Women's and residents’ experiences of communication in the diagnostic mammography suite

ObjectiveTo gain understanding of radiology residents’ and women's experiences, concerns, information needs, coping strategies and perspectives about optimal communication during diagnostic mammography.MethodsQualitative analysis of focus groups of radiology residents and women who had undergone diagnostic mammograms.ResultsFive categories of themes emerged from our analysis: information needs, perspectives and ideals, emotional experiences and observations, working together, individual experiences, and others’ roles. Women preferred continuous orientation, clear explanations and emotional support by physicians and radiology technologists throughout diagnostic processes. Communication about diagnostic mammogram results evoked the threat of breast cancer and was experienced as “bad news” by women, but not necessarily by all radiology residents. Lack of collaboration among radiologists, technologists and other healthcare professionals engendered confusion and anxiety in patients. Radiology residents felt inadequately prepared to meet the communication challenges of providing information and emotional support tailored to women's needs in this context.ConclusionWomen's experiences are influenced by the extent to which they receive clear information and support, and perceive collaboration among professionals involved in the diagnostic mammography process.Practice implicationsRadiology education must address communication with patients and among healthcare professionals involved in the care of patients undergoing diagnostic procedures and interventions.     

The information and support needs of patients diagnosed with High Grade Glioma

Objective

To understand patients’ experiences of High Grade Glioma and identify and describe information and support needs along the disease trajectory.

Methods

Semi-structured interviews were conducted with 19 patients. Data was analysed using grounded theory and the constant comparative method.

Results

Four major themes were identified: (1) feelings of uncertainty around prognosis and quality of life; (2) the need for individualised information; (3) dependence on carers due to cognitive deficits, loss of balance and inability to drive; and (4) communication with health professionals around prognostic uncertainty and disease progression with communication barriers due to complex language deficits.

Conclusion

Previous studies in HGG pre-date the current combined modality standard of care, or examined a mixed population. This study has found that patients with HGG have needs that differ from other patients with terminal malignancy and that these needs change over time with disease progression.

Practice implications

This study has identified that patients with brain tumours may have unique needs. Health professionals need to clarify patients’ information and support needs and be aware that these change over and within time.     

Information needs of parents of children admitted to a neonatal intensive care unit: A review of the literature (1990–2008)

Objective

This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness trajectories at NICU.

Methods

Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990–March 2008.

Results

The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention.

Conclusions

In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents.

Practice implications

Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals.     

Social support and online postpartum depression discussion groups: a content analysis

Objective

Social support has a positive influence on women's childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups.

Methods

A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months.

Results

The majority of the women's postings illustrated emotional support followed by informational and instrumental support.

Conclusions

Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope.

Practice implications

Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.     

What are internal medicine residents missing? A communication needs assessment of outpatient clinical encounters

Objective

In order to guide curricular innovation, we looked at the feasibility and utility of performing a targeted needs assessment of the communication skills of PGY2 internal medicine (IM) residents in their continuity clinic, utilizing faculty direct observation with a validated instrument for communication skills evaluation.

Methods

A convenience sample of PGY2 residents in the Emory University School of Medicine IM Residency Program was invited to participate. Using the SEGUE Framework, a checklist of medical communication tasks, faculty assessed residents during a clinic encounter.

Results

Thirty out of 53 (57%) PGY2 residents were assessed. SEGUE results indicate residents were most likely to “maintain patient's privacy” (100%), “greet patient appropriately” (97%) and “check/clarify information” (100%). Residents were least likely to “acknowledge waiting time” (7%), “explore psychosocial/emotional factors” (27%) and “outline agenda for visit” (33%).

Conclusion

The SEGUE Framework is a feasible tool to evaluate the communication skills of IM residents in a clinic setting. Many PGY2 IM residents in a large, urban practice do not elicit important psychosocial information during outpatient clinic visits.

Practice implications

More observation and evaluation of residents’ communication skills are needed, with emphasis on building skills to “Understand the Patient's Perspective.”     

Patients' and health professionals' views and experiences of atrial fibrillation and oral-anticoagulant therapy: a qualitative meta-synthesis

Objective

Atrial fibrillation (AF) patients are prescribed oral-anticoagulant (OAC) therapy, often warfarin, to reduce stroke risk. We explored existing qualitative evidence about patients’ and health professionals’ experiences of OAC therapy.

Methods

Systematic searches of eight bibliographic databases were conducted. Quality was appraised using the Critical Appraisal Skills Programme tool and data from ten studies were synthesised qualitatively.

Results

Four third-order constructs, emerged from the final step in the analysis process: (1) diagnosing AF and the communication of information, (2) deciding on OAC therapy, (3) challenges revolving around patient issues, and (4) healthcare challenges. Synthesis uncovered perspectives that could not be achieved through individual studies.

