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Wollney EN, Bylund CL, Bedenfield N, Parker ND, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Armstrong MJ. Persons living with dementia and caregivers' communication preferences for receiving a dementia diagnosis. PEC Innov 2024; 4:100253. [PMID: 38298558 PMCID: PMC10828581 DOI: 10.1016/j.pecinn.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Objective As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and caregivers. Methods We conducted semi-structured individual phone interviews with two groups: PLWD who were diagnosed in the past two years (n = 11) and family caregivers of PLWD (n = 19) living in Florida. PLWD and caregivers were not recruited/enrolled as dyads. Results The groups' communication preferences were largely similar. Data were analyzed thematically into five themes: communicate the diagnosis clearly, meet information needs, discuss PLWD/caregiver resources, prepare for continued care, and communicate to establish and maintain relationships. Conclusion Participants wanted clear communication, information, and support, but differed in some details (e.g. the language used to describe the diagnosis and the amount/type of desired information). Clinicians can apply general principles but will need to tailor them to individual preferences of PLWD and caregivers. Innovation Limited research has elicited PLWD and caregivers' communication preferences for receiving dementia diagnoses, particularly through an individualized data collection method allowing for richer descriptions and deeper understanding.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Noheli Bedenfield
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Naomi D. Parker
- College of Journalism & Communication, University of Florida, Gainesville, FL, United States of America
| | - Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Rosie E. Curiel Cid
- Department of Psychiatry & Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | | | - Melissa J. Armstrong
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
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Bylund CL, Taylor G, Vasquez TS, Alpert J, Johnson SB, Le T, Paige SR, Close J, Markham MJ. Talking with clinicians about online cancer information: a survey of cancer patients and surrogate information seekers. Support Care Cancer 2024; 32:362. [PMID: 38755329 DOI: 10.1007/s00520-024-08578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 05/14/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES To describe patients' and surrogate information seekers' experiences talking to clinicians about online cancer information. To assess the impact of clinicians telling patients or surrogate seekers not to search for information online. DESIGN Cross-sectional survey. SAMPLE A total of 282 participants, including 185 individuals with cancer and 97 surrogate seekers. METHODS Individuals were recruited through a broad consent registry and completed a 20-min survey. FINDINGS Cancer patients and surrogate seekers did not differ significantly in their experiences talking with clinicians about online cancer information. Nearly all patients and surrogate seekers who were told by a clinician not to go online for cancer information did so anyway. IMPLICATIONS Interventions for improving cancer information seeking and communication with clinicians should target both patients and surrogate seekers. Clinicians should be educated about effective ways to communicate with patients and surrogate seekers about online cancer information.
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Affiliation(s)
- Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, 32611, USA.
| | - Greenberry Taylor
- School of Creative Arts and Letters Flagler College, St. Augustine, FL, 32084, USA
| | - Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, 32611, USA
| | - Jordan Alpert
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Skyler B Johnson
- University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Tien Le
- College of Journalism and Communications, University of Florida, Gainesville, FL, 32611, USA
| | - Samantha R Paige
- College of Journalism and Communications, University of Florida, Gainesville, FL, 32611, USA
| | - Julia Close
- College of Medicine, University of Florida, Gainesville, FL, 32611, USA
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Linn AJ, van Weert JCM, Bylund CL. Are They Important? Patients' Communication Barriers to Discussing Online Health Information During Consultations. Health Commun 2024; 39:945-950. [PMID: 37072688 DOI: 10.1080/10410236.2023.2197311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A minority of the patients who search for online health information report discussing or having an intention to discuss this information with their healthcare provider. Not discussing online health information inhibits the provision of patient-centered care and limits the healthcare provider's possibility to tackle misinformation. Within the confines of the linguistic model of patient participation, we first provide an overview of barriers to discussing online health information during consultations. Second, we pinpoint which of these barriers indicate a need for improvement. Participants from the Netherlands (N = 300) completed a survey that measured the communication barriers (N = 15) as identified based on previous literature and interviews. Using the QUality Of Care Through the patient's Eyes (QUOTE) approach, we measured the extent to which a specific factor was a barrier ("importance") and assessed whether the barrier would withhold patients from discussing online health information ("performance"). Scores on importance and performance were multiplied to identify which barriers show the most significant room for improvement. Especially "preferring to discuss other matters" often occurred. Nine barriers showed a moderate need for improvement. We discuss the implications of these findings for healthcare providers in consultations. Future research should include observational data to analyze communication barriers to discussing online health information in consultations.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | | | - Carma L Bylund
