Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report

There are few data on the quality of cancer treatment information available on social media. Here, we quantify the accuracy of cancer treatment information on social media and its potential for harm. Two cancer experts reviewed 50 of the most popular social media articles on each of the 4 most common cancers. The proportion of misinformation and potential for harm were reported for all 200 articles and their association with the number of social media engagements using a 2-sample Wilcoxon rank-sum test. All statistical tests were 2-sided. Of 200 total articles, 32.5% (n = 65) contained misinformation and 30.5% (n = 61) contained harmful information. Among articles containing misinformation, 76.9% (50 of 65) contained harmful information. The median number of engagements for articles with misinformation was greater than factual articles (median [interquartile range] = 2300 [1200-4700] vs 1600 [819-4700], P = .05). The median number of engagements for articles with harmful information was statistically significantly greater than safe articles (median [interquartile range] = 2300 [1400-4700] vs 1500 [810-4700], P = .007).

Improving Clinical and Family Communication for Adult Child Caregivers of a Parent With a Blood Cancer: Single-Arm Pre-Post Pilot Intervention

Background

Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking.

Objective

We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents with a blood cancer, which aims to help participants learn and implement communication skills central to caregiving. We assessed the feasibility and acceptability of the training.

Methods

Eligible participants completed a preprogram survey. We assessed the feasibility of participants completing the intervention in the allotted time. Participants had 2 weeks to complete the 2-part, 90-minute online program and completed a postprogram survey that included program evaluation items and the Acceptability of Intervention Measure (AIM) using a 1-5 rating scale (5=strongly agree).

Results

Of 50 caregivers who initially expressed interest, 34 consented, and 30 completed the program and both surveys (88% completion rate). Caregivers had a mean age of 45.07 (SD 11.96) years and provided care for parents who had a mean age of 73.31 (SD 9.38) years. Caregivers were primarily daughters (n=22, 73%). Overall, scores on the AIM scale were high (mean 4.48, SD 0.67). Specifically, caregivers felt the content met their communication needs (mean 4.58, SD 0.62) and their own needs as a caregiver of a parent with a blood cancer (mean 4.39, SD 0.72).

Conclusions

We demonstrated the feasibility and acceptability of the Healthy Communication Practice program, which aims to enhance family and clinical communication skills among caregivers of a parent with a blood cancer. Future studies will examine the efficacy of the program and its impact on both caregiver and patient communication and health outcomes.

Secure Messaging and COVID-19: A Content Analysis of Patient-Clinician Communication During the Pandemic

Background: Coronavirus disease 2019 (COVID-19) immediately impacted patient-clinician communication, particularly in the oncology setting. Relatedly, secure messaging (SM) usage greatly increased, yet it is unknown what was discussed and whether the technology was utilized to disseminate information. Aims: This study aimed at identifying the most frequently discussed topics using SM as well as at understanding how the communication process transpired during the early stages of the pandemic. Materials and Methods: A mixed-methods design was utilized, consisting of a content analysis of more than 4,200 secure messages, aggregated into 1,454 patient-clinician discussions. Data were collected from February 2020 to May 2020. Discussions were from various oncology departments and included physicians, physician assistants, and nurses. Based on the identified categories, a thematic analysis was conducted to understand the nuances occurring within discussions. Results: Out of the 1,454 discussions, 26% (n = 373) related to COVID-19. Of the COVID-19 discussion, the most frequently coded category was "changes, adjustments, and re-arranging care" (65%, n = 241), followed by "risk for COVID-19" (24%, n = 90), "precautions inside the hospital" (18%, n = 66), and "precautions outside the hospital" (14%, n = 52). Natural language processing techniques were used to confirm the validity of the results. Thematic analysis revealed that patients were proactive in rescheduling appointments, expressed anxiety about being immunocompromised, and clinicians were uncertain about providing recommendations related to COVID-19. Conclusions: The COVID-19 outbreak revealed the need for responsive and effective public health communication. The SM can disseminate information from trusted sources, clinicians, but can be better utilized to deliver tailored information for specific patient populations.

