How Chronic Pain Patients' and Physicians' Communication Influences Patients' Uncertainty: A Pre- and Post-Consultation Study.

Chronic pain is a health problem that is difficult to diagnose, treat, and manage, partly owing to uncertainty surrounding ambiguous causes, few treatment options, and frequent misunderstandings in clinical encounters. Pairing uncertainty management theory with medical communication competence, we predicted that both physicians and patients are influential to patients' uncertainty appraisals and uncertainty management. We collected pre- and post-consultation data from 200 patients with chronic neck and spine/back pain and their physicians. Patients' reports of their physician's communication were a consistent predictor of their post-consultation uncertainty outcomes. Physicians' reports of both their own and patients' communication competence were associated with patients' positive uncertainty appraisals. Physicians' reports of patients' communication competence were also associated with reductions in patients' uncertainty. Findings illustrate how both interactants' perceptions of communication competence-how they view their own (for physicians) and the other's-are associated with patients' post-consultation outcomes.

Development and Initial Assessment of an Emotional Support Provision Training Intervention for Interpersonal Support Providers in the Context of Chronic Illness.

This study reports on the development and pilot testing of an emotional support provision training intervention for interpersonal support providers to those with chronic illnesses. Using findings from a needs assessment in combination with existing theory and research, we created a training framework consisting of verbal person-centered message design, empathic listening, and communicated perspective-taking. Then, we recruited 282 individuals to participate in a pre-training questionnaire, the online training module, a post-training questionnaire, and a two-week post-training questionnaire. Outcome variables included emotional support knowledge, efficacy, and intentions, as well as general support efficacy, response efficacy, and quality. Repeated measures MANCOVA revealed significant increases from T1 to T2 for all variables of interest. These increases were sustained at T3 for emotional support knowledge and efficacy, and support provision response efficacy. Participants rated the training favorably and provided helpful suggestions for improvement. This study answers the call for more theoretically-grounded support interventions that not only assess theory in real-world settings, but also help people better their supportive communication skills.

The Impact of Health Communication Research on Medical and Health Professional Education and Training.

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.

Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health.

Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.

Identity influences on medical students' orientation to feedback during third year clinical rotations.

Medical students' feedback orientation (their attitudes about and preferences for feedback from preceptors) may change over the course of the third year of medical school and is likely influenced by identity-related factors. This study proposed that both how students view themselves personally (i.e., impostor syndrome) and how they view themselves in relation to the group (i.e., identification with the profession) are identity factors related to related to feedback orientation during clinical rotations. 177 third-year medical students enrolled in a four-phase longitudinal survey study beginning at the start of clinical rotations and continuing every twelve weeks of the academic year thereafter. Feedback orientation was conceptualized and measured as comprising aspects of utility (i.e., feedback is valuable and useful), sensitivity (i.e., feeling intimidated or threatened by corrective feedback), confidentiality (i.e., public/private context of feedback), and retention (i.e., feedback remembered). Results indicated that these aspects of feedback orientation did not significantly change during the third year. Instead, impostor syndrome was at least marginally, significantly associated with all aspects of feedback orientation across phases. Group identity was associated with feedback utility and retention, and female-identifying students reported significantly greater feedback confidentiality and feedback retention. Interventions may be needed to improve medical students' attitudes about feedback, particularly for those who experience impostor syndrome. Fostering group cohesion among medical students may influence how well students remember feedback and find it useful.

Testing a Model of Disclosure, Perceived Support Quality, and Well-Being in the College Student Mental Illness Context: A Weekly Diary Study.

Prominent disclosure models elucidate decisions to disclose health information, yet explanations for disclosure consequences remain underdeveloped. Drawing on Chaudoir and Fisher's disclosure process model, this study aims to advance understandings of how disclosure to a parent contributes to well-being for college students with mental illness. We tested a mediational model in which, at the within-person level, perceived support quality explains the association between on-going disclosure of mental illness-related experiences and well-being. Participants were 163 college students who self-identified as having mental illness and who completed six consecutive, weekly surveys. A multilevel analysis showed that increases in disclosures of mental illness-related experiences, relative to participants' mean level, were associated with enhanced well-being via perceptions of higher quality support, above and beyond between-person differences. This study contributes to the literature by offering an explanation for the effects of disclosure on well-being and underscores the importance of capturing disclosures over time.

