This research program is guided by the following aims:
Example Studies: “Investigating Patient-centered Communication in Cancer Care”
Cancer is a word that produces fear like no other disease. This is not surprising as cancer is one of the leading causes of death in the U.S. and worldwide (see American Cancer Society for specific statistics). For example, women in the general population have a 12% chance of developing breast cancer and a 1% chance of developing ovarian cancer. Yet individuals who have a harmful BRCA genetic mutation are at a significantly increased risk of developing cancer during their lifetime (i.e., 40-87% breast and 22-65% ovarian for BRCA1 carriers and 18-87% breast and 10-35% ovarian for BRCA2 carriers, Mavaddat et al., 2013). Whether an individual at high-risk or a patient diagnosed with cancer, communication is key to accurate monitoring and diagnosis, effective treatment, and survivorship. In particular, patient-centered care enhances communication, which produces better health outcomes (i.e., cure, emotional well-being, quality of life, etc.). Thus, by investigating what patient-centered communication looks like in medical encounters between healthcare providers, patients, and family members, then eventually, the word cancer may not be as scary as we think. The following studies provide examples of research projects dedicated to this goal and desired outcome.
Abstract: The Internet is a popular source for Americans searching for health information. The potential for Internet usage for breast cancer information seeking makes it important to understand the types and relative frequency of content on environmental risk factors, prevention, detection, treatment, awareness, social support, and survivorship on popular breast cancer web pages. The top search results for websites in the most popular three search eninges (Google, MSN, and Yahoo) were used to identify websites and web pages, and a total of 415 web pages were analyzed. This study demonstrates that about half of the top appearing web pages in popular search engines provide at least some information regarding environmental risks, risk reduction behaviors, awareness, prevention, detection, and treatment, while social support and survivorship topics were less frequently appearing topics. The study used ordinal codes and individual web pages as unit of analysis, the results of which provide greater insight than prior content analyses of breast cancer media information.
Abstract: Objective: To describe pathways through which clinicians can more effectively respond to patients’ emotions in ways that contribute to betterment of the patient’s health and well-being. Methods: A representative review of literature on managing emotions in clinical consultations was conducted. Results: A three-stage, conceptual model for assisting clinicians to more effectively address the challenges of recognizing, exploring, and managing cancer patients’ emotional distress in the clinical encounter was developed. To enhance and enact recognition of patients’ emotions, clinicians can engage in mindfulness, self-situational awareness, active listening, and facilitative communication. To enact exploration, clinicians can acknowledge and validate emotions and provide empathy. Finally, clinicians can provide information empathetically, identify therapeutic resources, and give referrals and interventions as needed based to help lessen patients’ emotional distress. Conclusion: This model serves a framework for future research examining pathways that link clinicians’ emotional cue recognition to patient-centered responses exploring a patient’s emotional distress to therapeutic actions that contribute to improved psychological and emotional health. Practical Implications: Specific communicative and cognitive strategies are presented that can help clinicians better recognize a patient’s emotional distress and respond in ways that have therapeutic value.
Abstract: One of the most understudied and problematic aspects of communication skills in medical encounters is the management of uncertainty. This chapter reviews evidence related to theories of uncertainty in health and illness, different sources of uncertainty, the psychosocial effects of medical uncertainty, and communicative skills clinicians can use to assist patients 'manage' uncertainty. We then demonstrate how these communication skills can be learned and routinely applied in delivery of health care in order to improve health outcomes. We conclude with particular priorities for future research exploring uncertainty management in clinical encounters.
Abstract: On May 14, 2013 Angelina Jolie disclosed she carries BRCA1, which means she has an 87 percent risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5 percent. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie’s decision. Qualitative content analysis revealed four main themes—information about genetics, information about a PBM, information about healthcare, and information about Jolie’s gender identity. Broadly, the identified websites mention Jolie’s high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to healthcare services, costs, and insurances about Jolie’s health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie’s health decision in positive, negative, and/or both ways. Discussion centers on how this actress’ health decision impacts the public.