Fostering Interdisciplinary Boundary Spanning in Health Communication: A Call for a Paradigm Shift

Scholarship in the field of health communication is broad, with interdisciplinary contributions from researchers trained in a variety of fields including communication, nursing, medicine, pharmacy, public health, and social work. In this paper, we explore the role of "health communication boundary spanners" (HCBS), individuals whose scholarly work and academic appointment reflect dual citizenship in both the communication discipline and the health professions or public health. Using a process of critical reflective inquiry, we elucidate opportunities and challenges associated with HCBS across the spectrum of health communication in order to provide guidance for individuals pursuing boundary spanning roles and those who supervise and mentor them. This dual citizen role suggests that HCBS have unique skills, identities, perspectives, and practices that contribute new ways of being and knowing that transcend traditional disciplinary boundaries. The health communication field is evolving in response to the need to address significant healthcare and policy problems. No one discipline has the ability to single-handedly fix our current healthcare systems. Narrative data from this study illustrate the importance of seeing HCBS work beyond simply being informed by disciplinary knowledge. Rather, we suggest that adapting ways of knowing and definitions of expertise is an integral part of the solution to solving persistent health problems.

Impact of the family communication environment on burden and clinical communication in blood cancer caregiving

OBJECTIVE

We examined the effects of the family communication environment (conversation orientation) on adult child caregivers' burden and clinical interactions and if the effects are mediated by openness to communicate about cancer, avoidant cancer communication, and social support.

METHOD

Caregivers of a parent diagnosed with a blood cancer (N = 121) completed an online survey of validated measures of conversation orientation (i.e., the extent to which families openly communicate), social support, cancer openness, avoidance, caregiver burden, clinical communication skills, and quality of clinical interactions.

RESULTS

Conversation orientation had significant indirect effects on caregiver burden, mediated by social support (β = -0.11, p < .001), as well as cancer openness and avoidance (β = -0.07, p < .001). Conversation orientation also had significant indirect effects on caregivers' communication skills with a parent's clinician, mediated by avoidance (β = 0.08, p < .01) and social support (β = 0.06, p < .001). Finally, conversation orientation had significant indirect effects on caregivers' quality of clinical interactions mediated by avoidance (β = 0.71, p < .05).

CONCLUSIONS

Adult child caregivers whose families communicate more openly exhibit less caregiver burden and report better clinical interaction skills and perceived quality of the clinical interaction. Avoidance emerged as a key mediating factor. Caregivers from less open communication environments may benefit from interventions that help them navigate challenging but critical caregiving conversations. This article is protected by copyright. All rights reserved.

Practicing Mindfulness through mHealth Applications: Emerging Adults' Health-Enhancing and Inhibiting Experiences

Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and who are also at risk for distress. While adverse effects have been observed with MBIs/MBPs, this has not been examined when mindfulness is practiced using apps. We interviewed EAs (n = 22) to capture their motivations for using these apps and identified health-inhibiting and enhancing experiences. Data were thematically analyzed using the constant comparative method. Motivations for app use included accessibility, convenience, and stress/health management. EAs described health-enhancing outcomes (reduced distress, improved physical symptoms, increased focus) and health-inhibiting outcomes (worsened distress, performance uncertainty, dependency development, worsened physical health). They provided suggestions for improving apps (e.g., feedback option). These findings illustrate benefits and risks that EAs may encounter when practicing mindfulness using apps, which can inform the best practices for app design.

Disparities in Patient-Centered Communication via Telemedicine

Purpose: This study investigated disparities in the uptake of telemedicine and the degree of patient-centeredness of telemedicine consultations among vulnerable patient populations. The focus includes rural adults and adults living with psychological distress and a high risk for chronic obstructive pulmonary disease (COPD). Materials and Methods: In August 2020, a random sample of 932 U.S. adults ≥35 years old with a history of smoking tobacco completed an online survey. Chi-squared analyses were conducted to compare the sociodemographics of participants who did and did not use telemedicine. A series of analysis of variance tests were conducted to examine whether satisfaction with patient-centeredness of telemedicine consultations (i.e., open-endedness, expressed empathy, provider's ability, 5-point Likert scale) differs by rural/urban residence, psychological distress, and COPD risk. Results: About 25% of the sample (n = 240) reported having used telemedicine. Telemedicine use was associated with younger age, Hispanic ethnicity, and moderate-to-high psychological distress, but not rurality. Participants reported high general satisfaction with the patient-centeredness of telemedicine consultations (M = 4.42 ± 0.73). However, high psychological distress and identifying as a current smoker were associated with less satisfaction across all domains. High COPD risk was uniquely associated with less satisfaction in how providers express empathy remotely. Conclusion: Individuals with moderate-to-high psychological distress and a high risk for COPD experience challenges accessing high-quality, patient-centered care via telemedicine. As telemedicine becomes ubiquitous in health care, innovative solutions are needed to overcome barriers that prevent providers from delivering patient-centered care and patients from feeling satisfied with their remote consultations.