- College of Journalism and Communications, College of Medicine, University of Florida
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Koch MK, Bluck S, Maggiore S, Chochinov HM, Cogdill-Richardson K, Bylund CL. Facing off-time mortality: Leaving a legacy. Psychol Aging 2024:2024-72520-001. [PMID: 38602809 DOI: 10.1037/pag0000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Considering one's legacy is usual in later life but may be accentuated after receiving a serious and terminal cancer diagnosis. This may be particularly true when timing of the diagnosis is nonnormatively early, evoking the sense of losing future years of life. Acknowledging the severity of one's illness may also promote focus on legacy. We investigated the extent to which older individuals diagnosed with cancer narrated communion (i.e., loving, caring themes) when telling their legacy, including narration of aftermath concerns (i.e., concern for how others will fare after one's death). Communion was assessed in relation to individuals' potential years of life to lose and illness acknowledgment. Participants were a national sample of adults (N = 203; M = 65.80 years; 66% women; 77.94% White; 48.53% college-educated) with serious and terminal cancer receiving outpatient palliative care. They narrated legacies in semistructured interviews and completed measures of illness acknowledgment. We developed a novel construct, potential years of life to lose, calculated as the difference between chronological age and national life expectancy at birth. Coders, trained to high reliability, content-analyzed legacy narratives for communion with follow-up coding for aftermath concerns. Hierarchical regression indicated that for those with more potential years of life to lose, acknowledging the severity of their illness was critical to narrating communion-rich legacies. Similarly, aftermath concerns were common in those with the most years of life to lose who were able to acknowledge the severity of their illness. Findings affirm the psychological richness of individuals' legacies in the second half of life and highlight one way they adaptively respond to the nonnormative timing of serious and terminal cancer. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Susan Bluck
- Department of Psychology, University of Florida
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Alpert JM, Hampton CN, Campbell-Salome G, Paige S, Murphy M, Heffron E, Amin TB, Harle CA, Le T, Vasquez TS, Xue W, Markham MJ, Bylund CL. Tele-Oncology Use During the COVID-19 Pandemic: Patient Experiences and Communication Behaviors with Clinicians. Telemed J E Health 2024. [PMID: 38574250 DOI: 10.1089/tmj.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: Tele-oncology became a widely used tool during the COVID-19 pandemic, but there was limited understanding of how patient-clinician communication occurred using the technology. Our goal was to identify how communication transpired during tele-oncology consultations compared with in-person appointments. Methods: A convergent parallel mixed-method design was utilized for the web-based survey, and follow-up interviews were conducted with cancer patients from March to December 2020. Participants were recruited from the University of Florida Health Cancer Center and two national cancer organizations. During the survey, participants rated their clinician's patient-centered communication behaviors. Open-ended survey responses and interview data were combined and analyzed thematically using the constant comparative method. Results: A total of 158 participants completed the survey, and 33 completed an interview. Ages ranged from 19 to 88 years (mean = 64.2; standard deviation = 13.0); 53.2% identified as female and 44.9% as male. The majority of respondents (76%) considered communication in tele-oncology equal to in-person visits. Preferences for tele-oncology included the ability to get information from the clinician, with 13.5% rating tele-oncology as better than in-person appointments. Tele-oncology was considered worse than in-person appointments for eye contact (n = 21, 12.4%) and virtual waiting room times (n = 50, 29.4%). The following qualitative themes corresponded with several quantitative variables: (1) commensurate to in-person appointments, (2) uncertainty with the digital platform, (3) lack of a personal connection, and (4) enhanced patient experience. Conclusion: Patient-centered communication behaviors were mostly viewed as equally prevalent during tele-oncology and in-person appointments. Addressing the challenges of tele-oncology is necessary to improve the patient experience.