Abstract: Rationale: Women with a harmful mutation in the BReast CAncer (BRCA) gene are at significantly increased risk of developing hereditary breast and ovarian cancer (HBOC) during their lifetime, compared to those without. Such patients—with a genetic predisposition to develop cancer but who have not yet been diagnosed with cancer—live in a constant state of uncertainty and wonder not if they might get cancer but when. Objective: Framed by uncertainty management theory, the purpose of this study was to explore BRCA-positive patients’ health experiences after testing positive for the BRCA genetic mutation, specifically identifying their sources of uncertainty. Methods: Thirty-four, qualitative interviews were conducted with female patients. Participants responded to online research postings on the non-profit organization Facing Our Risk of Cancer Empowered’s (FORCE) message board and social media pages as well as HBOC-specific Facebook groups. The interview data were coded using the constant comparison method. Results: Two major themes representing BRCA-positive patients’ sources of uncertainty regarding their genetic predisposition and health experiences emerged from the data. Medical uncertainty included the following three subthemes: the unknown future, medical appointments, and personal cancer scares. Familial uncertainty encompassed the subthemes traumatic family cancer memories and motherhood. Conclusions: Overall, the study supports and extends existing research on uncertainty—revealing uncertainty is inherent in BRCA-positive patients’ health experiences—and offers new insight regarding uncertainty management and HBOC risk.
Abstract: Individuals with a genetic predisposition to develop hereditary breast and ovarian cancer (HBOC), but who have not been diagnosed with cancer, are referred to as previvors. Although genetic testing may reduce previvors’ worries about whether or not they have a high genetic cancer risk, testing positive produces negative emotions and long-term uncertainty—thus requiring the management of uncertainty. Existing research indicates family, friends, and social support networks are limited in their assistance for previvors’ uncertainty management. Therefore, this study examined how healthcare providers may assist previvors in uncertainty management by asking: What strategies do BRCA-positive previvors enact with their healthcare providers to help manage their uncertainty about HBOC? Purposive sampling was employed to recruit participants via online social media. The final sample consisted of 34 BRCA-positive women. Interviews revealed four uncertainty management strategies—seeking healthcare providers as informational sources, seeking healthcare providers as partners for decision-making, seeking healthcare providers for supportive communication, and seeking referrals from healthcare providers for social support networks. Findings indicate that healthcare providers who are knowledgeable about BRCA, provide information, answer questions, check understanding, and provide additional resources assist previvors in managing their uncertainties by distinguishing options and fostering meaning.
This research program is guided by the following aims:
1) Identify and explore how patients and providers define effective communication
2) Examine how healthcare environments and professionals’ roles impact the communication process
3) Broaden the understanding of medical communication beyond information exchange to a more holistic, multilayered viewpoint including rapport and contextual issues
4) Partner with medical professionals and organizations to heighten the translation of research to clinical care and practice
5) Develop communication interventions to enhance effective communication between patients, families, and healthcare providers to improve health outcomes
Example Studies: “Examining Emergency Department Communication Challenges and Practices in order to Improve Caregiving”
Effective communication is essential to successful medical interactions. While effective communication is a challenge in many healthcare contexts, the mix of multiple professions, pressing resource constraints, problems of uncertainty and information management, and physical space make emergency departments (EDs) particularly important settings for study. In order to understand how such challenges influence patient-provider interactions as well as identify communication practices to improve care, a recent research project examined communication at an ED named EmergiCare—an Academic Medical Center and Level-1 Trauma Center hospital located in the Southwestern US. The following studies provide a synopsis of the research project and their associated publications.