Parents Caring for Children Diagnosed with a Blood Cancer from Infancy to Emerging Adulthood: A Life span Perspective

Purpose: Pediatric blood cancer diagnosis is a stressful experience for families as it can involve urgent treatment that can be life-threatening and require extended hospital stays. Little is known about the experiences of parent caregivers of children with a blood cancer during the diagnosis period and how families' needs may differ in light of the patient's developmental phase in the life span. Methods: We conducted semistructured in-depth interviews with 20 parent caregivers (aged 30-65) of children diagnosed with a blood cancer, recruited through The Leukemia & Lymphoma Society's (LLS) constituency. Interview transcripts were thematically analyzed using the constant comparative method. To elucidate similarities and differences in caregiving experiences, findings were compared across parents with children diagnosed in three developmental periods: infancy-early childhood, age 0-6 (n = 9); pre-early adolescence, aged 9-14 (n = 5); and late adolescence-emerging adulthood, aged 16-27 (n = 6). Results: Across all developmental periods, parents described three similar caregiving experiences during the diagnosis period: being persistent to obtain a diagnosis, attending to the child's quality of life challenges, and attending to their other children's well-being. Among caregivers of younger children, persistence was motivated by parental intuition and challenges included coping with traumatic physical and psychological impacts of treatment procedures. For caregivers of late adolescents-early adults, persistence was motivated by the child's self-assessment and fertility-related concerns emerged. Conclusion: Results illustrate core issues for parent blood cancer caregivers and highlight ways to tailor supportive resources that facilitate good communication practices and shared decision-making to children's distinct developmental needs.

Clinicians' Attitudes and Behaviors Towards Communicating Electronically with Patients: A Grounded Practical Theory Approach

Secure messaging (SM), asynchronous communication between patients and clinicians, is an increasingly popular tool among patients to contact clinicians about their care. Despite patients' enthusiasm, clinicians have been hesitant to embrace the technology to communicate with patients. Using the theoretical and methodological framework of Grounded Practical Theory (GPT), we analyzed and interpreted clinicians' perceptions, attitudes, and approaches toward SM to communicate with patients. Twenty clinicians in medical oncology and radiation oncology participated in audio-recorded, semi-structured interviews. Findings revealed the problems with using SM, such as difficulty interpreting low-quality messages, the amount of time needed to devote to responding, and its potential to negatively affect the patient-clinician relationship. Techniques employed to manage such problems consisted of using different forms of communication and utilizing messaging to expedite workloads. The philosophical rationale of clinicians toward SM was that it can improve patient care and this form of communication is already embedded within existing patient care. Overall, this article clarifies how clinicians can re-conceptualize how they think about SM so that it becomes a productive, informative, and useful aspect of patient care.

Strategies to Improve Clinician-Patient Communication Experiences for Patients With Neurologic Conditions

Increasing research supports that effective clinician communication with patients and families leads to improved patient outcomes, higher patient satisfaction, and improved clinician experiences. As a result, patient- and family-centered communication is the focus of a 2020 American Academy of Neurology quality measure and part of neurology residency training milestones. Clinicians across training levels can implement strategies for improving patient- and family-centered communication, including optimizing the communication environment, using verbal and nonverbal skills, focusing on the patient's agenda, practicing active listening, demonstrating respect and empathy, individualizing encounters to patient and family needs, and providing clear explanations. These skills can be tailored for specialized encounters (e.g., when wearing masks, telemedicine) and for electronic communication. By purposefully identifying and incorporating key communication skills in everyday practice, clinicians have the opportunity to improve patient care and satisfaction and their own experiences in neurology clinical practice.

A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings

OBJECTIVES

A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as "disclosure," are measured and operationalized.

METHODS

We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients' communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region.

RESULTS

7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region.

CONCLUSIONS

Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging.

PRACTICE IMPLICATIONS

Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.

The Impact of an Online Training Program About Cancer Clinical Trials on Primary Care Physicians' Knowledge, Attitudes and Beliefs, and Behavior

