Between dad and son: initiating, delivering, and assimilating bad cancer news

Bearing Witness to Joy and Sorrow: Narrative Medicine and Reproductive Endocrinologist and Infertility (REI) Providers' Journeys in Infertility Treatment

This study examines providers' perceptions of provider-patient communication in reproductive endocrinology and infertility (REI) practices. Grounded in narrative medicine, we interviewed six REI providers about their experiences providing fertility care. REI providers crafted a narrative of bearing witness by (1) situating personal and professional self in REI narratives, (2) sharing news as important medical moments, and (3) cultivating affiliation between provider and patient. These findings offer insight into the power of narrative medicine in fertility care, the role of emplotment in narrative sense-making, and the emotional labor associated with information delivery in REI treatments. We offer several recommendations for how patients and providers can improve communication experiences in REI.

Factors that Influence Intent to Share Genetic Information Related to Cancer Risk with Family Members

We describe factors influencing patient decisions to share positive cancer genetic test results with family members. We focused on patients who were diagnosed with several different cancer types but did not have a family history that was suggestive of an inherited risk. Participants were recruited from Mayo Clinic and had been recently diagnosed with cancer. An 80+ gene panel was performed. Before receiving genetic test results, patients completed a 49-item survey on their intent to share their results with relatives. 1,721 (57.7%) of 2,984 individuals who elected to pursue genetic testing completed the survey. Most patients planned to share cancer-related genetic results with a spouse or partner (97.0%), at least one adult child (92.2%), at least one sibling (86.2%), and with at least one parent (70.3%). Familial support scores and familial communication scores were predictive of intent to share cancer-related genetic test results. Our data highlight differences in family communication capacity and support that are important for clinicians to consider when supporting patients who wish to share cancer-related genetic test results with family members. Our data point to several potential interventional strategies that might increase the likelihood of cancer-related genetic test results being shared with family members at risk.

Defining Moments, Revisited

'Defining moments' are revealed by weaving three strands together in this essay. First, by reenacting stories as 'tell-aboutables,' 'defining moments' are achieved through participants' methods for drawing attention to significant events. Occasioned reconstructions are designed by speakers as timely and worthy to be heard, responded to, and appreciated by recipients. In turn, 'defining moments' of shared existence emerge through next stories, serial orderings of storytelling achievements exposing (in Goffman's terms) less about people and their moments than moments and their people. Second, numerous examples are provided of how stories about cancer comprise altogether routine everyday life activities for patients, family members, and providers. 'Defining moments' can and do become radically re-defined when landscapes of wellness give way to progressive entanglements and forfeitures of sickness. When 'health' comes into play, it is not uncommon for priorities to be given less to self-promotion (e.g. blaming and boasting), and more to efforts designed to optimize mental, emotional, spiritual, and physical well-being. Third, personal stories about 'defining moments' are shared from my long-term investigations of family cancer and patient-oncologist interactions. A vibrant reflexivity is cultivated when we recognize that, and how, our basic research can be successfully translated to advance the public good.

Sharing news of a lung cancer diagnosis with adult family members and friends: a qualitative study to inform a supportive intervention

OBJECTIVE

Extensive research exists on breaking bad news by clinicians. This study examines perspectives of patients and those accompanying them at diagnosis-giving of subsequently sharing news of lung cancer with adult family/friends, and views of healthcare professionals, to inform development of a supportive intervention.

METHODS

Qualitative interviews with 20 patients, 17 accompanying persons; focus groups and interviews with 27 healthcare professionals from four Thoracic Oncology Units. Intervention development workshops with 24 healthcare professionals and six service users with experience of sharing a cancer diagnosis. Framework thematic analysis.

RESULTS

Patients and accompanying persons shared news of lung cancer whilst coming to terms with the diagnosis. They recalled general support from healthcare professionals but not support with sharing bad news. Six elements were identified providing a framework for a potential intervention: 1-people to be told, 2-information to be shared, 3-timing of sharing, 4-responsibility for sharing, 5-methods of telling others and 6-reactions of those told.

