Epidemiology of Connectional Silence in specialist serious illness conversations

ContextHuman connection can reduce suffering and facilitate meaningful decision-making amid the often terrifying experience of hospitalization for advanced cancer. Some conversational pauses indicate human connection, but we know little about their prevalence, distribution or association with outcomes.PurposeTo describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.MethodsWe audio-recorded 226 inpatient palliative care consultations at two academic centers. We identified pauses lasting 2+ seconds and distinguished Connectional Silences from other pauses, sub-categorized as either Invitational (ICS) or Emotional (ECS). We identified treatment decisional status pre-consultation from medical records and post-consultation via clinicians. Patients self-reported quality-of-life before and one day after consultation.ResultsAmong all 6769 two-second silences, we observed 328 (4.8%) ECS and 240 (3.5%) ICS. ECS prevalence was associated with decisions favoring fewer disease-focused treatments (OR_adj: 2.12; 95% CI: 1.12, 4.06). Earlier conversational ECS was associated with improved quality-of-life (p = 0.01). ICS prevalence was associated with clinicians' prognosis expectations.ConclusionsConnectional Silences during specialist serious illness conversations are associated with decision-making and improved patient quality-of-life. Further work is necessary to evaluate potential causal relationships.Practice implicationsPauses offer important opportunities to advance the science of human connection in serious illness decision-making.     

What do we know about written assessment of health professionals’ communication skills? A scoping review

ObjectiveThe aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals’ education.MethodsPubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995–7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics.ResultsFrom 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported.ConclusionThere are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.     

Health professionals’ view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review

ObjectiveTo identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC).MethodsSearch on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis.ResultsThirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation.ConclusionHope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions.Practical implicationsFindings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.     

Molecular modeling in cardiovascular pharmacology: Current state of the art and perspectives

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Challenges for precision public health communication in the era of genomic medicine

Although still in the early stages of development, the advent of fast, high-output, and cost-effective next-generation DNA sequencing technology is moving precision medicine into public health. Before this shift toward next-generation sequencing in public health settings, individual patients met geneticists after showing symptoms and through limited family screening. In the new era of precision public health, everyone is a possible participant in genetic sequencing, simply by being born (newborn screening), by donating blood (biobanking), or through population screening. These initiatives are increasingly offered to individuals throughout their life and more individuals are encountering opportunities to use DNA sequencing. This article raises awareness of these growing areas and calls for different models of public engagement and communication about genomics, including screening asymptomatic populations, obtaining consent for unspecified and unforeseen future uses of genomic data, and managing variants of uncertain significance. Given that such communication challenges loom large, established norms of practice in genomic medicine and research should be reconsidered.     

Fear of cancer recurrence in lymphoma survivors: A descriptive study

Abstract

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin’s and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population.

Research Approach: The parent study was a multi-site, cluster-randomized trial to assess a communication skills intervention: survivorship planning consultation (versus a time-attention control - wellness rehabilitation intervention) to promote transition to survivorship.

Participants & Methodological Approach: 199 patients enrolled in the study and completed a survivorship (or control) consultation one-month after receiving the news of their survivorship status; 141 of those patients (n?=?92 experimental arm, n?=?49 control arm) completed an interview at their 6-month follow-up consultation. In the interview, participants described frequency of FCR, causes of FCR, coping mechanisms, and specific things oncologists said to reduce FCR. Both qualitative and quantitative methods were utilized for analyzing participant responses.

Findings: The majority (88%) of participants reported experiencing FCR, with a higher number of participants in the experimental arm significantly more likely to endorse FCR compared to the control group participants. The main causes of FCR were having medical appointments and concerns about potential relapse and secondary cancers. Participants endorsed utilizing self-sufficient coping mechanisms. As well, participants reported that oncologists most frequently cited specific cure rates of lymphoma to reduce patients’ FCR.

Interpretation & Implications for Psychosocial Providers: Communication skills training programs should emphasize FCR in survivorship consultations.     

Suivi qualitatif de l’évolution de 120 enfants porteurs de troubles du spectre autistique pris en charge par la méthode des 3i

AimThe 3i intervention is a developmental play-therapy method that considers that children with Autism Spectrum disorders (ASD) present an altered developmental process. It aims to help the child progress along a natural developmental path. Each developmental deficit is dealt with successively, with full attention to the specific sensory characteristics of each child. The method is based on Intensive Individual Interaction (the 3Is) of the child with adults. The 3i intervention is managed by the parents and selected care-givers, 5 to 6 hours per day, 7 days per week, to favor constant stimulation of the child. A key characteristic of the 3i method is the intervention of numerous selected care-givers, each contributing their preferred way of playing with the child and their enthusiasm. These selected care-givers are mostly non-professionals in the field of ASD. They undergo preliminary screening and receive initial training before interacting with the child in the playroom. They subsequently participate each month in a group session with the other participants, together with the parents, under the supervision of a trained psychologist.GoalThe main objective of this retrospective study was to assess the development of communication and social skills among children diagnosed with autism spectrum disorders (ASD), treated with the 3i method for 2 years.Methods120 subjects who pursued the 3i method for 24 months were included in this study, on the basis of their individual files kept by the psychologist, who conducted the monthly meeting with professionals during the implementation of the 3i method. The psychologist rated six indicators (Imitation, Gaze Quality, Social and Emotional Regulation, Verbal Expression, Non-Verbal Expression and Verbal Comprehension) from 1 to 3 (1: not acquired; 2: partially acquired and 3: competence acquired). Thus a developmental acquisition stage or score was allocated to each patient at the beginning of 3i Method and 24 months later.ResultsFor each indicator, the statistical analysis showed that the group of patients significantly increased their skills over the 24 months of the 3i method. On average, the patients reached a higher level of skills in four of the six skill areas. There was a relatively greater increase in the skills relating to imitation and non-verbal communication.DiscussionBeyond the limitations arising from the retrospective nature of the study, which used a non-standardized assessment scale, these results are consistent with a previous prospective study on 20 subjects using international standardized instruments. These results suggest that disabilities related to autism spectrum disorders decrease as a result of a 3i intervention, enabling better daily-life interaction with parents and as a second step better integration in school with peers.ConclusionThis method could reduce the intensity of the autistic syndrome and improve the ability of ASD children to interact with their environment.