Assessing the relationship between patient-provider communication quality and quality of life among rural cancer survivors

"It's hard to talk to a computer, I get it": An exploratory analysis of clinician connection-building communication practices in rural telepalliative care encounters

Context/Objectives

Establishing human connection is critical during serious illness conversations, however the sensory and relational environment of telehealth may require innovative communication practices for clinicians, patients, and families to do so effectively. We sought to explore if and how recommended in-person best practices for establishing human connection are adapted to the telehealth palliative care (telePC) setting, to enable discovery and description of practice innovations in this new care environment.

Methods

We analyzed data from the Northern New England Palliative Care TeleConsult Research Study - a formative mixed-methods pilot study at two academic medical centers in rural US states with patients with serious illness (2019-2020). We used a qualitative descriptive approach paired with directed content analysis to analyze video-recorded telePC consultations.

Results

Nine video-recorded telePC consultations were analyzed including 9 patients and 6 palliative care clinicians. Patient-participants had a mean age of 68 years, 56 % were women, and 38 % did not complete high school. Mean consultation duration was 52 min (standard deviation 10, range 40-70 min). Our qualitative analysis of visits resulted in three key themes describing clinician communication: 1) Practices for fostering human connection; 2) Practices for overcoming technical problems/difficulties; and 3) Practices for engaging in multi-participant tele-conversations.

Conclusion

Our study findings help to provide proof-of-concept evidence that clinicians can use recommended in-person connection-building communication practices in telePC. As palliative care clinicians naturally adapt to telehealth environments, more empirical research is needed to understand which innovative approaches most effectively foster human connection.

Innovation

TelePC represents an expanding, yet understudied, mode of palliative care delivery. This study is among the first to describe how the telePC context is catalyzing naturally-occurring communication innovations.

An international study of clinical, demographic, and competence-related determinants of communication with professionals

PURPOSE

This study aims to identify a combination of clinical, demographic, and patient competence determinants of patients' communication with doctors and nurses in an international sample of cancer patients.

METHODS

For our cross-sectional study, cancer patients assessed their communication with their doctors or nurses at the start of their treatment. Patients completed EORTC communication questionnaire QLQ-COMU26 to assess ten areas of communication with their doctor or nurses plus another item to assess how competent they felt when communicating with professionals. Bivariable analyses and multivariable linear regression models were performed separately for each QLQ-COMU26 area.

RESULTS

Included in the study were 988 patients from 15 centres in 13 countries (five cultural areas). Higher age was related to higher level of communication in eight QLQ-COMU26 areas. Males reported higher level of communication in three areas. Lower levels of studies and higher level of perceived competence when communicating with professionals were related to higher level of communication in the ten QLQ-COMU26 areas. Communication was of a higher level with nurses than with doctors in four areas. Having received previous treatment with the same doctor or group of nurses was related to higher communication levels in seven areas. Lack of comorbidity was related to higher communication levels in two areas. Various differences in determinants were found among tumour sites.

CONCLUSION

Our regression model has shown several relationships between communication and the demographic and clinical variables that may help identify patients at risk of poor communication. Future studies could focus on communication at diagnosis and in follow-up, and on areas such as assessing the particularities of communication between patient and professionals in relation to cancer type.

The interplay of financial toxicity, health care team communication, and psychosocial well-being among rural cancer patients and survivors

BACKGROUND

Financial toxicity contributes to psychosocial distress among cancer patients and survivors. Yet, contextual factors unique to rural settings affect patient experiences, and a deeper understanding is needed of the interplay between financial toxicity and health care team communication and its association with psychosocial well-being among rural oncology patients.

PURPOSE

We examined associations between financial toxicity and psychosocial well-being among rural cancer patients, exploring variability in these linkages by health care team communication.

METHODS

Using data from 273 rural cancer patients who participated in Cancer Support Community's Cancer Experience Registry, we estimated multivariable regression models predicting depression, anxiety, and social function by financial toxicity, health care team communication, and the interplay between them.

RESULTS

We demonstrate robust associations between financial toxicity and psychosocial outcomes among our sample of rural cancer patients and survivors. As financial toxicity increased, symptoms of depression and anxiety increased. Further, financial toxicity was linked with decreasing social function. Having health care team conversations about treatment costs and distress-related care reduced the negative impact of financial toxicity on depressive symptoms and social function, respectively, in rural cancer patients at greatest risk for financial burden.

CONCLUSIONS

Financial toxicity and psychosocial well-being are strongly linked, and these associations were confirmed in a rural sample. A theorized buffer to the detrimental impacts of financial toxicity-health care team communication-played a role in moderating these associations. Our findings suggest that health care providers in rural oncology settings may benefit from tools and resources to bolster communication with patients about costs, financial distress, and coordination of care.

The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye

INTRODUCTION

Patient-centered communication is a type of communication that takes place between the provider and the patient.

OBJECTIVES

It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction.

METHOD

The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye.

RESULTS

More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction.

CONCLUSION

Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.

Mediational roles of stress-coping factors in the relationship between patient-perceived communication quality and physical functioning: racial difference between Chinese and Non-Hispanic White American breast cancer survivors

PURPOSE

The assumption that patient-provider communication may mediate patients' sense of control over cancer to affect health outcomes has limited evidence. This study examines whether patient-perceived cancer care communication quality (PPCQ) mediates stress appraisal and coping behavior, affecting physical functioning across different racial groups.