CONCLUSION

This study identifies the challenge of sharing bad news and a potential framework to guide delivery of a supportive intervention tailored to individual needs of patients.

PRACTICE IMPLICATIONS

The identified framework could extend the portfolio of guidance on communication in cancer and potentially in other life-limiting conditions.

Discussion of First-Degree Relatives' Colorectal Cancer Risk: Survivors' Perspectives

Although screening reduces colorectal cancer (CRC) incidence and mortality, screening rates are low, particularly among CRC patients' first-degree relatives (FDRs). Little is known about discussion of family members' risk of CRC among patients and their health care providers or with their FDRs. The purpose of this research, guided by the Protection Motivation Theory, was to assess patients' patterns of disclosure of CRC diagnosis to adult siblings and/or children and discussion of familial risk by healthcare providers. A cross-sectional sample of patients who received care at a comprehensive cancer center was recruited to complete telephone-based interviews related to disclosure of CRC diagnosis to FDRs, recall of physician counseling about familial risk, and patients' perception of CRC risk to FDRs. Sixty-nine patients completed the interview. Most participants (n = 67, 97%) had informed their adult children or siblings of their CRC diagnosis to keep their family informed of their health status (n = 15, 22%) and to encourage FDRs to screen for CRC (n = 14, 20%). More than half of the participants' physicians (n = 38, 55%) discussed FDRs' risk of developing CRC with the patient. However, a substantial proportion of patients reported no physician discussion of this risk (n = 28, 41%). Data from this study may guide the development of interventions to facilitate physician discussion and counseling of CRC patients about their FDRs' risk for CRC. However, future studies should explore whether FDRs are likely to be screened after becoming aware of their family member's diagnosis of CRC.

Creating the final conversations scale: a measure of end-of-life relational communication with terminally ill individuals

Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the "Final Conversations Scale" was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.

Systematically reviewing and synthesizing evidence from conversation analytic and related discursive research to inform healthcare communication practice and policy: an illustrated guide

Background

Healthcare delivery is largely accomplished in and through conversations between people, and healthcare quality and effectiveness depend enormously upon the communication practices employed within these conversations. An important body of evidence about these practices has been generated by conversation analysis and related discourse analytic approaches, but there has been very little systematic reviewing of this evidence.

Methods

We developed an approach to reviewing evidence from conversation analytic and related discursive research through the following procedures:

• reviewing existing systematic review methods and our own prior experience of applying these

• clarifying distinctive features of conversation analytic and related discursive work which must be taken into account when reviewing

• holding discussions within a review advisory team that included members with expertise in healthcare research, conversation analytic research, and systematic reviewing

• attempting and then refining procedures through conducting an actual review which examined evidence about how people talk about difficult future issues including illness progression and dying

Results

We produced a step-by-step guide which we describe here in terms of eight stages, and which we illustrate from our ‘Review of Future Talk’. The guide incorporates both established procedures for systematic reviewing, and new techniques designed for working with conversation analytic evidence.

Conclusions

The guide is designed to inform systematic reviews of conversation analytic and related discursive evidence on specific domains and topics. Whilst we designed it for reviews that aim at informing healthcare practice and policy, it is flexible and could be used for reviews with other aims, for instance those aiming to underpin research programmes and projects. We advocate systematically reviewing conversation analytic and related discursive findings using this approach in order to translate them into a form that is credible and useful to healthcare practitioners, educators and policy-makers.

The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.

Methodological diversity and integration in health communication inquiry

Research on health communication is complicated by myriad individual, organizational, and societal factors that influence health-related decisions and behaviors, making it difficult to control for secular trends (uncontrolled social and environmental influences) that affect health care and health promotion practices. Sophisticated research on health communication must take into account the numerous situational, psychological, and societal factors to fully examine the often hidden dynamics of health care and health promotion. This essay examines major research challenges, strategies, and opportunities for making sense of the complexities of health communication processes, recommending the power of methodological diversity and integration for health research.

