient participation. Patient participation was defined as information seeking and provision, assertive utterances, and emotional expressions. Patient participation discourse scores were used as the dependent variable in a multilevel regression analysis with 19 predictor variables representing cultural, organizational, and interpersonal factors of the ecological model. The analysis revealed eight significant predictors of patient participation. The results were discussed with respect to other research using the ecological model and their implications for continued study of factors that promote or retard patient participation.

Using health communication best practices to develop a web-based provider-patient communication aid: the CONNECT study.

OBJECTIVE: Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT), designed to facilitate treatment decision-making among patients with advanced cancer. METHODS: The communication aid included an on-line survey, patient skills training module and an automated physician report. Development steps included: (1) evidence-based content development; (2) usability testing; (3) pilot testing; and (4) patient utilization and satisfaction. RESULTS: Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the "patient testimonials" in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation. CONCLUSION: Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process. PRACTICE IMPLICATIONS: This developmental process can be translated to a broad array of community-based patient and provider educational interventions.

Patient communication skills training: a review with implications for cancer patients.

Although considerable attention has been given to physicians' communication, relatively little research has been directed to patients' communicative contributions to the medical interview. The research in patient communication skills training within the context of primary care is reviewed and implications are discussed for applying skills training in a cancer environment.

The other half of the whole: teaching patients to communicate with physicians.

BACKGROUND AND OBJECTIVES: A wide body of research suggests that the nature of communication between patients and physicians is strongly related to health outcomes. Interventions that involve teaching patients to communicate with physicians are important to assess in this context. METHODS: We conducted a review of randomized controlled trials (RCTs) in the outpatient setting from 1975 to 2000. Patient communication interventions were classified as high, medium, or low intensive, depending on the length of the intervention, use of personnel, and estimated cost. Characteristics of 16 studies were examined, including sample populations, types of interventions, and the nature of health outcomes. RESULTS: Patient improvement in a variety of outcomes as a result of communication training was demonstrated. Positive change variables included patient communication, medical outcomes, functional status, and adherence to treatment. Studies revealed mixed findings on the outcome of patient satisfaction. All US studies suggested that pre-visit training had no effect on the overall length of the medical visit. CONCLUSIONS: Studies indicated improvement in a variety of patient outcomes. However, the wide variation in study design, interventions, and outcomes hinders the ability to draw well-founded conclusions. Future research needs to further address biopsychosocial outcomes, cost-effectiveness, and their relationship.

A communication skills intervention for parents of pediatric surgery patients.

OBJECTIVE: It was hypothesized that parents exposed to a communication skills intervention would participate (e.g., ask questions, express concerns) in a pre-surgical consultation more than parents in the control group. METHODS: Sixty-five parents of prospective pediatric surgery patients were randomly assigned to either a communication skills intervention (booklet mailed prior to the consultation) or control group. Only initial consultation parents were included, no follow-ups. Audio-recordings of the medical consultations were obtained and the transcripts analyzed utilizing a content-coding system to determine patient participation. Also, parents were given a health literacy test (s-TOFHLA) and a post-interview questionnaire to gather demographic data. RESULTS: Intervention parents participated overall significantly more than control parents. Follow-up analyses revealed that intervention parents asked significantly more questions, and engaged in significantly more information verifying and expressing of concerns. There were no significant differences for parents' assertive statements or information provision. Other significant predictors of parents' participation were consultation length and parents' income. CONCLUSION: The intervention tested in this study promoted parents' participation in a pre-surgical consultation. As such, it has the potential to improve information exchange between parents and physicians with positive implications for informed consent. PRACTICE IMPLICATIONS: Providing parents with communication guidelines prior to a surgical consultation may improve physician-patient communication.

Improving symptom communication through personal digital assistants: the CHAT (Communicating Health Assisted by Technology) project.