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Affiliation(s)
- Jordan M Alpert
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chelsea N Hampton
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Samantha Paige
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
- Department of Behavior Science, Johnson and Johnson, Potsdam, New York, USA
| | - Martina Murphy
- Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
| | - Eve Heffron
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Tithi B Amin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christopher A Harle
- Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Tien Le
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Wei Xue
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Wright KB, Bylund CL, Bagautdinova D, Vasquez TS, Sae-Hau M, S Weiss E, Rajotte M, Fisher CL. Caring for an Individual with Chronic Lymphocytic Leukemia (CLL): Understanding Family Caregivers' Perceptions of Social Support, Caregiver Burden, and Unmet Support Needs. J Cancer Educ 2024; 39:180-185. [PMID: 38049567 DOI: 10.1007/s13187-023-02392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
Family caregivers (FCs) of a patient with chronic lymphocytic leukemia (CLL) can encounter unpredictable challenges and care demands. They can experience high levels of burden, a loss of self-care, and poor quality of life. Their receipt of social support and ability to communicate with clinicians may impact their burden. FCs would benefit from educational resources that teach them communication skills central to their ability to obtain the support they need-support that is imperative to reducing burden. To better target psychosocial educational interventions focused on social support and communication skills, we aimed to explore the relationship between social support, sources of support, and burden; the relationship between FCs' clinical communication and their perceptions of support and burden; and any unmet support needs. A total of 575 CLL FCs completed an online survey of validated scales about social support, burden, and clinical communication, as well as an open-ended item in which they reported any unmet support needs. Statistical analyses showed that FCs who perceived they were more supported reported less burden, and female FCs reported more burden than males. Support from family, friends, and professionals collectively contributed to FCs' support. FCs who perceived they had stronger communication skills with their loved one's clinicians reported more social support. FCs identified six areas of unmet support needs: financial, emotional, informational, instrumental, peer, and communication support. Collectively, findings show that increased social support can reduce FCs' burden and qualitative findings provide a roadmap of social support domains to target that could potentially improve the caregiving experience.
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Affiliation(s)
- Kevin B Wright
- College of Humanities and Social Sciences, George Mason University, Fairfax, VA, USA.
| | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- School of Medicine, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | | | | | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
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7
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Gutman CK, Fernandez R, McFarlane A, Krajewski JMT, Casey Lion K, Aronson PL, Bylund CL, Holmes S, Fisher CL. "Let us take care of the medicine": A qualitative analysis of physician communication when caring for febrile infants. Acad Pediatr 2024:S1876-2859(24)00070-6. [PMID: 38458491 DOI: 10.1016/j.acap.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Guidelines for the management of febrile infants emphasize patient-centered communication. Although patient-centeredness is central to high-quality healthcare, biases may impact physicians' patient-centeredness. We aimed to 1) identify physicians' assumptions that inform their communication with parents of febrile infants and 2) examine physicians' perceptions of bias. METHODS We recruited physicians from three academic pediatric emergency departments (EDs) for semi-structured interviews. We applied a constant comparative method approach to conduct a thematic analysis of interview transcripts. Two coders followed several analytical steps: 1) discovery of concepts and code assignment, 2) identification of themes by grouping concepts, 3) axial coding to identify thematic properties, and 4) identifying exemplar excerpts for rich description. Thematic saturation was based on repetition, recurrence, and forcefulness. RESULTS Fourteen physicians participated. Participants described making assumptions regarding three areas: 1) the parent's affect, 2) the parent's social capacity, and 3) the physician's own role in the parent-physician interaction. Thematic properties highlighted the importance of the physician's assumptions in guiding communication and decision-making. Participants acknowledged an awareness of bias, and specifically noted that language bias influenced the assumptions that informed their communication. CONCLUSIONS ED physicians described subjective assumptions about parents that informed their approach to communication when caring for febrile infants. Given the emphasis on patient-centered communication in febrile infant guidelines, future efforts are necessary to understand how assumptions are influenced by biases, the effect of such behaviors on health inequities, and how to combat this. WHAT'S NEW Physician communication drives health outcomes. In this qualitative investigation, physicians described making assumptions about parents, based on subjective assessments, which informed their communication and decision-making. This represents a step towards understanding how biases inform communication and result in health inequity.
