Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study.

BACKGROUND: Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. OBJECTIVE: This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. METHODS: Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. RESULTS: Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. CONCLUSIONS: Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

Positive Peers Mobile Application Reduces Stigma Perception Among Young People Living With HIV.

Background. The burden of HIV-related stigma is associated with disparities in linkage to HIV care and viral suppression. The Positive Peers smartphone application aims to provide young people living with HIV with a supportive virtual community to counteract perceived stigma and better manage their illness. Method. A mixed-methods study that included a prospective survey and in-depth interviewing was conducted with young adults living with HIV, aged 13 to 34 years (n = 128). As part of a larger study, participants used the Positive Peers mobile application and reported demographic data, perceived stigma, and other psychosocial variables at enrollment, 6 months, and 12 months (n = 128). Select participants (n = 15) described their experiences in audio-recorded qualitative interviews. Verbatim transcripts were analyzed for potential themes and patterns. Results. A longitudinal multivariate model was developed to assess changes in stigma over the study period, overall, and with respect to participant characteristics. Baseline and 6-month stigma scores were higher for White and Other ethnicity persons relative to Black participants. At the 12-month time point, no statistical differences in stigma scores based on ethnicity were apparent. Interviews revealed Positive Peers as a nondiscriminatory community that offered a sense of belonging that appeared to have a restorative effect on negative self-image. Conclusions. Positive Peers provides a protected virtual space where young people living with HIV can converge in the common desire to support similar others. Mobile health applications that offer peer interaction may provide a persistent sense of belonging that neutralizes internalized stigmas in addition to benefits derived from application activity.

Associations Between Social Support and Social Media Use Among Young Adult Cisgender MSM and Transgender Women Living With HIV.

Social media platforms offer the opportunity to develop online social networks. Use of these platforms has been particularly attractive to younger sexual and gender minority individuals as well as those living with HIV. This cross-sectional study examined the perceived level of social support and associations with social media use among youth and young adult cisgender men who have sex with men (MSM) and transgender (trans) women living with HIV and examined these associations by gender identity. The study drew from baseline data collected from 612 cisgender MSM and 162 trans women enrolling in one of 10 demonstration sites that were part of a Health Resources and Services Administration Special Projects of National Significance initiative. The individual projects were designed to evaluate the potential for social media/mobile technology-based interventions to improve retention in care and HIV health outcomes. The data used in this study came from baseline surveys completed when participants enrolled in a site between October 2016 and May 2018. Results demonstrated that a significantly greater proportion of MSM than trans women participants reported the use of social media platforms (e.g., Facebook: MSM = 86%, trans women = 62%; Instagram: MSM = 65%, trans women = 35%). Furthermore, increased social media use improved perceptions of social support only among MSM participants (direct adjusted OR = 1.49) and not trans women participants (gender identity interaction term adjusted OR = 0.64). These results revealed that MSM participants perceived greater social benefit from the use of social media platforms than trans women, which could be a result of generalized online transphobia experienced by trans women. More nuanced data on various social media platforms, that is, anonymous versus profile-based, and group differences, are needed to better understand how social media platforms can be best utilized to optimize health care outcomes among sexual and gender minority youth and young adults living with HIV.

Understanding Nicotine Dependence and Addiction Among Young Adults Who Smoke Cigarillos: A Qualitative Study.

