Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care

ObjectiveBoth patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations.MethodsAn exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings.Results24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings.ConclusionsPersuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact.Practice implicationsAwareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.     

Barriers and facilitators for an effective palliative care communication with older people: A systematic review

ObjectivesThe present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.MethodsThe review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.ResultsTwenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.ConclusionPalliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.Practice implicationsFacilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging.     

Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication

ObjectivesTelephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training.Methods50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C.ResultsMean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice.ConclusionsThis study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus.Practice implicationsCommunication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.     

Using qualitative methods to inform the design of a decision aid for people with advanced cystic fibrosis: The InformedChoices CF patient decision aid

ObjectiveTo assess information needs of adults with Cystic Fibrosis and their families toward designing a patient decision aid about invasive mechanical ventilation (IMV) and lung transplant.MethodsFocus groups and in-depth interviews explored participants’ knowledge, prior clinical conversations, and decisions about IMV and lung transplant. Interviews and focus groups were recorded and transcribed for analysis.ResultsN = 24 participants were recruited. Themes identified were: prior communication with clinicians, decision-making process, and living with CF. Participants having prior conversations with CF clinicians regarding: lung transplant (N = 17/74%), and IMV (N = 3/13%). Most 15(65%) felt it was important to hear patients’ real-life experience, others (3/13%) relied on their CF doctors for information. Most people (16/70%) believed hearing prognosis was helpful, but 5(22%) found this information frightening. High degrees of social isolation and a desire for more interaction with other CF adults were found.ConclusionsQualitative methods helped identify areas important for decision making about IMV and LT for CF adults. Future directions include usability and feasibility testing of the decision aid.Practice implicationsBecause IMV is rarely discussed with CF adults, clinicians might approach this topic, as with transplant, as lung function begins to decline. CF-care teams should also foster CF patient-level information exchange.     

Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

ObjectiveGeneral practitioners (GPs) disclose more uncertainty (e.g. “I don’t know”) in consultations with patients presenting medically unexplained symptoms (MUS) versus medically explained symptoms (MES), which could negatively affect patient outcomes. This study assessed if this pattern also holds for more subtle, implicit uncertainty expressions (e.g. “maybe”, “might”) during different consultation phases, and assessed their relation to patient pre-post consultation anxiety.MethodsWe quantified implicit markers of uncertainty of 18 GPs in 82 consultations about MUS or MES during different consultation phases. Relative frequencies of implicit uncertainty per consultation were regressed on differences in momentary anxiety pre and post consultation.ResultsWe coded 2590 GP utterances. Uncertainty expressions were more frequent in MUS versus MES consultations (OR = 1.54, p = .004), especially during diagnosis and treatment recommendations compared to physical examinations (OR =0 .45, p = .001). Implicit uncertainty was not related to patients’ changes in anxiety (b = ?0.11, p = .817).ConclusionsGPs express more uncertainty during MUS (versus MES) consultations, especially during the diagnostic phase and treatment recommendations. This does not necessarily affect patient anxiety.Practice implicationsImplicit uncertainty expressions reflect the mere complexity of communicating a medically unexplained diagnosis, which does not affect patient anxiety.     

Information provision as evaluated by people with cancer and bereaved relatives: A cross-sectional survey of 34 specialist palliative care teams

Objective

To explore how individuals with cancer and bereaved relatives evaluate information provision by specialist palliative care services (PCSs).

Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication

Objectives

Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training.

Methods

50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C.

Results

Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice.

Conclusions

This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus.

Practice implications

Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.     

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

ObjectiveTo analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations.MethodsConsultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m²) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed.ResultsWeight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes.ConclusionWeight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes.Practical implicationPCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.     

Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer

Objective

To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer.

Patient-health care provider communication among patients with newly diagnosed prostate cancer: Findings from a population-based survey

Objective

To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences.

Methods

The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling.

Results

Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCP's contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient-HCP communication and prostate cancer communication.

Conclusion

Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer.

Practice implications

HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer.     