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Affiliation(s)
- Colleen K Gutman
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine, Gainesville, FL.
| | - Rosemarie Fernandez
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | - Antionette McFarlane
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | | | - K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Fl
| | - Sherita Holmes
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Carla L Fisher
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
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Singh Ospina N, Patel Chavez C, Godinez Leiva E, Bagautdinova D, Hidalgo J, Hartasanchez S, Algarin Perneth S, Barb D, Danan D, Dziegielewski P, Hughley B, Srihari A, Subbarayan S, Castro MR, Dean D, Morris J, Ryder M, Stan MN, Hargraves I, Bylund CL, Treise D, Montori VM, Brito JP. Clinician feedback using a shared decision-making tool for the evaluation of patients with thyroid nodules-an observational study. Endocrine 2024; 83:449-458. [PMID: 37695453 PMCID: PMC10999160 DOI: 10.1007/s12020-023-03519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND We pilot-tested an encounter conversation aid to support shared decision making (SDM) between patients with thyroid nodules and their clinicians. OBJECTIVE Characterize the clinician feedback after providing care to patients with thyroid nodules using a tool to promote SDM conversations during the clinical encounter, and evaluate how clinicians used the tool during the visit. METHODS Mixed method study in two academic centers in the U.S., including adult patients presenting for evaluation of thyroid nodules and their clinicians. We thematically analyzed interviews with clinicians after they used the SDM tool in at least three visits to characterize their feedback. Additionally, investigators evaluated visits recordings to determine the extent to which clinicians engaged patients in the decision-making process (OPTION score, scale 0 to 100, higher levels indicating higher involvement), the tool's components used (fidelity), and encounter duration. Using a post-visit survey, we evaluated the extent to which clinicians felt the tool was easy to use, helpful, and supportive of the patient-clinician collaboration. RESULTS Thirteen clinicians participated in the study and used the SDM tool in the care of 53 patients. Clinicians thought the tool was well-organized and beneficial to patients and clinicians. Clinicians noticed a change in their routine with the use of the conversation aid and suggested it needed to be more flexible to better support varying conversations. The median OPTION score was 34, the fidelity of use 75%, and the median visit duration 17 min. In most encounters, clinicians agreed or strongly agreed the tool was easy to use (86%), helpful (65%), and supported collaboration (62%). CONCLUSION Clinicians were able to use a SDM tool in the care of patients with thyroid nodules. Although they wished it were more flexible, they found on the whole that its use in the clinical encounter was beneficial to patients and clinicians.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Chandani Patel Chavez
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Eddison Godinez Leiva
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Hartasanchez
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Algarin Perneth
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Diana Barb
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | | | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Ashok Srihari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sreevidya Subbarayan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Diana Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - John Morris
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mabel Ryder
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
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Armstrong MJ, Bedenfield N, Rosselli M, Curiel Cid RE, Kitaigorodsky M, Galvin JE, Lachner C, Grant Smith A, de Los Ángeles Ortega M, Mohiuddin Y, Shatzer J, Marasco D, Willis D, Bylund CL. Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process. Neurol Clin Pract 2024; 14:e200223. [PMID: 38152063 PMCID: PMC10750429 DOI: 10.1212/cpj.0000000000200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. Methods We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. Results The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Discussion Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Noheli Bedenfield
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Monica Rosselli
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Rosie E Curiel Cid
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Marcela Kitaigorodsky
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - James E Galvin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Christian Lachner
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Amanda Grant Smith
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - María de Los Ángeles Ortega
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Yasmin Mohiuddin
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Julie Shatzer
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Deann Marasco
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Dianna Willis
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
| | - Carma L Bylund