Introduction: Cigarillo use is increasing, particularly among young adults. Nicotine dependence (ND) is important for understanding smoking behavior and cessation, but the development of measures of ND has focused almost exclusively on cigarette smokers. We examined smoking patterns, preferences, and beliefs of cigarillo users to better understand their experience of addiction and expression of ND symptoms. Methods: Using purposive sampling, we conducted in-depth interviews between June 2015 and January 2016 with 30 young adults aged 18-28 who reported smoking ≥1 cigarillo per week. Interviews were based on a semi-structured guide designed to capture participants' smoking levels and patterns as well as their experiences of smoking and addiction. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results: Participants had a mean age of 23, with a majority being female (56%) and African American (80%). The median number of cigarillos smoked per week was 20; 70% also smoked cigarettes, and 43% also smoked marijuana blunts. Our analysis highlighted the complexity of measuring cigarillo use due to product manipulation, sharing, and multiple product use. Participants expressed a preference for smoking in a social group where cigarillos were shared, and not smoking an entire cigarillo at once when alone. Most cigarillo users did not consider themselves to be addicted. Conclusions: Cigarillo users express unique smoking practices and beliefs that signify the need for a more product-inclusive measure of ND, and can inform the development of tobacco cessation interventions tailored to cigarillo users. Implications: The increasing use of cigarillos among young adults has significant public health consequences. Addressing this issue requires accurate measurement and effective treatment of dependence on cigarillo products. The results of this study directly inform the development of a revised measure of ND, and can contribute to the efficacy of cessation interventions for cigarillo users.

Development of a Measure of Incremental Behavior Change Toward Smoking Cessation.

INTRODUCTION: A reliable measure capable of detecting progression towards smoking cessation would be valuable for evaluating and optimizing the effectiveness of low- to moderate-intensity cessation interventions, such as brief advice in the primary care setting. This article presents the development and evaluation of a brief self-report measure of Incremental Behavior Change toward Smoking cessation (IBC-S). METHODS: Sequential samples of 411 and 399 adult smokers completed items representing a spectrum of behavioral and cognitive changes antecedent to smoking cessation. The dimensionality, fit, range of difficulty, and reliability of items were evaluated using factor analysis and Rasch modeling. RESULTS: The final 15-item IBC-S measure met fit criteria and demonstrated acceptable reliability. Participants with a significant change in IBC-S score were over four times more likely to report cessation at 6-week follow-up (OR 4.37, 95% CI 1.83-10.42). CONCLUSION: The IBC-S is brief, reliable and associated with self-report of smoking reduction and cessation. IMPLICATIONS: This article presents the psychometric evaluation of a measure to assess a spectrum of behaviors and cognitions antecedent to smoking cessation. The findings indicate that the items show good measurement properties and good potential as a sensitive measure to evaluate interventions. This measure provides an alternative outcome for interventions that are designed to move individuals towards cessation attempts.

A randomized trial to evaluate primary care clinician training to use the Teachable Moment Communication Process for smoking cessation counseling.

OBJECTIVE: To implement and evaluate the impact of a Teachable Moment Communication Process (TMCP) training intervention on clinicians' smoking cessation counseling behaviors in practice. METHOD: Using a group randomized trial, 31 community-based, primary care clinicians in Northeast Ohio received either TMCP training or an attention control (2010-2012). TMCP training consisted of two, three-hour sessions involving didactic instruction, skill practice with standardized patients, and coaching. Clinician performance of TMCP elements was assessed by coding audio-recordings of routine visits with smokers at baseline and post-intervention (n=806). RESULTS: Baseline performance of all TMCP elements was similar in the two groups. After the intervention, TMCP-trained clinicians were more often observed advising patients to quit while linking smoking to the patient's concern (58% vs. 44%, p=0.01), expressing optimism (36% vs. 3%, p<0.001), expressing partnership (40% vs. 12%, p=0.003) and eliciting the patient's readiness to quit (84% vs. 65%, p=0.006) than clinicians in the comparison group. TMCP-trained clinician responses were also better aligned with patients' expressed readiness to quit smoking than comparison group clinicians (p<0.001). CONCLUSION: The intervention significantly changed the content of clinicians' smoking cessation communication in ways consistent with the TMCP model for health behavior change.

An Exploration of the relative influence of patient's age and cancer recurrence status on symptom distress, anxiety, and depression over time.

