The Pursuit of Positive Impacts: Translating Longitudinal Cancer Studies into Successful Health Communication Interventions.

Over a decade ago, in the 100th issue of Health Communication (Volume 25, issues 6-7); 2010), 30 "impact" articles addressed how our collective research findings had been translated to make a positive difference for persons across diverse communities. It is laudable to develop projects helping others to enhance their awareness about healthy living, refine practical communication skills to promote behavioral change, and rely on findings to enact important practices and policies giving priority to how well and long we live in contemporary society. As a preview, however, an article entitled "Why is it so difficult to talk about impact?" raised a series of inherent challenges faced whenever we conduct our research to advance basic knowledge by pursuing meaningful translation opportunities. These efforts are constrained in various ways: A lack of motivation, ability, and training to envision and implement protocols beneficial for the public good; the need to procure adequate resources (e.g., time and money) for sustaining longitudinal investigations; dealing with misconceptions that "applied" communication research has less value than "basic" studies; and creating and managing cross-disciplinary collaborations necessary to achieve project goals. When designing interventions to change others' lives in meaningful ways, attention must also be given to balancing community outreach while avoiding unnecessary self-promotion and imposition of social scientific priorities.

A White Family's Oral Storytelling About Cancer Generates More Favorable Evaluations From Black American Audiences.

One proposition of Entertainment Education (EE) suggests that actors communicating messages should be ethnically and culturally homogenous with targeted audiences. The present study challenges this assumption by investigating audience evaluations of When Cancer Calls... (WCC), a unique 80-minute theatrical production based on actual phone conversations between family members dealing with a loved one's cancer diagnosis, treatment, and eventual death. In WCC, the family is White and all interactions are drawn verbatim from 61 recorded phone calls made over 13 months. This study addresses whether authentic family storytelling about cancer minimizes differences between the White family in WCC, diverse Persons of Color (POC), and specifically how WCC resonates with Black Americans' cancer experiences. Data collected (n=483) from audiences in four U.S. cities confirmed overall positive audience reactions to viewings of WCC. Blacks were significantly more likely to evaluate WCC favorably than Whites or other POC. Rooted in the prominence of oral communication traditions, these findings confirm the power of family storytelling as a vehicle for designing health communication campaigns for Black American audiences. For example, when Blacks were forbidden to learn how to read and write during American slavery, family storytelling was a powerful tool for preserving history, sharing news, resisting racism in hostile environments, and sustaining resilience necessary for survival. These WCC findings provide innovative strategies for facilitating communication among cancer patients and family members, especially Black Americans who are deeply affected and face ongoing challenges talking about cancer.

The Transformative Power of Authentic Conversations About Cancer.

Entertainment-education (E-E) assumes that actors performing content should be ethnically and culturally homogeneous with targeted audiences. The present study challenges this basic E-E assumption. Findings are presented from audience members who viewed When Cancer Calls… This theatrical production was constructed from verbatim transcriptions of naturally occurring telephone conversations between White family members as they communicated about and through their cancer journey. Non-White audience members were significantly more likely than White audience members to (a) regard the performance as authentic, (b) find it would influence "people like me," and (c) recommend the production to others. These findings suggest that all people must rely on communication when facing health challenges together. Such interactions that are fundamental to family membership are thus primal for the human social condition, regardless of differences in race and ethnicity. These findings also suggest innovative approaches to E-E health interventions that may contradict traditional market segmentation theories based on cultural differences and the principle of homophily.

The Conversations About Cancer (CAC) Project-Phase II: National findings from viewing When Cancer Calls and implications for Entertainment-Education (E-E).

OBJECTIVE: We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls…(WCC…), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone. METHODS: A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members. Comparisons were made with a control video on cancer nutrition and diet. Pretest-posttest sample size was 1006, and 669 participants completed a 30-day follow-up impacts assessment. RESULTS: All five family and communication indices increased significantly for WCC…. When compared to the placebo, average pretest-posttest change scores were higher for self-efficacy (775%), family fabric (665%), outside support (189%), and family communication (97%). One month following viewings, WCC…participants reported 30% more conversations about cancer among patients and family members about cancer. CONCLUSION: A new genre of Entertainment-Education (E-E) was created that triggers positive reactions from audience members. Managing delicate and often complex communication about the trials, tribulations, hopes, and triumphs of cancer journeys is fundamentally important for everyday living. PRACTICE IMPLICATIONS: Unique opportunities exist to make WCC… available to national and global audiences, create tailored curricula, and integrate these viewings into educational programs for patients, family members, and care-provider teams across diverse health, corporate, and governmental systems.

Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews.

New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.

The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play.

Basic communication research has identified a major social problem: communicating about cancer from diagnosis through death of a loved one. Over the past decade, an award-winning investigation into how family members talk through cancer on the telephone, based on a corpus of 61 phone calls over a period of 13 months, has been transformed into a theatrical production entitled The Cancer Play. All dialogue in the play is drawn from naturally occurring (transcribed) interactions between family members as they navigate their way through the trials, tribulations, hopes, and triumphs of a cancer journey. This dramatic performance explicitly acknowledges the power of the arts as an exceptional learning tool for extending empirical research, exploring ordinary family life, and exposing the often taken-for-granted conceptions of health and illness. In this study, a Phase I STTR project funded by the National Cancer Institute (NCI), we assess the feasibility of educating and impacting cancer patients, family members, and medical professionals who viewed the play as a live performance and through DVD screenings. Pre- and postperformance questionnaires were administered to solicit audience feedback. Pre-post change scores demonstrate overwhelming and positive impacts for changing opinions about the perceived importance, and attributed significance, of family communication in the midst of cancer. Paired-sample t-tests were conducted on five factor-analyzed indices/indicators-two indices of opinions about cancer and family communication, two indices measuring the importance of key communication activities, and the self-efficacy indicator-and all factors improved significantly (<.001). Informal talkback sessions were also held following the viewings, and selected audience members participated in focus groups. Talkback and focus-group sessions generated equally strong, support responses. Implications of the Phase I study are being applied in Phase II, a currently funded effort to disseminate the play nationally and to more rigorously test its impact on diverse audiences. Future directions for advancing research, education, and training across diverse academic and health care professions are discussed.