- Department of Neurology (MJA, NB, YM), University of Florida College of Medicine; UF Health Fixel Institute for Neurological Diseases (MJA, NB, YM), Gainesville; Department of Psychology (MR), Florida Atlantic University, Davie; Department of Psychiatry and Behavioral Sciences (RECC), University of Miami Miller School of Medicine; FL Neuro-Health (MK), Miami; Comprehensive Center for Brain Health (JEG), Department of Neurology, University of Miami Miller School of Medicine, Boca Raton; Department of Neurology (CL); Department of Psychiatry and Psychology (CL), Mayo Clinic, Jacksonville; Byrd Alzheimer's Institute (AGS); Department of Psychiatry and Behavioral Neurosciences (AGS), Morsani College of Medicine, University of South Florida, Tampa; Louis and Anne Green Memory and Wellness Center (MÁO), Christine E. Lynn College of Nursing, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Alzheimer's Association (JS, DM), Florida Region, Clearwater; Department of Health Outcomes and Biomedical Informatics (CLB), University of Florida College of Medicine, Gainesville, FL; and [N/A - caregiver representative] (DW)
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10
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Wollney EN, Bylund CL, Kastrinos AL, Campbell-Salome G, Sae-Hau M, Weiss ES, Fisher CL. Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer. PEC Innov 2023; 3:100198. [PMID: 37662692 PMCID: PMC10468798 DOI: 10.1016/j.pecinn.2023.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Rationale Parents of a child or adolescent (CA) or young adult (YA) diagnosed with a hematologic cancer often face uncertainty. Managing uncertainty is critical to reduce the psychosocial burden of illness-related stressors. Objective This study sought to identify: 1) sources of uncertainty among parents of a child diagnosed with a hematologic cancer, 2) strategies used by parents to manage uncertainty, and 3) clinicians' responses to parents' online information-seeking approach to managing uncertainty. Methods Parents of CAs/YAs diagnosed with a hematologic cancer within the past 1-18 months and living in the U.S. participated in an in-depth, semi-structured phone interview (n = 20). Data were analyzed thematically. Results Parents reported uncertainty about treatment (options, efficacy, and side effects or risks) and uncertainty about the future (recurrence, whether worry would subside, and how to approach the child's future). Parents managed uncertainty by seeking information online, talking to clinicians, and joining support groups. Clinicians' responses to online information-seeking were described as supportive and unsupportive. Conclusion Parents described struggling with uncertainty across the cancer continuum (from primary treatment to survivorship). Parents' psychosocial health may benefit from individual and systems level interventions that help address and manage uncertainty, especially interventions focusing on parent caregiver-clinician communication.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
| | - Amanda L. Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, PA, United States of America
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
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Staras SAS, Wollney EN, Emerson LE, Silver N, Dziegielewski PT, Hansen MD, Sanchez G, D'Ingeo D, Johnson‐Mallard V, Renne R, Fredenburg K, Gutter M, Zamojski K, Vandeweerd C, Bylund CL. Identifying locally actionable strategies to increase participant acceptability and feasibility to participate in Phase I cancer clinical trials. Health Expect 2023; 27:e13920. [PMID: 38041447 PMCID: PMC10726272 DOI: 10.1111/hex.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Recruitment of cancer clinical trial (CCT) participants, especially participants representing the diversity of the US population, is necessary to create successful medications and a continual challenge. These challenges are amplified in Phase I cancer trials that focus on evaluating the safety of new treatments and are the gateway to treatment development. In preparation for recruitment to a Phase I recurrent head and neck cancer (HNC) trial, we assessed perceived barriers to participation or referral and suggestions for recruitment among people with HNC and community physicians (oncologist, otolaryngologist or surgeon). METHODS Between December 2020 and February 2022, we conducted a qualitative needs assessment via semistructured interviews with a race and ethnicity-stratified sample of people with HNC (n = 30: 12 non-Hispanic White, 9 non-Hispanic African American, 8 Hispanic and 1 non-Hispanic Pacific Islander) and community physicians (n = 16) within the University of Florida Health Cancer Center catchment area. Interviews were analyzed using a qualitative content analysis approach to describe perspectives and identify relevant themes. RESULTS People with HNC reported thematic barriers included: concerns about side effects, safety and efficacy; lack of knowledge and systemic and environmental obstacles. Physicians identified thematic barriers of limited physician knowledge; clinic and physician barriers and structural barriers. People with HNC and physicians recommended themes included: improved patient education, dissemination of trial information and interpersonal communication between community physicians and CCT staff. CONCLUSIONS The themes identified by people with HNC and community physicians are consistent with research efforts and recommendations on how to increase the participation of people from minoritized populations in CCTs. This community needs assessment provides direction on the selection of strategies to increase CCT participation and referral. PATIENT OR PUBLIC CONTRIBUTION This study focused on people with HNC and community physicians' lived experience and their interpretations of how they would consider a future Phase I clinical trial. In addition to our qualitative data reflecting community voices, a community member reviewed the draft interview guide before data collection and both people with HNC and physicians aided interpretation of the findings.