Past research suggests that psychosocial responses to advanced or recurrent cancer vary by age. This study compares the relative influences of patients' age and recurrence status on indicators of symptom distress, anxiety, and depression following a diagnosis of advanced cancer. A prospective study of advanced cancer support provided patient outcome data reported at baseline, 3-, and 6-month intervals. Cohorts were defined by age group and recurrence status and latent growth curves fit to anxiety, depression, and symptom distress outcomes. Middle-age recurrent patients reported the highest symptom distress, depression, and anxiety across time points. Older recurrent patients fared worse at baseline than older nonrecurrent patients, but outcome scores converged across time points. Recurrent cancer presents a distinct challenge that, for middle-age patients, persists across time. It may be beneficial to develop targeted educational and support resources for middle-age patients with recurrent disease.

A Teachable Moment Communication Process for smoking cessation talk: description of a group randomized clinician-focused intervention.

BACKGROUND: Effective clinician-patient communication about health behavior change is one of the most important and most overlooked strategies to promote health and prevent disease. Existing guidelines for specific health behavior counseling have been created and promulgated, but not successfully adopted in primary care practice. Building on work focused on creating effective clinician strategies for prompting health behavior change in the primary care setting, we developed an intervention intended to enhance clinician communication skills to create and act on teachable moments for smoking cessation. In this manuscript, we describe the development and implementation of the Teachable Moment Communication Process (TMCP) intervention and the baseline characteristics of a group randomized trial designed to evaluate its effectiveness. METHODS/DESIGN: This group randomized trial includes thirty-one community-based primary care clinicians practicing in Northeast Ohio and 840 of their adult patients. Clinicians were randomly assigned to receive either the Teachable Moments Communication Process (TMCP) intervention for smoking cessation, or the delayed intervention. The TMCP intervention consisted of two, 3-hour educational training sessions including didactic presentation, skill demonstration through video examples, skills practices with standardized patients, and feedback from peers and the trainers. For each clinician enrolled, 12 patients were recruited for two time points. Pre- and post-intervention data from the clinicians, patients and audio-recorded clinician‒patient interactions were collected. At baseline, the two groups of clinicians and their patients were similar with regard to all demographic and practice characteristics examined. Both physician and patient recruitment goals were met, and retention was 96% and 94% respectively. DISCUSSION: Findings support the feasibility of training clinicians to use the Teachable Moments Communication Process. The next steps are to assess how well clinicians employ these skills within their practices and to assess the effect on patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01575886.

VIPCare: Understanding the support needed to create affective interactions between new caregivers and residents with dementia.

INTRODUCTION: In this paper, we study the support needed by professional caregivers of those with dementia, and present a first step toward development of VIPCare, a novel application with the goal of assisting new caregivers at care-centres in interacting with residents with dementia. METHODS: A mixed-methods study including two questionnaires, two focus groups, and seven co-design sessions with 17 professional caregivers was conducted to (a) understand caregivers' challenges/approaches used to reduce negative interactions with persons with dementia, (b) identify the existing gaps in supporting information for improving such interactions, and (c) co-design the user interface of an application that aims to help improve interactions between a new professional caregiver and persons with dementia. A pre-questionnaire assessed knowledge of smartphones and attitude toward technology. A post-questionnaire provided an initial evaluation of the designed user interface. RESULTS: Focus groups emphasized the importance of role-playing learned through trial and error. The layout/content of the application was then designed in four iterative paper-prototyping sessions with professional caregivers. An iOS/Android-based application was developed accordingly and was modified/improved in three iterative sessions. The initial results supported efficiency of VIPCare and suggested a low task load index. CONCLUSIONS: We presented a first step toward understanding caregiver needs and developing an application that can help reduce negative interactions between professional caregivers and those with dementia.

Using the Positive Peers Mobile App to Improve Clinical Outcomes for Young People With HIV: Prospective Observational Cohort Comparison.