Down-regulation of UTP23 promotes paclitaxel resistance and predicts poorer prognosis in ovarian cancer

ObjectiveFrequent resistance to paclitaxel and carboplatin based chemotherapy remains a therapeutic challenge in ovarian cancer. UTP23, a small sub-unit processome component, is down-regulated in a paclitaxel-resistant cell line SKOV3-TR30 compared with its parental SKOV3 cells based on our previous study. However, the specific mechanism of UTP23 in regulating ovarian cancer chemotherapy resistance remains largely unknown.MethodsImmunohistochemical (IHC) staining was used to measure UTP23 expression in 133 ovarian cancer tissues. Then we used short hairpin RNA (shRNA), over-expression plasmid and cell counting kit-8 (CCK-8) assay to evaluate the function of UTP23 on modulating paclitaxel resistance in ovarian cancer. RNA-sequencing (RNA-seq) was used to find targeted downstream molecular of UTP23. Quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting were utilized to detect related genes expression.ResultsWe confirmed that UTP23 was down-regulated in both SKOV3-TR30 and A2780-TR cells compared with their parental cells. Decreased UTP23 expression was observed in ovarian cancer tissues with paclitaxel resistance. Moreover, lower expression of UTP23 was tightly correlated with patients of worse prognosis. Further UTP23 silence by shRNA increased paclitaxel resistance in SKOV3 and A2780 cells. And UTP23 over-expression by plasmid decreased paclitaxel resistance in SKOV3-TR30 and A2780-TR cells. Additionally, RNA-seq and qRT-PCR validation revealed that growth differentiation factor 15 (GDF15) was probably a downstream target for UTP23. GDF15 was notably up-regulated upon the depletion of UTP23 in both SKOV3 and A2780 cells.ConclusionOur findings elucidated a previously unknown function for UTP23 in regulating paclitaxel sensitivity and UTP23 could serve as a potential prognostic predictor for ovarian cancer.     

Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review

ObjectiveEnd-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents’ likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs.MethodsUsing the framework proposed by Arksey and O’Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study.ResultsThree mechanisms were identified: a) promotion of family carers’ understanding about their family member’s health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents’ preferences.ConclusionFamily carers’ understanding, shared decision-making, and knowledge of residents’ preferences contribute to palliative-oriented care in NHs.Practice implicationsDiscussions about end-of-life should take place early in a resident’s disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives.     

Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups

Objective

Our objective was to explore whether there are differences in institutional trust across racial/ethnic groups and what factors might contribute to these differences.

Methods

We studied a convenience sample of 569 adults in Chicago grocery stores who self-identified as African American, Mexican-Hispanic, or white. We measured institutional trust and dichotomized responses into “high” and “low” trust. We used chi squared tests to examine differences in institutional trust across racial/ethnic groups and stepwise multivariable logistic regression to investigate how sociodemographic factors, health care access, health care usage, and previous negative experience with the health care system modified this relationship.

Results

In unadjusted analysis, race/ethnicity was significantly associated with institutional trust (p < 0.001). In the fully adjusted model, African Americans and Mexican-Hispanics had greater odds of reporting low trust compared to whites (OR: 1.90; 95%CI, 1.13–3.17; and OR: 2.34; 95%CI, 1.43–3.81, respectively); reporting a previous negative health care experience was the only other factor significantly related to having low trust (OR: 2.84; 95%CI, 1.83–4.41).

Conclusion

We found lower institutional trust in African Americans and Mexican-Hispanics and among participants reporting previous negative health care experiences.

Practice implications

Improving health care experiences, especially for racial/ethnic minority groups, could improve institutional trust and decrease health disparities in these populations.     

IL17RB expression might predict prognosis and benefit from gemcitabine in patients with resectable pancreatic cancer

Background(Interleukin 17 Receptor Beta) IL17RB has been implicated in several malignancies. However, its role in the progression of and chemosensitivity in pancreatic cancer remains unknown. We aimed to determine the clinical significance of IL17RB expression in the prognosis of resectable pancreatic cancer and in the benefits from gemcitabine treatment.Materials and methodsWe used microarray and immunohistochemical staining techniques to evaluate IL17RB expression in 91 resectable pancreatic cancer tissues and their respective matched adjacent non-cancerous tissues. Quantitative real-time PCR and Western blotting were used to evaluate IL17RB in human pancreatic cancer cell lines after gemcitabine treatment. The correlation between IL17RB expression and overall survival and disease-free survival times were analyzed.ResultsIL17RB expression correlated with lymph node metastasis and (Vascular endothelial growth factor) VEGF expression. Cox proportional model showed that high IL17RB expression is a significant negative prognostic factor for both (overall survival) OS and (disease-free survival) DFS. Kaplan–Meier survival curves confirmed significantly reduced median overall and DFS time in high IL17RB patients as compared with low IL17RB patients. Furthermore, Cox proportional model confirmed a correlation between adjuvant treatment with gemcitabine-based chemotherapy and IL17RB expression. Kaplan–Meier survival curves showed that low IL17RB expression was associated with longer OS and DFS in patients than high IL17RB expression and gemcitabine-based adjuvant chemotherapy. In human pancreatic cancer cell lines, the messenger RNA and protein levels of IL17RB were signi?cantly enhanced after gemcitabine treatment.ConclusionsIL17RB predicts the prognosis and benefit from gemcitabine in patients with resectable pancreatic cancer.     

