The CAUSE model: a research-supported aid for physicians communicating with patients about cancer risk

Improving Patient Comprehension Through Explanatory Communication

This JAMA Insights illustrates how explanatory communication strategies can help improve patient comprehension, including adherence to treatment recommendations and self-management.

How good are medical students at communicating risk? An implementation study at three German medical schools

OBJECTIVE

To assess the objective and subjective risk communication skills of medical students in three universities in Germany METHODS: We developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance.

RESULTS

Participants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = -5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001).

CONCLUSIONS

Medical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum.

PRACTICE IMPLICATIONS

Our research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.

The effect of risk communication on the nurses' task and contextual performance in disease outbreak control in Ghana: Application of the cause model

BACKGROUND

The re-emerging of infectious disease outbreaks is a menace in Ghana. As the acceptance of risk communication rises, health workers are using it to control outbreaks. Yet, research in risk communication and health workers' performance remains unexplored in Ghana.

OBJECTIVE

This study explores how risk communication works among nurses and its effect on their task (behaviors that are delineated based on role requirements and identified by a thorough analysis of the job) and contextual performance (behaviors that do not fall within the employee's assigned duties, but are a very important part of job performance). Thus, we adopted the CAUSE model, which proposes that effective risk communication creates five goals (Confidence, Awareness, Understanding, Satisfaction, and Enactment) amongst communicators.

METHOD

This study involves a quantitative approach complemented with qualitative data. It was conducted in three hospitals in Ghana, from which a sample of 398 nurses were selected.

RESULT

The result depicts that risk communication has a significant and positive effect on task performance (β = .65; P < .001), and contextual performance (β = .55; P < .001).

CONCLUSION

Our study shows that confidence is the strongest predictor of risk communication in influencing task and contextual performance. Yet, risk communication overall improves nurses' task and contextual performance.

Using the CAUSE Model to Understand Public Communication about Water Risks: Perspectives from Texas Groundwater District Officials on Drought and Availability

Public communication about drought and water availability risks poses challenges to a potentially disinterested public. Water management professionals, though, have a responsibility to work with the public to engage in communication about water and environmental risks. Because limited research in water management examines organizational communication practices and perceptions, insights into research and practice can be gained through investigation of current applications of these risk communication efforts. Guided by the CAUSE model, which explains common goals in communicating risk information to the public (e.g., creating Confidence, generating Awareness, enhancing Understanding, gaining Satisfaction, and motivating Enactment), semistructured interviews of professionals (N = 25) employed by Texas groundwater conservation districts were conducted. The interviews examined how CAUSE model considerations factor in to communication about drought and water availability risks. These data suggest that many work to build constituents' confidence in their districts. Although audiences and constituents living in drought-prone areas were reported as being engaged with water availability risks and solutions, many district officials noted constituents' lack of perceived risk and engagement. Some managers also indicated that public understanding was a secondary concern of their primary responsibilities and that the public often seemed apathetic about technical details related to water conservation risks. Overall, results suggest complicated dynamics between officials and the public regarding information access and motivation. The article also outlines extensions of the CAUSE model and implications for improving public communication about drought and water availability risks.

Communication guidelines as a learning tool: an exploration of user preferences in general practice

OBJECTIVE

To explore characteristics of written communication guidelines that enhance the success of training aimed at the application of the recommendations in the guidelines.

METHODS

Seven mixed focus groups were held consisting of communication skill teachers and communication skill learners and three groups with only learners. Analysis was done in line with principles of grounded theory.

RESULTS

Five key attributes of guidelines for communication skill training were identified: complexity, level of detail, format and organization, type of information, and trustworthiness/validity. The desired use of these attributes is related to specific educational purposes and learners' expertise. The low complexity of current communication guidelines is appreciated, but seems ad odds with the wish for more valid communication guidelines.

CONCLUSIONS

Which guideline characteristics are preferred by users depends on the expertise of the learners and the educational purpose of the guideline.

PRACTICE IMPLICATIONS

Communication guidelines can be improved by modifying the key attributes in line with specific educational functions and learner expertise. For example: the communication guidelines used in GP training in the Netherlands, seem to offer an oversimplified model of doctor patient communication. This model may be suited for undergraduate learning, but does not meet the validity demands of physicians in training.

Consumer health informatics: an overview of patient perspectives on health information needs

Patients are increasingly expressing their need for more information about their health. Different healthcare professionals provide a range of information to their patients during delivery of care. By means of a detailed literature search and a study of available evidence, this article explores patients' perspectives in gaining health-related information from the healthcare system, with particular emphasis on patients who come in contact with breast cancer services. The literature review indicates that the main issues concerning health information available to consumers can be divided into the following sections: quantity of information (amount of information, number of sources, types and strategies for distribution); quality of information (validity, relevance, accessibility, understandability, timing of acquisition); and consumer/patient factors (age, health status, empowerment to make decisions). Information-seeking behaviour of consumers should be considered as part of a broader environmental and role-related context. The acquisition of information and the decision to seek information (either personally or using the help or services of other people) is affected by stress, perception of risk, hope for reward and perceived level of self-efficacy.

Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study

Background

The quality of doctor-patient communication has a major impact on the quality of medical care. Communication guidelines define best practices for doctor patient communication and are therefore an important tool for improving communication. However, adherence to communication guidelines remains low, despite doctors participating in intensive communication skill training. Implementation research shows that adherence is higher for guidelines in general that are user centred and feasible, which implies that they are consistent with users' opinions, tap into users' existing skills and fit into existing routines. Developers of communication guidelines seem to have been somewhat negligent with regard to user preferences and guideline feasibility. In order to promote the development of user centred and practicable communication guidelines, we elicited user preferences and identified which guideline characteristics facilitate or impede guideline use.

Methods

Seven focus group interviews were conducted with experienced GPs, communication trainers (GPs and behavioural scientists) and communication learners (GP trainees and medical students) and three focus group interviews with groups of GP trainees only. All interviews were transcribed and analysed qualitatively.

Results

The participants identified more impeding guideline characteristics than facilitating ones. The most important impeding characteristic was that guidelines do not easily fit into GPs' day-to-day practice. This is due to rigidity and inefficiency of communication guidelines and erroneous assumptions underpinning guideline development. The most important facilitating characteristic was guideline structure. Guidelines that were structured in distinct phases helped users to remain in control of consultations, which was especially useful in complicated consultations.

Conclusion

Although communication guidelines are generally considered useful, especially for structuring consultations, their usefulness is impaired by lack of flexibility and applicability to practice routines. User centred and feasible guidelines should combine the advantages of helping doctors to structure consultations with flexibility to tailor communication strategies to specific contexts and situations.

Factors associated with patients' perceptions of health care providers' communication behavior

We examined patients' ratings of communication with health care providers by sociodemographic characteristics, health care access, and health status. Data were from a national, population-based survey, the 2003 Health Information National Trends Survey (HINTS). The survey was administered to 6,369 adults from a representative sample of U.S. households. Linear regression analysis was conducted using SUDAAN. None of the sociodemographic variables were significantly associated with patients' ratings of providers' communication behavior in the linear model. Ratings of health care providers' communication behavior, however, were significantly higher among respondents with health insurance (p = 0.007) and those with a usual source of health care from whom they consistently sought care (p < 0.001). Ratings of provider communication were significantly lower among respondents who perceived their general health to be fair or poor (p < 0.001) and among those respondents with greater depressive symptoms (p < 0.001). Differences in patient ratings of health care providers' communication by health care access and health status suggest the potential for disparities in health outcomes.