BACKGROUND: Disparities in HIV outcomes persist among racial, gender, and sexual minorities in the United States. Younger people face a greater risk of contracting HIV, often living without knowledge of their HIV status for long periods. The Positive Peers App (PPA) is a multifunctional HIV support tool designed to improve HIV-related clinical outcomes for young people with HIV. The app was designed according to the specifications of an in-care young adult HIV community in Northeast Ohio. Data provided in this study provide preliminary evidence of the usefulness of PPA as a relevant tool for engaging this clinical patient population in care and facilitating viral suppression. OBJECTIVE: In this study, we aimed to describe variations in PPA use and examine the associations between use and HIV clinical outcomes between self-selected user and nonuser cohorts in the same clinical population. METHODS: The PPA was offered free of charge to persons with HIV, aged 13 to 34 years of age, diagnosed with HIV within the last 12 months, out of care for 6 months during the last 24 months, or not virally suppressed (HIV viral load >200 copies/mL) in the prior 24 months. Baseline and 6- and 12-month surveys were administered via an audio computer-assisted self-interviewing system to all participants. The app's user activity was tracked natively by the app and stored in a secure server. Participant demographic and HIV care data were extracted from clinical records within 12 months before the start of the study and across the duration of the study period. HIV care outcomes of PPA users (n=114) were compared with those of nonusers (n=145) at the end of the study period (n=259). RESULTS: The analysis showed that younger PPA users (aged 13-24 years) were more likely to obtain HIV laboratories (adjusted odds ratio 2.85, 95% CI 1.03-7.90) and achieve sustained viral suppression than nonusers (adjusted odds ratio 4.2, 95% CI 1.2-13.9). CONCLUSIONS: The PPA appears to help younger users sustain HIV suppression. The app offers an important tool for addressing this critical population. The PPA remains in the field and is currently being adopted by other localities to facilitate their efforts to end the HIV epidemic. Although our reported observational results require additional validation and stringent ongoing surveillance, the results represent our best efforts in a pilot study to provide a measure of efficacy for the PPA. Next steps include a large-scale evaluation of the PPA acceptability and effectiveness. Given the building evidence of user reports and outcomes, the freely available PPA could be a helpful tool for achieving Ending the HIV Epidemic goals.

A comprehensive observational coding scheme for analyzing instrumental, affective, and relational communication in health care contexts.

Many observational coding schemes have been offered to measure communication in health care settings. These schemes fall short of capturing multiple functions of communication among providers, patients, and other participants. After a brief review of observational communication coding, the authors present a comprehensive scheme for coding communication that is (a) grounded in communication theory, (b) accounts for instrumental and relational communication, and (c) captures important contextual features with tailored coding templates: the Siminoff Communication Content & Affect Program (SCCAP). To test SCCAP reliability and validity, the authors coded data from two communication studies. The SCCAP provided reliable measurement of communication variables including tailored content areas and observer ratings of speaker immediacy, affiliation, confirmation, and disconfirmation behaviors.

Patient perceptions of oncologist-patient communication about prognosis: changes from initial diagnosis to cancer recurrence.

Cancer recurrence presents oncologists with many challenges, including discussing prognosis. A thematic analysis of patient interviews was conducted to learn more about how this challenge is met by doctors and patients in their communication. Female patients being treated for a cancer recurrence at a comprehensive cancer center (N = 30) were asked to recall how they discussed their prognosis with oncologists when initially diagnosed and when the cancer recurred. All interviews were recorded, transcribed, and thematic analysis applied to patients' remarks concerning prognosis. Following comparison of prognosis quotes identified in the transcript, two primary themes were drawn from the data: communicating optimism at the initial diagnosis; and communicating chronic disease management at recurrence. Three subthemes were also identified in the recurrence communication: managing the new information; ambiguous communication about the prognosis; and the information seeking paradox. Problematic integration theory is offered as an important explanatory mechanism for understanding oncologist-patient communication about prognosis during a cancer recurrence.

"Positive Peers": Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care.

BACKGROUND: Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. OBJECTIVE: The objective of this study was to describe the "Positive Peers" app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. METHODS: "Positive Peers" was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. RESULTS: The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The "Positive Peers" mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. CONCLUSIONS: Successful development of the "Positive Peers" mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator.

Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer.