Communicating about illness: a family narrative

INTRODUCTION

Cancer is often so pervasive that healthcare systems are generally unaware of the impact it has in shaping the social images of the illness reality within the family milieu. Families are catapulted into an unfamiliar environment where they have little or no time emotionally and psychologically to incorporate, absorb and integrate the illness within the average course of their lives. This presentation will examine how communication, in its multi-faceted forms, can be the conduit by which the patient, family, and healthcare team negotiate their way successfully through the illness trajectory.

FAMILY NARRATIVES IN CONFRONTING ILLNESS

Families and patients construct their own personal narratives to apprehend the meaning of the illness experience. Although there is a tendency to construct profoundly different interpretations of the same event, these narratives can teach us how illness can be a non-threatening communicative phenomenon.

CONCLUSION

Communication, verbally or non-verbally, represents more than just a singular act. It symbolizes the complexity of family interactions as members confront the illness. Communication with families means developing an ethic of negotiation and accommodation, a balancing suggested as the basis for the physician-family relationship.

Disclosing and responding to cancer “fears” during oncology interviews

Video-excerpts from routine oncology interviews are examined to reveal how patients demonstrate and doctors respond to "fears" about cancer. Vocally and visually, embodied impacts of dealing with dreaded consequences of cancer are apparent when addressing both good and potentially bad cancer news. Even a "brush" with cancer can promote negative and ongoing impacts provoking unresolved illness dilemmas. We reveal how, in the midst of extending answers and initiating concerns, patients exhibit trepidations when volunteering narrative information about their medical history and experience of symptoms. In response, doctors are shown to acknowledge yet exhibit minimal receptiveness to patients' lifeworld disclosures and demonstrations (e.g., redirecting attention away from patients' concerns by offering "textbook" symptoms and related pursuits of biomedical agendas). Discussion focuses on interactional criteria for identifying "fears", patients' lay orientations to medical visits, and implications for refining educational workshops for oncologists.

Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework

This paper uses the conceptual framework of Feldman-Stewart et al. to organize and review the types of research methodologies used to investigate various aspects of patient-health care professional communication in the context of cancer. Research methods employed are classified as either non-experimental or experimental. Non-experimental designs include naturalistic observational studies (e.g. participant observation, audio- or videotaping of interactions) and retrospective introspective descriptions (e.g. self-report questionnaires, qualitative interview methods). Experimental designs often involve interventions aimed at improving communication, such as physician or patient training, and the use of technology to enhance communication (e.g. audiotapes, computers). Using the conceptualization of the communication framework description, we argue that the outcome measures used in these studies address either primary goals, enabling goals, or secondary communication outcomes. Outcomes that are related to primary goals of the communication exchange include assessing the level of understanding of information conveyed, aspects of decision making, planning around treatments, or general provision of care. Outcomes related to enabling goals focus on elements that affect the ability to achieve primary goals. Outcomes secondary to the communication do not relate directly to what the communication is attempting to achieve. We conclude by identifying priority areas for further research, such as identifying the goals of both participants, understanding how particular aspects of the communication process affect their ability to achieve their goals, and examining the external environment in which communication takes place.

A review and application of social scientific measures of religiosity and spirituality: assessing a missing component in health communication research

Social and behavioral scientists in fields such as psychology, sociology, anthropology, nursing, and medicine have been investigating the relation between religious or spiritual variables and health outcomes for several decades. This article reviews a sample of the major empirical instruments used in this research, including extrinsic and intrinsic religiosity, spiritual well-being, and religious coping. The review encompasses suggestions for application of these scales to health communication theory and research associated with identity, self-efficacy, social support, and media use. Cautionary advice regarding ethical issues together with guidelines for use is advanced.

Silence and cancer: why do families and patients fail to communicate?

This study examined the phenomenon of avoidance of family communication about cancer. Thirty-seven Stage III or IV lung cancer patients and 40 caregivers, including 24 primary and 16 secondary caregivers, were interviewed; a total of 26 families were studied. The interviews were audiotaped and transcribed. Analysis of the interviews indicated that two thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: avoidance of psychological distress; desire for "mutual protection;" and belief in positive thinking. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer. The adverse impact of communication avoidance and the implications of our findings are discussed.