Ask questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.

OBJECTIVE: This descriptive, single-arm study assessed the implementation and patient perceptions of an evidence-based Question Prompt List (QPL), the ASQ brochure, across a network of oncology clinics in a diverse patient population. METHOD: The QPL was revised in collaboration with stakeholders. Implementation was assessed using the RE-AIM framework. Eligible patients were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (perceived knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and linear mixed-effects models. RESULTS: Reach: Participants (n = 81) represented the diverse population served by the clinic network. EFFICACY: All outcomes improved significantly, with no significant differences by clinic site or patient race. Adoption: All eight invited clinics participated and recruited patients. Patient perceptions of the ASQ brochure were overwhelmingly positive. CONCLUSION: Implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. PRACTICAL IMPLICATIONS: This evidence-based communication intervention can be implemented widely in similar medical contexts and populations.

Addressing multilevel barriers to clinical trial participation among Black and White men with prostate cancer through the PACCT study.

BACKGROUND: Cancer clinical trial participation is low and inequitable. Partnering Around Cancer Clinical Trials (PACCT) addressed systemic and interpersonal barriers through an observational study of eligibility and an intervention to improve patient-physician communication and trial invitation rates. METHODS: Physicians at two comprehensive cancer centers and Black and White men with prostate cancer participated. Patients were followed for 2 years to determine whether they became potentially eligible for an available therapeutic trial. Potentially eligible patients were randomized to receive a trials-focused Question Prompt List or usual care. Patient-physician interactions were video-recorded. Outcomes included communication quality and trial invitation rates. Descriptive analyses assessed associations between sociodemographic characteristics and eligibility and effects of the intervention on outcomes. RESULTS: Only 44 (22.1%) of participating patients (n = 199) became potentially eligible for an available clinical trial. Patients with higher incomes were more often eligible (>$80,000 vs. <$40,000, adjusted OR = 6.06 [SD, 1.97]; $40,000-$79,000 vs. <$40,000, adjusted OR = 4.40 [SD, 1.81]). Among eligible patients randomized to the intervention (n = 19) or usual care (n = 25), Black patients randomized to the intervention reported participating more actively than usual care patients, while White intervention patients reported participating less actively (difference, 0.41 vs. -0.34). Intervention patients received more trial invitations than usual care patients (73.7% vs. 60.0%); this effect was greater for Black (80.0% vs. 30.0%) than White patients (80.0% vs. 66.7%). CONCLUSIONS: Findings suggest the greatest enrollment barrier is eligibility for an available trial, but a communication intervention can improve communication quality and trial invitation rates, especially for eligible Black patients.

Physicians' use of plain language during discussions of prostate cancer clinical trials with patients.

OBJECTIVE: This study described physicians' use of plain language during patient-physician cancer clinical trial discussions. METHODS: Video-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial. We used descriptive, qualitative discourse analysis, a method that identifies language patterns at or above the sentence level. We first excerpted discussions of clinical trials, then identified instances of plain language within those discussions. Finally, we inductively coded those instances to describe physicians' plain language practices. RESULTS: The analysis identified four plain language practices. Lexical simplification replaced medical terminology with simpler words. Patient-centered definition named, categorized, and explained complex medical terminology. Metaphor explained medical terminology by comparing it with known concepts. Finally, experience-focused description replaced medical terminology with descriptions of patients' potential physical experiences. CONCLUSION: These plain language practices hold promise as part of effective information exchange in discussions of cancer clinical trials. Testing is needed to identify patient preferences and the extent to which these practices address patient health literacy needs. PRACTICE IMPLICATIONS: Pending further testing, these plain language practices may be integrated into physician clinical trial and other communication training.

Analysis of Bystander Behavior Towards Intimate Partner Violence via Peerformance.

This study of a South Asian community in the midwestern USA examines what bystanders do when they witness an incident of intimate partner violence (IPV). Because of ethical and safety constraints, in lieu of observation in a natural setting, data were collected at a Peerformance, a peer-led IPV prevention program, using the forum theatre method introduced in Augusto Boal's Theatre of the Oppressed. Event attendees were invited to respond to an IPV incident enacted by peer educators in which a controlling husband's behavior escalates to the point of suggesting physical violence. Using a grounded theory approach, we analyzed the videotaped bystander actions while applying pertinent aspects of visual analysis. Event attendees responded in variety of ways, exploring and/or de-escalating the situation, providing information, and encouraging the couple to resolve their conflict and/or seek outside help. They expressed empathy, support, and (dis)agreement with the husband and the wife. Their actions encompassed a number of dimensions: introductory, investigative, supportive/empathic, informational, instructional, instrumental, and confrontational. Participants' vastly varied responses to IPV within the same scenario suggest difficulty in developing a generic IPV bystander program. The findings also suggest possible directions for developing bystander programs to address IPV. In lieu of prescribing and/or proscribing specific actions in a given risk situation, bystander training can help participants build their repertoire of actions while collectively examining the strengths and limitations of various actions in their sociocultural context. Such bystander training is complex and difficult to manualize; it will involve reflexive and critical discussions and learning and trying out various possible alternatives. A Peerformance is a site of action, a realistic and familiar milieu where community members can imagine and try out interventions that may be different from the norm of indifference and non-intervention. It can open up new possibilities for addressing IPV in diverse communities.

Peerformance: Bystanders Enacting and Challenging Gender Norms in Community-Based Theater to Prevent Domestic Violence.

This study examined the gender beliefs and norms expressed by South Asian community members when intervening as bystanders in Peerformance, a publicly performed scene depicting a husband's controlling behavior toward his wife enacted by a peer-led theater group. Using a grounded theory approach, inductive coding and reiterative visual analysis of videotaped bystander interactions revealed that, while most community members confronted the husband, beliefs about gender roles and relations impacted how these confrontations occurred. The complexity of gender norms in bystanders' interventions calls for sociocultural tailoring; bystander programs must attend to the rich, within-group variations in community members' attitudes and beliefs.