Empathic Communication and Implicit Bias in the Context of Cancer Among a Medical Student Sample.

Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters (M = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student (OR = 3.24, p = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.

Implicit biases in healthcare: implications and future directions for gynecologic oncology.

Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.

Emotion regulation and positive affect in the context of salivary alpha-amylase response to pain in children with cancer.

BACKGROUND: Children with cancer routinely undergo painful medical procedures invoking strong physiological stress responses. Resilience to this pain may be conferred through resources such as emotion regulation strategies and positive affect. PROCEDURE: This study measured dispositional positive affect in children with cancer (N = 73) and randomly assigned participants to one of three emotion regulation strategy conditions (distraction, reappraisal, or reassurance). Children applied their assigned strategy during an experimental pain procedure (the cold pressor task [CPT]) and provided saliva samples before, immediately after, and 15 min after the CPT. Saliva samples were later assayed for salivary alpha amylase (sAA)-a surrogate marker for autonomic/sympathetic nervous system activity and regulation. RESULTS: Children in the reassurance group had sAA levels that continued to rise after completion of the CPT compared to children in the distraction (b = -1.68, P = 0.021) and reappraisal conditions (b = -1.24, P = 0.084). Furthermore, dispositional positive affect moderated the effect of condition such that children in the reassurance group with lower levels of positive affect had sAA levels that continued to rise after completion of the CPT (dy/dx = 1.56, P = 0.027), whereas children in the reassurance condition with higher levels of positive affect did not exhibit this rise (P > 0.05). CONCLUSIONS: Specific emotion regulation strategies, such as distraction and reappraisal, may attenuate the stress response to pain in pediatric patients with cancer, and positive affect may confer resilience in response to pain even with use of less effective coping strategies such as reassurance.

Cold Pressor Pain Response in Children With Cancer.

OBJECTIVE: The goal of this study was to examine pain responses in pediatric patients with cancer. METHOD: Children (ages 6 to 18) undergoing treatment for cancer (N=68) completed the cold pressor task. RESULTS: Average pain tolerance was 118.22 seconds (SD=101.18) and 40% of the children kept their hand in the water the entire 4-minute ceiling. On a 0 to 10 numeric rating scale, children reported a pain severity of 5.07 (SD=3.47) at their first report of pain, a pain severity of 5.94 (SD=3.54) at their maximum report of pain, and a pain severity of 5.33 (SD=3.72) at the time they reached pain tolerance. Children receiving chemotherapy agents (N=56) with possible neuropathic effects exhibited higher pain tolerance compared with children not receiving such treatments (N=10), ß=0.84, SE=0.38, Wald χ1=4.88, P=0.027, hazard ratio=2.33, 95% confidence interval (1.10-4.92). CONCLUSIONS: This study provides data on experimental pain responses in a sample of children undergoing cancer treatment and suggests that pain experience may be moderated by cancer treatment type.

Supporting a Young Adult with Social Anxiety Disorder and Improving Engagement in Cancer Care: A Case Report.

Adolescent and young adult (AYA) patients with cancer often demonstrate suboptimal engagement in cancer care due to a host of logistical, developmental, and psychological factors. This clinical case study of a young adult (YA) with cancer highlights the multiple ways in which social anxiety disorder (SAD) impacted a YA's engagement in cancer care. The case study also details the use of an evidence-based treatment for SAD to support behavioral change. Identification and receipt of timely evidence-based psychological intervention for SAD have the potential to improve AYA well-being and enhance cancer care engagement.

Usability and Acceptability of a Web Platform to Host the Group-Based TOGETHER-YA Quality of Life Intervention for Young Adult Cancer Survivors.

BACKGROUND: Young adult (YA) cancer survivors aged 18-39 frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). Our team has developed a supportive care intervention, titled TOGETHER-YA, to improve YA cancer survivors' stress management skills. TOGETHER-YA is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. OBJECTIVE: The purpose of this two-part study was to design and test a website to host the TOGETHER-YA intervention for YA cancer survivors aged 18-39. TOGETHER-YA is a 10-week, group-based program designed to promote health-related quality of life. METHODS: In Part 1, we leveraged an existing online platform and adapted it to meet the needs of TOGETHER-YA. We conducted three iterative waves of usability testing with three YAs per wave to refine the website. In Part 2, we conducted a single-group feasibility trial of TOGETHER-YA using the website. Primary outcomes were feasibility (i.e., recruitment, retention, attendance) and acceptability (i.e., satisfaction). RESULTS: Usability testing participants (N=9) indicated that the TOGETHER-YA website was easy to use (M=5.9, SD=1.3) and easy to learn (M=6.5, SD=0.9) (possible ranges: 1-7). Qualitative feedback identified needed revisions to the aesthetics (e.g., images), content (e.g., session titles), function (e.g., clarity of functionality), and structure (e.g., expandable sections), which were implemented. In the feasibility trial, participants (N=7) were an average of 25 years old (SD=4.7) and mostly non-Hispanic White (57%). Recruitment (70%) and retention (71%) rates and average session attendance (M=7.1, SD=4.2) supported feasibility. Participant agreement with positive statements about TOGETHER-YA and average satisfaction ratings (M=5.06, SD=1.64; possible range: 1-7) demonstrated acceptability. CONCLUSIONS: Results supported the usability, feasibility, and acceptability of the TOGETHER-YA program and website. By hosting the content online, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER-YA's efficiency and explore its efficacy for improving targeted outcomes. CLINICALTRIAL: NCT05597228, October 24, 2022.

Examining provider perceptions and practices for comprehensive geriatric assessment among cancer survivors: a qualitative study with an implementation science focus.

Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.