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Affiliation(s)
- Stephanie A. S. Staras
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Easton N. Wollney
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Lisa E. Emerson
- Department of Microbiology and Cell Science, Institute of Food and Agricultural SciencesUniversity of FloridaGainesvilleFloridaUSA
| | | | - Peter T. Dziegielewski
- Department of OtolaryngologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Marta D. Hansen
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Gabriela Sanchez
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Dalila D'Ingeo
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | | | - Rolf Renne
- Department of Molecular Genetics and MicrobiologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Kristianna Fredenburg
- Department of PathologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Michael Gutter
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Kendra Zamojski
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Carla Vandeweerd
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
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12
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Paige SR, Bylund CL, Wilczewski H, Ong T, Barrera JF, Welch BM, Bunnell BE. Communicating about online health information with patients: Exploring determinants among telemental health providers. PEC Innov 2023; 2:100176. [PMID: 37384157 PMCID: PMC10294076 DOI: 10.1016/j.pecinn.2023.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
Objective To investigate determinants of telemental health (TMH) providers' openness to discuss and confidence to use online mental health information with patients, focusing on providers' eHealth literacy and perceived usefulness of online MH information. Methods TMH providers (N = 472) completed a web-based survey with questions about discussing and using online health information with patients, perceived usefulness of the Internet as a source of patient information, and eHealth literacy. Results Providers were open to discussing online health information with patients if they were not treating substance abuse disorders (b = -0.83), felt the Internet was a useful resource (b = 0.18), and felt confident in their skills to evaluate the online information (b = 0.21). Providers were confident using online health information if they worked in a small clinic (b = 0.37), felt the Internet was a useful resource (b = 0.31), knew where to access relevant online health information (b = 0.13), and had skills to help their patients find (b = 0.17) and evaluate (b = 0.54) online information. Conclusion TMH providers are likely to use online health information resources if they know where and how to find them and perceive the Internet as a useful resource. Innovation To effectively discuss online health information with patients, providers require skills to evaluate the information with patients.
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Affiliation(s)
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
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Wollney EN, Vasquez TS, Fisher CL, Armstrong MJ, Paige SR, Alpert J, Bylund CL. A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians' communication. Patient Educ Couns 2023; 117:107976. [PMID: 37738791 DOI: 10.1016/j.pec.2023.107976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures. METHODS Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors. RESULTS Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items. CONCLUSION There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction. PRACTICE IMPLICATIONS Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Taylor S Vasquez
- College of Journalism & Communications, University of Florida, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, FL, USA
| | - Samantha R Paige
- Health & Wellness Solutions, Johnson & Johnson, Inc., New Brunswick, NJ, USA
| | - Jordan Alpert
- Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
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14
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Raisa A, Alpert JM, Bylund CL, Jarad-Fodeh S. Identifying the mechanisms of patient-centred communication in secure messages between clinicians and cancer patients. PEC Innov 2023; 2:100161. [PMID: 37384151 PMCID: PMC10294087 DOI: 10.1016/j.pecinn.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Abstract
Objective Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging. Methods A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identified five components of PCC: information giving, information seeking, emotional support, partnership, and shared decision-making. Textual analysis was also performed to understand the context of PCC expressions within messages. Results Information-giving was the predominant (n = 346, 68.1%) PCC category used in secure messaging, more than double of the other four PCC codes, information-seeking (n = 82, 16.1%), emotional support (n = 52, 10.2%), shared decision making (n = 5, 1.0%), combined. The textual analysis revealed that clinicians informed patients about appointment reminders and new protocols while patients reminded clinicians about upcoming procedures and outcomes of test results conducted by other clinicians. Although less common, patients expressed statements of concern, uncertainty, and fear; enabling clinicians to provide support. Conclusion Secure messaging is mainly used for exchanging information, but other aspects of PCC emerge using this channel of communication. Innovation Meaningful discussions can occur via secure messaging, and clinicians should be mindful of incorporating PCC when communicating with patients through secure messaging.