OBJECTIVE: To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer. METHODS: Female patients diagnosed with advanced breast cancer (n = 25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups. RESULTS: Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment. CONCLUSION: Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver. PRACTICE IMPLICATIONS: Regular implementation of T-PAT may help clinicians' build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care.

User and Content Characteristics of Public Tweets Referencing Little Cigars.

OBJECTIVES: Compared to cigarettes, little cigars and cigarillos (LCC) are minimally regulated, affordable, and widely available to young people. Because Twitter is a preferred mode of communication among younger people, product portrayals may be useful for informing both interventions and public health or tobacco policy. METHODS: A mixed-methods study was implemented to analyze the content of public tweets (N = 288) and profile photos sampled from a search of 2 LCC brands (Black & Mild and Swisher Sweets). Metadata and manifest attributes of profile photo demographic features and tweet message features were coded and analyzed. Thematic analysis of the tweets was conducted using an iterative immersion/ crystallization method. RESULTS: Tweeters were most often boys or men (63%) and appeared young (76%). Prevalent content themes included expressing affiliation for the LCC product and reporting smoking activity. Although men and women tweeted affiliation for LCC products and reported smoking activity in similar numbers, women were significantly less likely to tweet about blunting than men. CONCLUSIONS: Twitter provides a potentially potent source of nuanced information about how young people are using little cigars. These observed characteristics may be useful to inform counter-messaging strategies and interventions.

Comparing primary care physicians' smoking cessation counseling techniques to motivational interviewing.

OBJECTIVES: This study examined the degree of similarity between motivational interviewing (MI) methods and smoking cessation techniques that are routinely used by primary care physicians. Its purpose was to inform the development of more effective MI-based health behavior change training programs for primary care physicians. METHODS: Visits to primary care physicians were audio-recorded in northeast Ohio from 2005 to 2008. Doctor-patient talk about smoking cessation (n = 73) was analyzed for adherence to MI using the Motivational Interviewing Skills Code (MISC) version 2.1 behavioral coding system. Participating physicians were not provided with MI training as part of the study and were blinded as to the study's purpose. RESULTS: Physicians displayed MI adherent behaviors in 56% of discussions and MI nonadherent behaviors in 57%. The most common MI adherent statements involved affirming the patient; least common were requests for the patient's permission before raising concerns. The most frequent MI nonadherent behaviors were directing, confronting, and warning the patient. Physicians made simple reflections and complex reflections in 36% and 25% of visits, respectively. CONCLUSIONS: Physicians used both MI adherent and MI nonadherent behaviors in approximately equal proportions, suggesting a base of MI adherent smoking cessation counseling skills upon which additional MI skills can be built. Efforts to improve smoking-cessation effectiveness may involve providing training in brief MI models and additional MI skills, while reinforcing physicians' current use of MI adherent methods.

Facilitating enrollment in a Cancer Registry through modified consent procedures: a pilot study.

Research registries are increasingly important in medical research and are essential to the mission of cancer centers. However, designing enrollment and data collection procedures that are consistent with ethical norms and regulatory requirements yet are efficient and cost effective is a major challenge. Current standard consent forms can be a barrier to enrollment because of their length, multiple components, and technical language. We pilot tested an IRB-approved registry booklet and simplified one-page, tiered consent form, allowing for choice of extent of participation. The booklet was mailed to patients with breast cancer as part of their routine information packet prior to the first clinic appointment. A research nurse met with 27 patients at initial treatment to review the booklet, answer questions, obtain informed consent, and collect quality of life data. The consent rate was 78% with 21 patients enrolling in the study. Twelve of the 21 patients (57%) did not read the booklet prior to the visit. The 9 patients (43%) who had read the booklet prior to arrival found it easy to understand. The multi-stage, simplified consent process and data collection were acceptable to these patients and readily integrated into clinical operations. An easy-to-read registry booklet may be an effective guide for discussion, but in-person consent procedures and further testing of the approach are required.