Participation in cancer clinical trials (CCTs) is critical to improving cancer treatments and quality of care. However, rates of patient participation remain low. Research has shown that a trusted physician recommendation is an important influence on patients' decisions to enroll in a CCT. Improving primary care providers' (PCPs') knowledge, attitudes, and beliefs about CCTs is a promising potential path for improving CCT participation. The aim of this pilot study was to test the effect of an online educational course for PCPs about clinical trials on primary care providers' knowledge, attitudes and beliefs, and behavior. Forty-one PCPs in the New York City area participated in a 1-h online training session on cancer clinical trials. These PCPs had self-selected to complete the training in a previous survey. The objectives of the training module were to (1) educate the PCPs about clinical trials, with a focus on overcoming misconceptions; and (2) discuss roles of PCPs in partnering with oncologists to help patients gain access to clinical trials. The training module included didactics, audio excerpts, and case descriptions. Participants completed a pre-test immediately before taking the course, a post-test immediately after taking the course, and a 3-month post-course survey. All three assessments included a general T/F knowledge test, a 7-item attitude/belief scale, and a knowledge test focused specifically on local resources and access for clinical trials. Forty-one PCPs completed the module and the pre-post course surveys. Eighty percent (33/41) also completed the 3-month post-course survey. General knowledge and local knowledge increased significantly (p < .05) from pre- to post-course. At 3 months post-training, both general and local knowledge scores remained significantly increased from baseline. For those who completed the 3-month post-course survey, attitudes and beliefs increased significantly from pre- to post-course, but this change was not sustained at 3 months post-training. At 3 months post-training, 52% of the PCPs who had an interaction with a recently diagnosed cancer patient reported speaking with patients about CCTs as a result of the training. A brief online course showed significant and sustained improvement in PCPs' general and local knowledge about cancer clinical trials, which translated into self-reported behavior change. Future dissemination of the course and further research into its impact are important next steps.

Responding empathically to patients: a communication skills training module to reduce lung cancer stigma

Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

BACKGROUND

Physician burnout is pervasive within graduate medical education (GME), yet programs designed to reduce it have not been systematically evaluated. Effective approaches to burnout, aimed at addressing the impact of prolonged stress, may differ from those needed to improve wellness.

OBJECTIVE

We systematically reviewed the literature of existing educational programs aimed to reduce burnout in GME.

METHODS

Following the PRISMA guidelines, we identified peer-reviewed publications on GME burnout reduction programs through October 2019. Titles and abstracts were reviewed for relevance, and full-text studies were acquired for analysis. Article quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

A total of 3534 articles met the search criteria, and 24 studies were included in the final analysis. Article quality varied, with MERSQI assessment scores varying between 8.5 and 14. Evaluation was based on participant scores on burnout reduction scales. Eleven produced significant results pertaining to burnout, 10 of which yielded a decrease in burnout. Curricula to reduce burnout among GME trainees varies. Content taught most frequently included stress management (n = 8), burnout reduction (n = 7), resilience (n = 7), and general wellness (n = 7). The most frequent pedagogical methods were discussion groups (n = 14), didactic sessions (n = 13), and small groups (n = 11). Most programs occurred during residents' protected education time.

CONCLUSIONS

There is not a consistent pattern of successful or unsuccessful programs. Further randomized controlled trials within GME are necessary to draw conclusions on which components most effectively reduce burnout.

Blood cancer caregiving during COVID-19: understanding caregivers' needs

The COVID-19 pandemic likely exacerbated caregiving challenges for caregivers of parents diagnosed with a blood cancer. Providing care during a public health crisis presents a complex web of uncertainties regarding cancer care, personal health, and COVID-19 risk. Identifying caregivers’ uncertainty experiences during the COVID-19 pandemic can be a first step in learning where to direct resources or alter policies to ensure that they can not only perform their caregiver role but also cope in health-promoting ways. Using uncertainty management theory, this study explored how the pandemic has impacted adult child caregivers’ experiences caring for a parent diagnosed with a blood cancer, as well as their experiences of uncertainty and uncertainty management. As part of a larger study on blood cancer caregivers’ needs, a survey was administered from March 30 to June 1, 2020, to recruit caregivers through the Leukemia and Lymphoma Society. A qualitative and quantitative content analysis was conducted on open-ended responses from 84 caregivers. Caregivers described changes illustrating the complexity of providing care during a pandemic: (a) increased fears and uncertainty-related distress, b) reduced in-person care opportunities, (c) increased isolation, and (d) enhanced family communication. Caregivers with parents diagnosed with acute blood cancers used significantly more uncertainty management strategies and had more sources of uncertainty than caregivers with parents living with chronic blood cancer types. Findings highlight the need for supportive services to help caregivers manage uncertainty and improve their capacity to provide care in an unpredictable global health crisis. Such support may reduce poor psychosocial outcomes.

Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE)

BACKGROUND

Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers.

PURPOSE

Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging.

METHODS

A 2⁶ balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets.

RESULTS

210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored.

CONCLUSIONS

Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies.

PRACTICE IMPLICATIONS

Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).

Oncology Care Provider Training in Empathic Communication Skills to Reduce Lung Cancer Stigma

BACKGROUND

Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication.