Conclusion

Physicians’ and patients’ experiences present a dichotomy of opinion on decision-making, which requires further exploration and changes in practice. Outcomes of workload pressure on both health professionals and patients should be investigated. The need for on-going support and education to patients and physicians is critical to achieve best practice and treatment adherence.

Practice implications

Such research could encourage health professionals to understand and attend better to the needs and concerns of the patient. Additionally these findings can be used to inform researchers and healthcare providers in developing educational interventions with both patients and health professionals.     

Challenges in the communication between ‘communication vulnerable’ people and their social environment: An exploratory qualitative study

Objective

Communication vulnerable people are often unable to communicate effectively within their social environment, hindering client-centered care and participation in daily life. This study aims to explore the experiences of communication and the factors that influence this in long term care settings.

Methods

A qualitative study using the critical incident method. Communication vulnerable clients and people within their immediate environment were interviewed about their communication experiences.

Results

Thirty-nine individuals in three settings participated in the interviews, of which 14 were clients. Specific challenges in communication were presented in different relationships. The main influencing factors in the communication between clients and professionals were: effort put into improving the communication, knowledge of the professional, augmentative and alternative communication, time for communication and the influence and power of the client.

Conclusion

Communication vulnerable people and people within their immediate environment face daily challenges in communicating with each other. In particular, communication among clients, can be very difficult. Augmentative and alternative communication tools are only rarely used.

Practice implications

Professionals need to develop adequate knowledge and skills to improve their communication. Also, more attention should be focussed on use of AAC, communication between professionals and family members, and support in the communication among clients.     

Palliative and supportive care needs of patients with high-grade glioma and their carers: A systematic review of qualitative literature

Objective

Patients diagnosed with Primary Malignant Glioma (PMG) face substantial challenges with poor prognosis, high symptom burden and care needs. This study aims to collate current literature detailing the supportive and palliative care needs of patients with PMG and their carers, and to subject it to a novel approach of formal evaluation.

Methods

Medline, EMBASE, CINAHL, PsychInfo were searched with core concepts: (1) glioma, (2) high-grade disease, and (3) palliative and supportive care needs. A narrative synthesis approach was undertaken including a quality appraisal of the 21 included studies.

Results

Key themes related to the need for consistent well-delivered information around disease sequelae, treatment, and resources available; health service needs including a key professional identified to coordinate care; the need for psychological and social supports, and clear avenues of communication with treating professionals.

Conclusion

The literature remains limited in the number and quality of evidence with two Level I, eight Level II, and eleven Level III studies. The findings call for improved information, communication and support practices to address the complexity and breadth of needs.

Practice implications

Specialised and individually tailored information, attention to clear, consistent communication and support practices should be incorporated into a future needs-based model of care.     

The experience of people with lung cancer with a volunteer-based lay navigation intervention at an outpatient cancer center

Objective

To describe the experiences of patients with lung cancer with a volunteer-based lay navigation intervention.

Methods

Forty patients with newly diagnosed lung cancer enrolled in a three-step navigation intervention delivered by trained volunteer lay navigators (VLNs), beginning prior to their first oncologist's appointment and ending before the start of treatment. Methodological triangulation of data was used in a mixed method study design. Cases were categorized based on the predominant needs met by the VLN: emotional, practical/informational, family, and complex. Data were analyzed using framework analysis.

Results

The provision of emotional support, information, and referrals to other services by the VLN were of particular benefit to the patient and their families. Satisfaction with the program and its timing was high; it was considered an effective means for patients to share concerns and have their needs attended to before starting treatment.

Conclusion

This study demonstrates capacity for lay volunteers to address the multifaceted needs of lung cancer patients during their transition from primary care in the diagnosis to treatment phase.

Practice implications

Using volunteers as navigators offers an opportunity to meet patient needs with minimal resources, increase access to services for patients, and improve the sustainability of the program.     

Patients’ perspectives of the doctor–patient relationship and information giving across a range of literacy levels

Objective

This study explored the patient's experience of the doctor–patient relationship and information giving in health care. The views of patients with a range of literacy levels were examined.

Method

321 patients at an in-patient cardiology unit provided the sample. The Health Literacy (HL) of participants was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). All participants (low and adequate HL) were then asked open ended questions about their experiences of communication with healthcare professionals. The qualitative data underwent a thematic analysis.

Results

22% of the patients interviewed were found to have a low level of literacy as indicated by the REALM. Many patients felt that health information should be given in simpler language. Patients frequently stated that they either did not read information leaflets or were confused or worried by them. They described the importance of the doctor–patient relationship and the need to build up trust. These views were expressed by patients with adequate HL as well as patients with low HL.