Women's Experiences of Health-Related Communicative Disenfranchisement.

Women's inequitable healthcare experiences are epistemic injustices by which women are discredited and harmed in their position as knowers of their health and their bodies. Drawing on the theory of communicative disenfranchisement (TCD), we sought to amplify voices of women experiencing communicative disenfranchisement (CD) and to unify their stories according to theoretical premises, namely, attention to power, material conditions, discourse, identities and relationships, and process. We interviewed 36 women living in the United States whose health issues have not been taken seriously by health care providers, friends, and family - pervasive sources of disenfranchising talk surrounding health. Mapping onto the TCD framework, our findings explicate the process of CD, including the material and immaterial consequences of disenfranchising talk and women's responses to such talk. CD unfolded as a protracted and often circular process of women seeking care but encountering health dismissals and minimalizations, blaming and shaming, normalizing of their pain, and psychologizing. We unpack how disenfranchising talk rendered women crazy and dehumanized them and inflicted shame and loss. Women responded to disenfranchising talk with silence, and they (re)claimed their voice by resisting psychogenic explanations for their problems, critiquing women's healthcare, asserting their needs, and advocating for others. We discuss the implications of this research for theory and praxis.

The Role of Interpersonal Communication in Mental Health Literacy Interventions for Young People: A Theoretical Review.

School-based mental health literacy (MHL) programs can increase knowledge, reduce stigma, and encourage help-seeking behaviors in school-aged children. Yet, MHL intervention effects are inconsistent and unsustainable over time, and scholars have called for more theoretical work to address these limitations. The purpose of this theoretical review is to investigate how theory is utilized in MHL interventions, explore the interpersonal communication processes integrated in MHL interventions, and uncover the theoretical assumptions made in MHL interventions about interpersonal communication. We identified 27 articles for inclusion and utilized both content and interpretive analyses. Findings suggest that very few MHL interventions are based in theory; interpersonal communication is a central component within MHL programming; and numerous assumptions are made about interpersonal communication within MHL interventions that need to be addressed theoretically and empirically. Accordingly, we recommend that MHL intervention content and delivery practices are grounded in interpersonal communication theory related to disclosure and social support (seeking and provision). Additionally, teaching disclosure and social support skills may be a productive way for MHL interventions to help students build self-efficacy in communication about mental health for themselves and others.

"I Want Them to Still Trust Me with Their Child's Care": A Longitudinal Study of Pediatric Residents' Reactions to and Communication with Parents about Medical Uncertainty across Residency.

Physicians in residency training experience high levels of medical uncertainty, yet they are often hesitant to discuss uncertainty with parents. Guided by the theory of motivated information management and a multiple goals perspective, this mixed-methods longitudinal study examines associations among residents' tolerance of and reactions to uncertainty, efficacy communicating about uncertainty, and perceptions of parents' trust in them as physicians. To contextualize these associations, we also examined residents' task, identity, and relational goals when communicating about uncertainty with parents. We surveyed 47 pediatric residents at the beginning of each year of their residency program. As they progressed through their training, residents' uncertainty-related anxiety and reluctance to communicate uncertainty to parents decreased, and their efficacy communicating uncertainty with parents increased. Residents' concerns about bad outcomes remained unchanged. Residents pursued multiple, often conflicting, conversational goals when communicating uncertainty with parents. Results reveal important considerations for addressing how residents can manage their uncertainty in productive ways.

Denying and Accepting a Family Member's Illness: Uncertainty Management as a Process.