METHODS

Two hundred and twenty Chinese American and 216 non-Hispanic White (NHW) women (ages 28-80) with stage 0-III breast cancer, 1-5 years post-diagnosis, and without recurrence, enrolled and completed a cross-sectional telephone survey. Physical functioning was measured by the NIH-PROMIS short form. Validated measures of PPCQ, patients' evaluation of their socioeconomic well-being, stress appraisal (perceived severity and control), use of coping strategies, treatment-related symptoms, and comorbidities were also assessed. Path analyses were used to examine the mediation for each racial group.

RESULTS

Regardless of race, treatment-related symptoms, comorbidities, and socioeconomic well-being were all directly related to physical functioning (p < 0.05). The impact of PPCQ on physical functioning was mediated by perceived control in the Chinese American group (p < 0.05), but not in the NHW group. Perceived severity and coping were not mediators of physical functioning in either group.

CONCLUSIONS

The mediational pathway from PPCQ to perceived control to physical functioning in Chinese American survivors may be partially explained by their lower socioeconomic well-being and culturally valued conformity to physicians as a medical authority. These sociocultural dynamics reinforce the importance of cancer care communication. For NHW survivors, the impact of treatment-related symptoms and socioeconomic well-being on physical functioning outweighed their PPCQ and perceived control.

Similarities and differences across the underlying dimensions of social functioning in rural and nonrural cancer survivors: A mixed-methods study

PURPOSE

For cancer survivors, social functioning greatly influences other quality of life dimensions. While there is potential for differences in social functioning to vary as a function of geographic residence, few studies examine the social functioning of rural cancer survivors specifically. This study aims to help fill this gap.

METHODS

This was an embedded mixed-methods study where all participants completed a questionnaire, and some were purposively selected to complete an interview to gather more information about social functioning (ie, social roles, activities, network, support, and constraint). Participants (n = 93; 63% rural) were recruited through a state cancer registry and cancer care facility. Participants were predominately White, non-Hispanic (92.47%), roughly half female (54.84%), and on average, diagnosed in the past two years (SD = 1.68), and 61.45 (SD = 10.87) years old.

FINDINGS

Few differences in the social functioning of rural and nonrural participants were found on questionnaires, though rural participants reported larger networks and more overall support. Across groups, common themes in the interview data were the experience of both social support (eg, instrumental support) and social constraint (eg, others minimizing participants' problems or sharing their own negative experiences).

CONCLUSIONS

This was the first cancer survivorship study to thoroughly examine social functioning by geographic residence. Rural cancer survivors described some unique strengths, but major group differences were not apparent. All participants highlighted situations when others, even with good intentions, were unhelpful to them. Future interventions to improve social functioning could work to dispel the belief that cancer survivors should handle their cancer on their own.

Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination

OBJECTIVE

This study aimed to understand how cancer survivors in rural Queensland seek and receive information, as well as their preferences regarding the content and delivery of health-related information.

METHODS

This study explored cancer survivors' experiences in seeking and comprehending health information using a qualitative descriptive approach. Semi-structured interviews were conducted with 24 participants. Data were analysed using reflexive thematic analysis.

RESULTS

Two major themes and six sub-themes were identified including 1) information content and gaps - a) information about diagnosis and treatment, b) survivorship information gaps and c) practical support needs and 2) delivery and acceptance of information - a) sources of information, b) personalised information needs and c) information seeking or avoidance. Findings suggested that health information provision was inconsistent; survivors' attitudes towards seeking information varied greatly; and survivors' had difficulty processing information due to emotional distress.

CONCLUSION

The role of the health professional is critical in providing information and support to rural cancer survivors. Information provided should be tailored to meet the needs and preferences of individuals taking into consideration demographic factors and attitudes. Implications for public health: The current findings imply that quality information provision after cancer treatment would facilitate improvements in satisfaction among rural cancer survivors.

Understanding the relationship between positive and negative social support and the quality of life among African American breast cancer survivors

PURPOSE

Social support improves several quality of life (QOL) domains among African American breast cancer survivors. How different dimensions of social support are associated with QOL among African American breast cancer survivors may however differ from other populations. This study explores this hypothesis by examining associations of positive social support (supportive interactions that promote affection) and negative social support (non-supportive interactions wherein the provider of support may not have the best intended actions) with QOL among Chicago-based African American breast cancer survivors.

METHODS

Study participants were eligible if they (1) were identified as being an African American female, (2) were at least 18 years of age or older, and (3) were diagnosed with breast cancer during or after navigation was implemented at the study hospital. Participants completed validated questionnaires via telephone or in-person interviews.

RESULTS

Among our sample of 100 participants, positive support was associated with greater mental well-being in non-imputed (Std β=1.60, CI: 0.51, 2.69, p= 0.004) and imputed models (Std β= 1.67, CI: 0.68, 2.73, p=0.001). There was also a weaker inverse association with negative support and mental well-being when using non-imputed data (Std β=-0.82, CI:-1.65, 0.02, p= 0.05).

CONCLUSIONS

Our findings suggest that positive support, in particular, is highly influential for improving mental well-being among African American breast cancer survivors. Simultaneously, negative support appears to be an independent, albeit weaker, determinant of mental well-being.