Abstract: The purpose of this study was to explore Emergency Department (ED) physicians’ perspectives of guidelines for effective communication. More specifically, the ways in which physicians manage the tensions among effective communication dimensions framed by relational dialectics theory are examined. This study used in-depth interviews with 17 ED physicians and 70 hours of observations to identify five dimensions of effective communication: efficiency, clarity/accuracy, relevance, comprehension, and rapport. Two communication tensions resulted from these dimensions: efficiency vs. rapport and efficiency vs. comprehension. In almost all instances, physicians chose efficient communication at the expense of comprehension or rapport. In addition, there was a tension between patient and physician perspectives of clarity and relevance that physicians tended to resolve by emphasizing what was relevant and clear from their own perspective. Implications for managing tensions in terms of efficiency and a physician-centered approach are discussed.
Abstract: The importance of effective communication in medical encounters cannot be understated. Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial as providers typically do not know patients’ medical history or have established relationships; conversations are time-constrained, and interruptions are frequent; and patients’ health problems may create additional tension during interactions. Yet, health communication often emphasizes information exchange—the transmission and receipt of messages leading to a mutual understanding of patients’ condition, needs, and treatments. Such an approach can be problematic because it does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information that is exchanged. The purpose of this article is to share the perspective of communication scientists to enrich the current approach to medical communication, broadening the understanding of medical communication beyond information exchange to a more holistic, multi-layered viewpoint, which includes rapport and contextual issues. We propose the use of a socio-ecological model for understanding communication in acute ambulatory care. The socio-ecological model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Specifically, its key elements include the following: a) message exchange; b) individual factors; c) organizational factors, d) societal factors; and e) cultural factors. Using this model, providers and medical educators can analyze and teach about communication by considering these factors, and we provide recommendations to do so.
Abstract: The purpose of this paper is to provide practical recommendations for shadowing as a method of organizational study with a focus on the situated processes and practices of shadowing fieldwork. This paper reflects on the shadowing experiences of three researchers – in a hospital emergency department, nuclear power plants, and entrepreneur workspaces – to generate recommendations by identifying and synthesizing solutions that emerged during the encounters with the challenges and opportunities in shadowing. Considering shadowing as an ongoing and emergent research process can be helpful to prepare for particular aspects of shadowing fieldwork. Shadowing presents research challenges that may emerge in the practice of fieldwork, including how to negotiate awkward conversations with participants, what to bring and wear, and how to take notes. Though the recommendations for shadowing are based on particular experiences and may not generalize to all shadowing engagements, they offer concrete, practical recommendations useful across experience levels. The recommendations should sensitize researchers to the intimate and situational character of shadowing, and offer strategies for coping with the distinctive requirements of shadowing. By looking across diverse experiences of shadowing, the paper generated guidelines that help to make sense of shadowing processes, manage uncertainty in the field, and build on the emerging work on shadowing. The ten recommendations provide insight into shadowing that are of particular value to graduate students, junior researchers, and those new to shadowing. Moreover, the experienced shadower may find value in the camaraderie of shared experience, the concrete ideas about another’s experience of shadowing, and insight in recommendations that capture aspects of fieldwork that they are also exploring.
Abstract: Communication is key to hospital emergency department (ED) caregiving. The mix of multiple professions, pressing resource constraints, problems of uncertainty and information management, and physical space make EDs important settings for study. Informed by communication-as-design (CAD) approach, this study reports an analysis of the communication at EmergiCare—an Academic Medical Center and Level-1 Trauma Center hospital located in the Southwestern US. Based on 70 hours of shadowing, this study explores the intersection of professional roles and the physical space in which communication occurred at EmergiCare. Analysis revealed two communication patterns “case talk” and “comfort talk” and highlights how such talk was influenced by professional roles and the physical setting such as provider stations, patient rooms, and corridors. Additionally, given the interconnectedness of communication and physical space, a hypothetical “redesign” of EmergiCare is offered. Overall, this study answers calls to consider macro-discursive concerns of work and occupation alongside material reality as well as the need to mirror innovations in medical technology with innovative communication.