BACKGROUND: Communication problems impede effective symptom management during chemotherapy. The primary aim of this pilot randomized controlled trial was to test the effects of a personal digital assistant-delivered communication intervention on pain, depression, and fatigue symptoms among breast cancer patients undergoing chemotherapy. Secondary aims included assessment of 1) study feasibility, 2) patient and clinician responses to study participation, and 3) intervention effects on health-related quality of life (HRQoL) and communication self-efficacy. METHODS: Intervention group participants (n = 27) completed symptom inventories at baseline, once per week during treatment, and at posttreatment. Depending on symptom severity, they viewed race-concordant videos on how to communicate about pain, depression and/or fatigue, using the personal digital assistant. Symptom records were tracked and shared with clinicians. Control group participants (n = 23) received usual care. Longitudinal random effects modeling assessed the changes in average symptom scores over time. Descriptive statistics assessed study feasibility and intervention effects on HRQoL and communication self-efficacy. Postintervention focus groups, interviews, and surveys assessed responses to study participation. RESULTS: Mean age of the participants was 51.0 years; 42 participants (84%) were white. In comparison with control, intervention group participants reported lower average pain severity over time (P = .015). Mean pain interference scores over time were marginally different between groups (P = .07); mean depression and fatigue scores over time were statistically nonsignificant. Feasibility outcomes and perspectives about study participation were positive. Mean pre-post decreases in HRQoL were generally higher among intervention group participants; pre-post changes in communication self-efficacy were equivalent. CONCLUSION: Mixed findings of the study indicate the need for future research.

Further examination of the impact of patient participation on physicians' communication style.

OBJECTIVE: Previous research in primary care has shown that physicians are more informative and/or patient-centered when they interact with high participation patients (e.g., those who ask questions, express preferences and concerns). This study contributes to this literature by examining parents' participation and physicians' discourse in a pediatric surgery context. METHODS: The audiotapes of 7 pediatric surgeons and 68 of their patients' parents/guardians were coded and examined for physicians' information exchange and support utterances as they interacted with parents/guardians with varying degrees of participation. RESULTS: The results of a multilevel regression analysis showed, consistent with related research, that the same physicians were more informative overall and provided more information in response to parents' questions when interacting with high participation parents. However, participation was not associated with physicians' volunteered information, general explanations, or support utterances. DISCUSSION AND CONCLUSION: The results are discussed with respect to the impact of participation on physicians' information provision and implications for future research, particularly with respect to general explanations, volunteered information, and medical context. PRACTICE IMPLICATIONS: This study suggests that surgeons may provide more detailed information to patients who are active participants in the preoperative interview, thereby improving the adequacy and validity of informed consent for surgical procedures.

The impact of patients' participation on physicians' patient-centered communication.

OBJECTIVE: The goal of this study is to add to a small, but growing body of research exploring how patients' communication style affects physicians' communication. In particular, we examine how patients' active participation (e.g., asking questions, providing information) affects physicians' use of patient-centered communication. METHODS: The same 25 physicians were observed interacting with high and low participation patients. High participation was defined as the frequency of information seeking/verifying, information provision, assertive utterances, and expressing concerns. On average, physicians interviewed 2.56 high participation patients and 3.44 low participation patients. Transcripts of the interviews were coded for physicians' patient-centered communication. High and low patient participation interviews were then compared using nested ANOVAs. RESULTS: When interacting with high participation patients, physicians engaged in significantly more patient-centered communication overall than when interacting with low participation patients. Analyses on separate components of patient-centeredness indicated that physicians engaged in significantly more exploring of patients' disease and illness, but did not engage in significantly more understanding of the whole person or finding of common ground. CONCLUSION: Patients who actively participate in medical interviews influence physicians to adopt a more patient-centered style of communication.

Development Of An Educational Video To Improve Patient Knowledge And Communication With Their Healthcare Providers About Colorectal Cancer Screening.

BACKGROUND: Low rates of colorectal cancer (CRC) screening persist due to individual, provider and system level barriers. PURPOSE: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. METHODS: Focus groups of patients were conducted prior to the development of an educational video and focus groups of patients provided initial feedback about the developed CRC screening educational video. Medical personnel reviewed the video and made recommendations prior to final editing of the video. RESULTS: Patients identified CRC screening barriers and made suggestions about the information to include in the educational video. Their suggestions included using a healthcare provider to state the importance of completing CRC screening, demonstrate how to complete the fecal occult blood test, and that men and women from diverse ethnic groups and races could be included in the same video. Participants reviewed the developed video and mentioned that their suggestions were portrayed correctly, the video was culturally appropriate, and the information presented in the video was easy to understand. Medical personnel made suggestions on ways to improve the content and the delivery of the medical information prior to final editing of the video. DISCUSSION: Participants provided valuable information in the development of an educational video to improve patient knowledge and patient-provider communication about CRC screening. The educational video developed was based on the Protection Motivation Theory and addressed the colon cancer screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. TRANSLATION TO HEALTH EDUCATION PRACTICE: Educational videos can provide important information about CRC and CRC screening to average-risk adults.