专项护理干预在晚期癌症姑息治疗患者家属上的临床应用

目的：探讨专项护理干预在晚期癌症姑息治疗患者家属上的应用效果。方法：选择自2014年3月至2015年6月在我院治疗的临床上被确诊为癌症晚期且接受姑息治疗的101例患者及其家属101例作为研究对象,按照入院治疗的先后顺序进行分组。其中对照组患者共52例,仅给对照组患者进行姑息治疗;观察组患者共计49例,在对照组姑息治疗的基础上同时对其家属进行专项护理干预。观察分析两组患者家属的焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)评分,并对两组患者在干预前后的焦虑及郁闷指数情况和两组患者在干预后的QLQ-C30量表中各项功能得分情况进行分析对比。结果：观察组家属的SDS、SAS两项评分均显著低于对照组,差异比较有统计学意义(P<0.05)。对比两组患者干预前后的焦虑、郁闷指数,干预前,两组患者无明显差异(P>0.05);干预后,观察组的指数显著低于对照组,对比具有统计学意义(P<0.05)。观察组患者的QLQ-C30各项功能得分均显著高于对照组,差异显著,具有统计学意义(P<0.05)。结论：针对癌症晚期姑息治疗患者家属的专项护理干预效果显著,不仅对患者家属的焦虑和抑郁有缓解,更能够影响患者的情绪并提高患者的生活质量,值得在临床上推广应用。     

Racial and ethnic disparities in communication study enrollment for young people with cancer: A descriptive analysis of the literature

ObjectiveWe aimed to evaluate the racial and ethnic diversity of study participants in recent pediatric cancer communication literature.MethodsWe systematically searched for communication studies in pediatric oncology published between January 2018 and September 2020, limiting analysis to US studies. We considered race and ethnicity as separate categories in our analysis. Two authors screened studies and abstracted characteristics of race and ethnicity reporting and enrollment.ResultsOf 98 articles included in this analysis, many studies failed to report participants’ race (21/98) and ethnicity (40/98). Most studies ascertained race and ethnicity by self-report (51/98); 25 studies did not describe how they ascertained race and ethnicity. White participants were overrepresented in studies relative to the US population (median 80% in studies vs 72% in 2020 US census). Racial and ethnic minorities were underrepresented (Black: 7% vs 14%; Asian: 4% vs 7%; Pacific Islander: 0% vs 0.5%; Native American: 0.5% vs 3%; Hispanic 8% vs 19%).ConclusionCommunication literature in pediatric oncology underrepresents all racial and ethnic minority populations and is inconsistent in the reporting of race and ethnicity.Practice implicationsFuture work should follow best practices to ensure this literature adequately represents the experiences of all families in pediatric oncology.     

Provider burnout and patient-provider communication in the context of hypertension care

ObjectiveBurnout is prevalent among healthcare providers and associated with poor patient-provider communication. Patient-provider communication is essential for effective care, particularly among patients with conditions such as hypertension. We examined the association between provider burnout and patient-provider communication in hypertension care.MethodsWe used cross-sectional data from 26 primary care providers and their 80 patients with hypertension. Patient-provider primary care visits were audiotaped and providers completed surveys. Patients were 65% Black/African American and 58% female. Providers were 54% white and 65% female. Patient-provider communication was coded using the Medical Interaction Process System (MIPS). We also assess provider-reported level of burnout and suboptimal patient care using validated surveys.ResultsOur findings show an inverse association between burnout and relationship building communication (e.g., displaying empathy) (b=-4.7 p < .05) and between relationship building communication and suboptimal patient care (b=-0.6 p < .05) in multivariate, adjusted models.ConclusionGiven the role of patient-provider communication, our work highlights provider burnout as a potentially significant hindrance to patient-provider relationship building in hypertension care.Practice implicationsFuture research should examine the factors that contribute to provider burnout in order to mitigate their negative effects on patient-provider communication and patient care.