Doubt is a common, yet challenging form of uncertainty to have about another's illness. Although navigating illness uncertainty is a process of continual (re)appraisal and management, existing research narrowly examines windows of uncertainty experience. To illustrate how uncertainty management in the context of doubt is recursive, nonlinear, and ongoing, we apply a process approach to communication to uncertainty management theory. Drawing on interviews with 33 U.S. adults, our findings explicate a prominently teleological (i.e., goal-driven) process wherein participants' uncertainty management served to accept or deny illness, depending on the extent individuals valued their own and the other's identity and the relationship. Participants generally moved through this process along one of three trajectories: growth, stagnation, or resentment. We also observed dialectical, evolutionary, and life cycle processes in the data. Findings demonstrate the heuristic value of studying uncertainty management as a multiple motor process.

Living with Long COVID: A Longitudinal Interview Study of Individuals' Communicative Resilience Through the "Long Haul".

It is estimated that there are 65 million people globally - 19 million U.S. adults alone - who have long COVID, or persistent symptoms and conditions that continue or develop after an initial SARS-CoV-2 infection. Amidst their suffering and the ambiguity surrounding their health, people with long COVID engage processes of reintegrating from disruptions brought upon by their COVID-19 infection and its fallout, as well as the pandemic writ large. This process is communicative resilience (Buzzanell, 2010, 2017, 2019), and the purpose of this study is to document the experiences of people with long COVID as they sensemake, adapt, and transform their lives through communication. We employed longitudinal interviewing during the middle stages of the pandemic (Summer 2021 to Summer 2022), talking to 19 people with long COVID over the course of one year (five interviews each; 89 total interviews). Grounded in the six processes of communicative resilience, findings center the temporal and dialectic nature of resilience, with throughlines of grief, patience, and hope set against a tumultuous sociopolitical backdrop. Findings of this study have implications for how resilience is studied across time; how people learn to live with chronic illnesses; and how to support people living with long COVID and those who provide them care.

Why Is It Difficult for Social Network Members to Support People Living with Mental Illnesses?: Linking Mental Illness Uncertainty to Support Provision.

For people living with mental illness, support from social network members, including family, romantic partners, and friends, is critical but often inadequate. However, robust theoretical explanations for why it might it be difficult to support people living with mental illness are lacking. We assessed an appraisal-based model of uncertainty, hypothesizing that fear and anxiety and supportive communication efficacy mediate the association between mental illness uncertainty and support provision (i.e., quantity and quality). We also predicted that perceptions of others' communication about their mental illness (i.e., ambiguity and volume) would exacerbate feelings of fear and anxiety in relation to uncertainty. Analyses of data gathered from 300 individuals across the United States (Mage = 34.07, SD = 9.49; 50% female) supported our central prediction; uncertainty had a negative direct or indirect effect on all support types and overall support quality, partly through decreases in supportive communication efficacy. Counter to predictions, fear and anxiety positively predicted support quantity for all types. Findings of this study point to a difficult situation for social network members: although uncertainty seems to motivate support provision by activating fear and anxiety, this effect could be undermined for forms of support that require complex communication skills (e.g., emotional, esteem, overall quality) through corresponding decreases in supportive communication efficacy. We discuss the theoretical and practical implications of this research for social support and relationships within the context of mental illness.

Mental illness self-disclosure among college students: a pre-requisite of social support or a booster of social support benefits?

BACKGROUND: Self-disclosing a concealable stigmatized identity (CSI) such as mental illness is generally associated with enhanced psychological well-being. Research also supports the link between social support and psychological well-being. Yet, few theoretical explanations exist for the role that mental illness disclosure plays in the association between social support PWB. AIMS: To test two competing models linking self-disclosure to psychological well-being: a mediator model in which self-disclosure indirectly contributes to psychological well-being via social support quality (i.e., self-disclosure is a pre-requisite of social support), and a moderator model in which self-disclosure enhances social support benefits (i.e., self-disclosure is a "booster" of social support benefits). METHOD: College students (N = 174) who identified as being diagnosed with a mental illness completed an online survey. RESULTS: Structural equation modeling results largely supported both the mediator and the moderator models; however, which model statistically outperformed the other depended on the confidant (e.g., mother, friends). CONCLUSIONS: These findings suggest the validity of conceptualizing social support as both pre-requisite of social support and the "booster" of social support benefit on psychological well-being.