Conclusion

Many patients irrespective of their HL skills, feel unable to access, understand and utilize health information.

Practice implications

If patients are to be actively engaged in achieving and maintaining good health, healthcare professionals must improve their communication skills and ensure that health information is clear and easy to access.     

Discrepancies between adolescents’ attributed relevance and experiences regarding communication are associated with poorer client participation and learning processes in psychosocial care

Objective

To examine adolescents’ attributed relevance and experiences regarding communication, and whether discrepancies in these are associated with clients’ participation and learning processes in psychosocial care.

Methods

Adolescents receiving psychosocial care (n = 211) completed measures of communication in three domains: affective communication, information provision, and shared decision-making. Participation involved clients’ attendance and adherence (professional-reported). Learning processes involved clients’ improved understanding and improved confidence (client and professional-reported).

Results

Important but less often experienced affective communication was associated with low adherence (odds ratio, 95% confidence interval: 2.8, 1.1–6.8), less improvement in understanding (3.7, 1.5–9.0), and less improvement in confidence (4.5, 1.8–11.6). If information provision or shared decision-making was important but less often experienced, adolescents were more likely to demonstrate less improvement in understanding (3.1, 1.1–8.5; 4.2, 1.7–10.8). The combination “less important but experienced” only had an effect regarding affective communication; these adolescents were more likely to demonstrate less improvement in confidence (6.0, 2.3–15.4).

Conclusion

Discrepancies between attributed relevance and experiences frequently occur. These discrepancies negatively affect adolescents’ participation and their learning processes, although the pattern differs across communication domains.

Practice implications

Care professionals should pay considerable attention to their clients’ communication preferences and adapt their communication style when necessary.     

Communicating shared decision-making: Cancer patient perspectives

Objective

To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients’ perspectives.

Methods

Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients.

Results

Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care.

Conclusion

In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities.

Practice implications

Shared decision-making as a practice standard must be balanced against individual patient preferences.     

"I am worried, Doctor!" Emotions in the doctor-patient relationship

Objective

To review research on emotional communication in medical interviews regarding predictors, physiological correlates and effects of clinicians’ responses to patients’ cues and concerns and individual differences among patients.

Methods

A selective review of research literature on emotional communication in medical interviews was conducted.

Results

Four questions regarding emotional communication were explored: What factors predict how clinicians respond to emotional cues and concerns? What happens in the brain and the body of both patients and clinicians during emotional talk? Are there individual differences in patients’ responses to emotional talk in medical interviews? Do clinicians’ responses to emotion affect health outcome?

Conclusion

Building on evidence reviewed, research on predictors of clinician responses, physiological correlates of behavior, individual differences and effects on outcome should be further pursued.

Practice implications

In communication skills training programs, better understanding of the phenomena described could have implications for training clinicians to handle emotions in clinical interviews.     

How do people with asthma use Internet sites containing patient experiences?

Objective

To understand how people engage with websites containing patient authored accounts of health and illness. To examine how people with asthma navigate their way through this information and make use of the patient experiences they find.

Methods

Twenty-nine patients with diagnoses ranging from mild to severe asthma were shown a range of websites, some containing patient experiences, and selected two sites to explore further. They discussed their choices in a series of focus groups and interviews.

Results

Participants were influenced initially by the design quality of the sites and were subsequently drawn to websites containing patient experiences but only when contributions were from similar people offering ‘relevant stories’. The experiences reminded participants of the serious nature of the disease, provided new insights into the condition and an opportunity to reflect upon the role of the disease in their lives.

Conclusion

For people with asthma websites containing other patients’ personal experiences can serve as a useful information resource, refresh their knowledge and ensure their health behaviours are appropriate and up-to-date.

Practice implications

Health professionals should consider referring asthma patients to appropriate websites whilst being aware that online experiences are most engaging when they resonate with the participants own situation.     

Patients’ experiences with navigation for cancer care

Objective

We examined how navigation, defined as the assessment and alleviation of barriers to adequate health care, influences patients’ perspectives on the quality of their cancer care.

Methods

We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in New York. We interviewed patients about their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance.

Results

Thirty-five patients newly diagnosed with breast or colorectal cancer. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving, and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support.

Conclusion

Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. Navigated patients received emotional support and assistance with information needs, problem-solving, and logistical aspects of cancer care coordination.

Practice implications

Navigation services may help improve cancer care outcomes important to patients by addressing fragmented, confusing, uncoordinated, or inefficient care.     