Information seeking and satisfaction with physician-patient communication among prostate cancer survivors.

Relatively little is known about prostate cancer patients' information seeking after diagnosis, how they use such information in making a treatment decision, or what role information plays in adjusting to quality-of-life issues posttreatment. This research sought to explore some of these issues by examining prostate cancer patients' information seeking and its relationship to assessments of feeling informed and satisfied with physician-patient communication about prostate cancer. Respondents felt reasonably informed about prostate cancer, although over one third of them reported being less then informed. Similarly, many respondents were generally satisfied with their communication with physicians, but nearly 40% of them reported being less than satisfied. However, there was no relationship between respondents' information seeking about prostate cancer and their assessments of being informed or satisfied with physician-patient communication. These and other results are discussed with respect to future research on prostate cancer patients' information needs and uses of such information.

Cancer patient preferences for quality and length of life.

BACKGROUND: Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of a life-threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of the current study was to describe cancer patient values regarding QOL and LOL and explore associations with communication preferences. METHODS: Patients with advanced cancer completed a computer-based survey before the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences, and cancer-related distress. RESULTS: Among 459 patients with advanced cancer, 55% placed equal valued on QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer-related distress (P < .001). A QOL preference was also associated with older age (P = .001), male sex (P = .003), and higher educational level (P = .062). Patients who preferred LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. CONCLUSIONS: These data indicate that a values preference for LOL versus QOL may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients.

The impact of patient participation on physicians' information provision during a primary care medical interview.

This study investigated the impact of patients' participation on physicians' information provision during a primary care medical interview. When communicating with high-participation patients, physicians provided significantly more information overall, more information in response to patients' questions, and volunteered more information than when interacting with low-participation patients. The most significant differences with respect to volunteered information involved communication about treatment and tests or procedures. These results were interpreted to suggest that high-participation patients' communication style promotes better alignment of patients' and physicians' goals and agendas. Overall, the results suggest that patients' style of participation during a medical interview significantly influenced the extent and type of information physicians provided. Given that patients' biggest complaint about physicians often is a lack of desired information, this study has important implications for physician-patient communication.

Emerging trends and future directions in patient communication skills training.

Despite several reviews of research on the effects of patient communication skills interventions, relatively few new studies on the topic have been published recently. The purpose of this article is to identify areas of needed research into patient communication skills training, with the intent of stimulating further investigation. Several topics are discussed, including longitudinal research, issues for studying underserved populations, the role of patients' preference for involvement with their health care, and the assessment of the effects of patient communication skills training on health outcomes.

Physician communication skills training: a review of theoretical backgrounds, objectives and skills.

CONTEXT: Significant shortcomings have been noted in the literature in communication skills training for practising doctors. Given the importance of competent communication to the doctor-patient relationship and health care in general, these shortcomings should be addressed in future research. OBJECTIVE: Research into physician communication skills training is examined with respect to the communication objectives and behaviours that are addressed. METHODS: A Medline search of literature from 1990 to the present was conducted. RESULTS: A total of 26 studies of doctor communication skills training were found. The majority of studies included insufficient information about the communication behaviours taught to participants. In several studies, there was a mismatch between stated behaviours and instruments or procedures used to assess them. CONCLUSION: Three recommendations are suggested. Firstly, future researchers should take greater care in matching assessment instruments with stated communication skills. Secondly, researchers should provide and use a theoretical framework for selecting communication skills to address in interventions, and thirdly, the timing of communication skills within the interview context should be part of the instruction in interventions.

Physicians' and patients' perceptions of patients' communication competence in a primary care medical interview.

Considerable research suggests that patients and physicians often perceive aspects of the medical interview quite differently. Despite extensive research into physician-patient communication, virtually no attention has been given to assessing patients' and physicians' perceptions of communication competence during the medical interview. The purpose of this research was to determine the extent of agreement between physicians and patients on what behaviors constitute competent patient communication. The results indicate that there is considerable agreement between physicians and patients on the categories of competent patient communication. However, there is little or no evidence for agreement at the dyadic level on the occurrence of competent patient communication. Moreover, there is little evidence that physicians' and patients' perceptions of competence correlate with patients' actual discourse. These results are discussed with respect to implications for future research on patient communication skills training interventions.