Memorable Messages Parents of Children with Vascular Birthmarks Receive from Others: Implications for Stigma and Identity.

Parents of children with visible illnesses and physical differences, such as vascular birthmarks (VBs), often fear that their child will be stigmatized by others. Despite their use of various strategies to minimize this stigma, parents still frequently receive comments and questions from others about their child's condition. In the current study, we explore the source, content, and valence of these messages using a memorable messages framework. We also examine how parents react to messages from others and why those messages are considered memorable. To collect data, we administered a cross-sectional online survey through the website and social media pages of a national support group for parents of children with vascular birthmarks. A total of 70 parents completed the survey and, altogether, recalled 92 memorable messages. Our analyses revealed that the significance of the memorable messages coalesced around identity. Specifically, the messages described carried implications for a) participants in terms of their identities as parents, and b) participants' children in terms of their identities as stigmatized individuals. When messages were directed at parents, parents appraised them negatively or positively to the extent that they made parents feel judged or validated as parents of children with VBs. When messages were directed at children, parents appraised them negatively or positively to the extent that they labeled children and their VB as abnormal, unattractive, and undesirable, or accepted and complimented children as unique, special, and beautiful. The current research extends previous research exploring the role of memorable messages in negotiating identity.

"I Don't Claim to Be the World's Foremost Expert, But . . . ": How Individuals "Know" Family Members Are Not Experiencing Health Issues as Severely as They Claim.

To understand how individuals come to "know" that their family members are not experiencing their health issues as severely as they claim, we interviewed 32 individuals (nine men and 23 women, M age = 35.28 years, SD = 9.91 years) about a family member who they believe falsifies or exaggerates his or her health condition(s). Our analyses illuminate two interlinked processes of knowledge construction: (a) developing evidentiary standards and (b) gathering evidence. In engaging these processes, participants sought two types of consistency: correspondence with external "facts" (e.g., medical information, cultural [mis]conceptions), and internal coherence (i.e., complaints were highly self-contradictory and unpredictable or were overly predictable). When initial inconsistencies made participants doubt their family member, participants gathered additional evidence, including experiential, behavioral, and interactional evidence, to test and revise their initial suspicions. We discuss the implications of this research for theory and for families coping with illness.

Misrepresenting Health Conditions Through Fabrication and Exaggeration: An Adaptation and Replication of the False Alarm Effect.

This article reports on a series of studies of the false alarm effect (FAE), suggesting that individuals' perceptions that relational partners are fabricating and exaggerating their health conditions are negatively associated with perceptions of health condition credibility, which in turn are associated with decreases in individuals' protective behaviors and attitudes. In Study One (N = 216), we took a mixed-methods approach to test an initial model predicting that health condition credibility mediates associations between individuals' perceptions that partners are fabricating and exaggerating and the extent to which individuals provide support, seek information about the condition, feel efficacious in their ability to assist partners, and believe that the condition is serious. We also analyzed open-ended responses to parse the source(s) of credibility lost when individuals believe partners are fabricating and exaggerating their health conditions. We found that they express doubt not only about the credibility of the health condition itself, but also about their partner's credibility in terms of trustworthiness. We then refined our conceptual model to account for these two sources of credibility and tested it with a path model in a second study utilizing a nationally representative sample (N = 508). Results supported our hypotheses. We discuss the implications of this research for how people present themselves as ill in personal relationships, and what happens when these presentations are unconvincing.

Stress, Frequency of Challenges, and Coping for Partners of Individuals with Mental Health Conditions.