Information needs and preferences of women as they proceed through radiotherapy for breast cancer

Objective

While radiotherapy is commonly employed in the treatment of breast cancer, many women know little about treatment and experience treatment related anxiety. The aims of this study were to: Prioritise breast cancer patients’ radiotherapy related information needs and concerns; determine unmet information needs; ascertain which information sources patients prefer to receive; and explore whether information provision reduces anxiety and depression.

Methods

A longitudinal survey was administered at four time points: after initial consultation with radiation oncologist, after the planning appointment, within first week of treatment and after treatment completion. Data was analysed using generalised estimating equations.

Results

123 women participated. Women were most concerned about the impact treatment would have on their health in the future. Women identified high information needs prior to treatment planning and commencing treatment. Women's anxiety at baseline (mean = 6.07, SD = 3.89) did not significantly drop until after treatment commencement (mean = 5.33, SD = 4.15).

Conclusion

This study demonstrates that women's information needs and anxiety levels are high until treatment commencement.

Practice implications

In order to reduce patients’ psychological distress, information needs and concerns we recommend that a greater focus is placed on providing information to patients prior to treatment planning and prior to treatment.     

Women's preferences for selective estrogen reuptake modulators: An investigation using protection motivation theory

Objective

Selective estrogen receptor modulators (SERMs) reduce breast cancer risk by 38%. However, uptake is low and the reasons are not well understood. This study applied protection motivation theory (PMT) to determine factors associated with intention to take SERMs.

Methods

Women at increased risk of breast cancer (N = 107), recruited from two familial cancer clinics in Australia, completed a questionnaire containing measures of PMT constructs. Hierarchical multiple linear regression analysis was used to analyze the data.

Results

Forty-five percent of women said they would be likely or very likely to take SERMs in the future. PMT components accounted for 40% of variance in intention to take SERMs. Perceived vulnerability, severity and response efficacy appeared the most influential in women's decisions to take or not take SERMs.

Conclusion

Many women are interested in SERMs as a risk management option. Accurate risk estimation and an understanding of the benefits of SERMs are critical to women's decision making.

Practice implications

Health professionals need to explore women's perceptions of their risk and its consequences, as well as providing clear evidence-based information about the efficacy of SERMs. Exploring the source and strength of beliefs about SERMs may allow more effective, tailored counseling.     

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.     

From support to boundary: A qualitative study of the border between self-care and professional care

Objective

While healthcare systems globally are promoting self-care, patients’ perceptions of the policy shift remain relatively unexplored. Our qualitative study explored how organisation of care shaped patients’ perceptions and experiences of self-care in dealing with their respiratory illnesses.

Methods

We recruited 31 people, representing a range of ages and respiratory conditions and generated data using illness diaries, telephone interviews and focus group discussions. Data were transcribed, analysed and triangulated using the framework approach.

Results

Patients were aware of the increasing focus on self-care, but felt that the term was incongruous as it described what they were already doing. While many respondents appreciated increased clinical responsibility some felt ‘abandoned’ by professionals. To be active partners in care, they needed flexible access to trusted healthcare professionals who respected patients’ knowledge about their condition and preferences for management.

Conclusion

The shift to self-care needs to be underpinned by a whole system change. Professionals need communication skills to engage with patients as partners in care, working within systems that offer flexible access to supportive care.

Practice implications

Systems of care for people with long-term conditions need to ensure flexible access between self-care and professional support. Simplification of systems, clear sign-posting and co-ordination of individual patient care by a key trusted professional are essential.     

Breast cancer screening programmes: Challenging the coexistence with opportunistic mammography

Objective

This study investigated predictive factors of women's participation in organized mammography screening (OrgMS) and/or opportunistic mammography screening (OppMS) when the two screening modes coexist.

Methods

Questionnaires were sent to 6,000 women aged 51–74 years old invited to attend an OrgMS session between 2010 and 2011 in France. Data collected concerned the women's healthcare behaviour and their socioeconomic characteristics. Women without a personal or family history of breast cancer that could explain their participation in OppMS were retained in the generalized logits analysis.

Results

The data of 1,202 women were analysed. Of these, 555 (46.2%) had attended OrgMS only, 105 (8.7%) OppMS only and 542 (45.1%) had performed both OrgMS and OppMS. Multivariable analyses showed that women who had regular gynaecological check-ups were more likely to perform OppMS only or both OrgMS and OppMS, OR 95% CI were 2.1 [1.1–3.9], 1.9 [1.4–2.6], respectively. Being employed also increased participation in OppMS only [OR: 2.1 (1.2–3.7)] or both OrgMS and OppMS [OR: 1.5 (1.1–2.05)].

Conclusion and practice implications

In countries where OrgMS and OppMS coexist, strategies involving gynaecologists, referring doctors or company doctors and the organization of healthcare services to promote adequate screening round may help to reduce the overuse of mammography.