RESEARCH QUESTION

What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)?

METHODS

Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP.

RESULTS

OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P < .05], stigma-mitigating skills [t(28) = -3.88; P < .001], and breadth of communication skill use [t(28) = -2.91; P < .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy.

INTERPRETATION

Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.

Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy

BACKGROUND

Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested.

AIM

The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy.

DESIGN

Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions.

PARTICIPANTS

Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited.

RESULTS

Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1-12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r = .46), greater spiritual distress (r = .44), and lower quality of life (r = -.56).

CONCLUSION

Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.

A qualitative analysis of clinicians' communication strategies with family members of patients experiencing hospital-acquired delirium

OBJECTIVE

Identify doctors' and nurses' perceptions of effective communication strategies when talking with family members of patients with hospital-acquired delirium.

METHODS

We conducted focus groups and interviews of hospitalists, anesthesiologists, and nurses using a semi-structured approach. We rigorously analyzed transcribed data using a constant comparative method.

RESULTS

We conducted six focus groups and 14 interviews. Participants included 20 hospitalists, 9 anesthesiologists, and 21 nurses. Clinicians identified three communication approaches as effective when communicating with family of delirium patients: Provide reassurance, educate families, and engage in family-centered communication.

CONCLUSION

In communicating with families of patients with post-operative delirium, clinicians work to reassure and educate families using family-centered communication. Different approaches are used by different types of clinicians to accomplish this goal. Clinicians recognized the importance of involving family members in the patients' recovery.

PRACTICE IMPLICATIONS

Though clinically common and familiar to clinicians, delirium may be a new diagnosis for family members and thus compassion and education are vital. Due to the different clinical roles, education may be different for each discipline.

PGx in psychiatry: Patients' knowledge, interest, and uncertainty management preferences in the context of pharmacogenomic testing

OBJECTIVE

Pharmacogenomic testing (PGx) is expanding into psychiatric care. PGx could potentially offer a unique benefit to psychiatric patients, providing information about patients' reaction to medications that could reduce the time and financial burdens of drug optimization. The aims of this study were to: (1) examine psychiatry patients' familiarity and interest in PGx, and (2) explore how Uncertainty Management Theory relates to PGx testing in psychiatry.

METHOD

We surveyed psychiatric patients, measuring their PGx familiarity and interest, attitudes toward PGx testing, and preference for managing illness uncertainty.

RESULTS

We analyzed data from 598 patients. Patients' familiarity of PGx was low, but interest was high. Thirty percent of patients were familiar with the test from communication with their healthcare provider or their own online health information seeking. A preference for seeking information was a significant positive predictor of testing interest (p < .001).

CONCLUSION

Psychiatric patients were interested in PGx testing, regardless of their uncertainty management preferences.

PRACTICE IMPLICATIONS

This study is one of the first to examine psychiatric patients' perspectives on PGx testing in mental health care. Our findings show that psychiatric patients are interested in the test and are familiar enough with PGx to be included in future research on the topic.

Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients

Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.

Fatalistic Cancer Beliefs Across Generations and Geographic Classifications: Examining the Role of Health Information Seeking Challenges and Confidence

Information seeking is an active health behavior that influences cancer fatalism; however, people commonly experience challenges in accessing high-quality and actionable health information that is personally relevant. This is especially common among older and rural adults who have a high cancer risk. The purpose of this study was to examine the theoretical assumption that enhancing perceived confidence to overcome health information seeking challenges will alleviate cancer fatalism. In 2017, 895 adults from a large southeastern medical university's cancer catchment area participated in a random digit dial survey. Participants were Millennials (18-35; 19%), Generation X (36-51; 23%), Baby Boomers (52-70; 40%), and Silent Generation (71-95; 16.9%) who had equal representation across metro (78.9%) and nonmetro (21.1%) counties. Younger generations (Millennials and Generation X) held stronger fatalistic cancer beliefs ("It seems like everything causes cancer," "When I think about cancer, I automatically think about death") than older generations. Most participants believed that precautionary efforts exist to reduce their chances of getting cancer, which was strongest among individuals residing in metro counties. In controlling for generation and geographic residence, individuals who experienced challenges in the process of accessing health information had stronger fatalistic beliefs about cancer prevention; however, this relationship was most pronounced among individuals with confidence to ultimately obtain information that they needed. This study contributes to evidence for health information equity in combatting fatalistic cancer beliefs. Findings have important implications for the optimized dissemination of culturally adapted cancer education and skill-based training to efficiently access and evaluate relevant cancer education.