This study applied Lazarus and Folkman's stress and coping framework to understand how romantic partners cope with the challenges of a significant other's mental health condition at three levels (i.e., individual, dyadic, and social), how coping at each of these three levels contributes to the association between stress and relational quality for these partners, and how these associations depend upon the frequency of challenges partners experience. We predicted that stress would be negatively associated with relational quality, and that individual (i.e., emotion and problem-focused), dyadic, and social coping would mediate this association. We also posited that the extent to which partners cope would depend on the frequency of challenges they face. We analyzed data from 325 individuals with a moderated multiple-mediation model. Findings provided support for the mediating role of dyadic coping and its positive association with relational quality; partial support for the mediating role of emotion-focused coping and its negative association with relational quality; and partial support for the moderating role of frequency of challenges. We discuss the study's findings and contributions.

College Students' Drinking and Posting About Alcohol: Forwarding a Model of Motivations, Behaviors, and Consequences.

College drinking continues to remain a public health problem that has been exacerbated by alcohol-related posts on social networking sites (SNSs). Although existing research has linked alcohol consumption, alcohol posts, and adverse consequences to one another, comprehensive explanations for these associations have been largely unexplored. Thus, we reasoned that students' personal motivations (i.e., espousing an alcohol identity, needing entertainment, and adhering to social norms) influence their behaviors (i.e., alcohol consumption and alcohol-related posting on SNSs), which can lead to alcohol problems. Using structural equation modeling, we analyzed data from 364 undergraduate students and found general support for our model. In particular, espousing an alcohol identity predicted alcohol consumption and alcohol-related SNS posting, needing entertainment predicted alcohol consumption but not alcohol-related SNS posting, and adhering to social norms predicted alcohol-related SNS posting but not alcohol consumption. In turn, alcohol consumption and alcohol-related SNS posting predicted alcohol problems. It is surprising that alcohol-related SNS posting was a stronger predictor of alcohol problems than alcohol consumption. We discuss the findings within their applied applications for college student health.

Mother-teen communication about weight management.

Although research shows family members can influence each other's diet and exercise behaviors, the specific strategies that most effectively motivate individuals to enact healthy behaviors have not been revealed. Toward this goal, this study employed confirmation theory to assess how the quality of weight management (WM) communication between 107 mother-teen dyads was related to their diet and exercise behaviors as well as their subjective perceptions of the productivity of WM conversations. Confirmation theory proposes two components of confirmation: acceptance and challenge. Analyses revealed that accepting and challenging communication were both positively related to the perceived productivity of WM conversations. However, more complex associations emerged for diet and exercise. Acceptance was more helpful in motivating better eating habits for mothers with low health motivation and teens with high health motivation. For exercise, challenge was helpful in motivating teens with higher sensitivity about communicating about weight issues; however, counter to predictions, challenge was negatively related to exercise for teens with low health motivation and low sensitivity. These interactions, however, explained less variance than analyses for perceived effectiveness and satisfaction.

The State of Machine Learning in Outcomes Prediction of Transsphenoidal Surgery: A Systematic Review.

The purpose of this analysis is to assess the use of machine learning (ML) algorithms in the prediction of postoperative outcomes, including complications, recurrence, and death in transsphenoidal surgery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed all papers that used at least one ML algorithm to predict outcomes after transsphenoidal surgery. We searched Scopus, PubMed, and Web of Science databases for studies published prior to May 12, 2021. We identified 13 studies enrolling 5,048 patients. We extracted the general characteristics of each study; the sensitivity, specificity, area under the curve (AUC) of the ML models developed as well as the features identified as important by the ML models. We identified 12 studies with 5,048 patients that included ML algorithms for adenomas, three with 1807 patients specifically for acromegaly, and five with 2105 patients specifically for Cushing's disease. Nearly all were single-institution studies. The studies used a heterogeneous mix of ML algorithms and features to build predictive models. All papers reported an AUC greater than 0.7, which indicates clinical utility. ML algorithms have the potential to predict postoperative outcomes of transsphenoidal surgery and can improve patient care. Ensemble algorithms and neural networks were often top performers when compared with other ML algorithms. Biochemical and preoperative features were most likely to be selected as important by ML models. Inexplicability remains a challenge, but algorithms such as local interpretable model-agnostic explanation or Shapley value can increase explainability of ML algorithms. Our analysis shows that ML algorithms have the potential to greatly assist surgeons in clinical decision making.