Differences in oncologist communication across age groups and contributions to adjuvant decision outcomes.

The objective of this study was to assess potential age-related differences in oncologist communication during conversations about adjuvant therapy decisions and subsequent patient decision outcomes. Communication was observed between a cross-section of female patients aged 40 to 80 with early-stage breast cancer (n=180) and their oncologists (n=36) in 14 academic and community oncology practices in two states. Sources of data included audio recordings of visits, followed by post-visit patient interviews. Communication during the visit was assessed using the Siminoff Communication Content and Affect Program. Patient outcome measures included self-reported satisfaction with decision, decision conflict, and decision regret. Results showed that oncologists were significantly more fluent and more direct with older than middle-aged patients and trended toward expressing their own treatment preferences more with older patients. Satisfaction with treatment decisions was highest for women in their 50s and 60s. Decision conflict was significantly associated with more discussion of oncologist treatment preferences and prognosis. Decision regret was significantly associated with patient age and education. Older adults considering adjuvant therapy may find that oncologists' communication accommodations to perceived deficiencies in older adult cognition or communication challenge their decision-making involvement. Oncologists should carefully assess patient decision-making preferences and be mindful of accommodating their speech to age-related stereotypes.

The role of primary care physicians in advanced cancer care: perspectives of older patients and their oncologists.

OBJECTIVES: To examine data from advanced cancer patients and their oncologists regarding patient age-related differences in patient and oncologist perspectives on involvement of primary care physicians (PCPs) in aspects of cancer management. DESIGN: Randomized controlled trial of a support intervention for patients with late-stage cancer treated in two teaching hospital-based cancer clinics caring for underserved populations. PARTICIPANTS: Three hundred fifty-seven patients who had an oncologist and PCP enrolled 2 to 3 months after an advanced cancer diagnosis. MEASUREMENTS: Sociodemographic data and structured interviews were used to assess patients' perceptions of PCP involvement in care discussions and decision-making and satisfaction with that involvement, oncologists' beliefs about how involved PCPs should be in these discussions and decisions, and their shared care practices. RESULTS: Older patients (>or=65) were more likely to have a PCP (P=.02). Patients reported a broad range of perceived PCP involvement and satisfaction with that involvement. Greater involvement was associated with greater satisfaction (P<.001). Half of oncologists reported themselves as PCP for more than 25% of their patients. Approximately half of oncologists reported that more older than younger patients had PCPs, yet only 20% reported differences in PCP involvement or in their communication with PCPs for older late-stage patients. CONCLUSION: Results support involvement of PCPs in advanced cancer care and demonstrate variable perspectives on PCP involvement. Matching patient preferences and practices may improve satisfaction. Clarification of elements in the partnership between patients, PCPs, and oncologists will inform efforts to optimally care for older patients with advanced cancer.

Modeling patient-centered communication: oncologist relational communication and patient communication involvement in breast cancer adjuvant therapy decision-making.

OBJECTIVE: Relational communication refers to those messages communicators naturally express that carry meaning about the type and quality of relationship they share. It is expected that patients of oncologists who express positive relational communication will be more communicatively involved in their office visits, and regret their decision for adjuvant therapy following surgery less. METHODS: One hundred eighty (180) audio-recorded discussions between oncologists (n=40) and early stage (I-III) breast cancer patients were coded with the Siminoff Communication Content and Affect Program (SCCAP). The data were used to test the relationships between patient demographics, oncologist relational communication, patient communication involvement and self-reported patient decision regret. RESULTS: After controlling for clinician clusters, oncologists' verbal (i.e., confirming messages) and nonverbal (i.e., direct and inclusive speech) relational communication is indirectly associated with lower patient decision regret via the mediating effect of greater patient communication involvement. CONCLUSION: Clinician relational communication provides an influential affective climate for decision-making that appears to have important effects on patients' decision confidence. PRACTICE IMPLICATIONS: Clinicians should recognize the potential of their own relational messages to facilitate patients' communication involvement in decision-making during cancer care.