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Affiliation(s)
- Aantaki Raisa
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jordan M. Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samah Jarad-Fodeh
- Department of Emergency Medicine, Yale School of Public Health – Biostatistics, Yale Center for Medical Informatics, Yale University, New Haven, CT, USA
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15
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Koenig CJ, Vasquez TS, Peterson EB, Wollney EN, Bylund CL, Ho EY. Mapping Uncharted Terrain: A Systematic Review of Complementary and Integrative Health Communication Using Observational Data in Biomedical Settings. Health Commun 2023; 38:3147-3162. [PMID: 36602254 DOI: 10.1080/10410236.2022.2140080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Complementary and integrative health (CIH) use is diverse and highly prevalent worldwide. Prior research of CIH communication in biomedical encounters address safety, efficacy, symptom management, and overall wellness. Observational methods are rarely used to study CIH communication and avoid recall bias, preserve ecological validity, and contextualize situated clinical communication. Following PRISMA guidelines, we systematically reviewed studies at the intersection of social scientific observational research and findings about CIH communication between clinicians, patients, and caregivers in biomedical settings. We identified international, peer-reviewed publications from seven databases between January 2010 and December 2020. Titles and abstracts were first screened for inclusion, then full studies were coded using explicit criteria. We used a standard checklist was modified to assess article quality. Ten of 11,793 studies examined CIH communication using observational methods for CIH communication in biomedical settings. Studies used a range of observational techniques, including participant and non-participant observation, which includes digital audio or video recordings. Results generated two broad sets of findings, one focused on methodological insights and another on CIH communication. Despite methodological and topic similarities, included studies addressed CIH communication as a process and as proximal and intermediate health outcomes. We recommend how observational studies of CIH communication can better highlight relationships between communication processes and health outcomes. Current research using observational methods offers an incomplete picture of CIH communication in biomedical settings. Future studies should standardize how observational techniques are reported to enhance consistency and comparability within and across biomedical settings to improve comparability.
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Affiliation(s)
| | | | - Emily B Peterson
- Annenberg School for Communication and Journalism, University of Southern California
| | | | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida
| | - Evelyn Y Ho
- Communication Studies, San Francisco State University
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Wollney EN, Vasquez TS, Stalvey C, Close J, Markham MJ, Meyer LE, Cooper LA, Bylund CL. Are evaluations in simulated medical encounters reliable among rater types? A comparison between standardized patient and outside observer ratings of OSCEs. PEC Innov 2023; 2:100125. [PMID: 37214504 PMCID: PMC10194306 DOI: 10.1016/j.pecinn.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/20/2022] [Accepted: 01/20/2023] [Indexed: 05/24/2023]
Abstract
Objective By analyzing Objective Structured Clinical Examination (OSCE) evaluations of first-year interns' communication with standardized patients (SP), our study aimed to examine the differences between ratings of SPs and a set of outside observers with training in healthcare communication. Methods Immediately following completion of OSCEs, SPs evaluated interns' communication skills using 30 items. Later, two observers independently coded video recordings using the same items. We conducted two-tailed t-tests to examine differences between SP and observers' ratings. Results Rater scores differed significantly on 21 items (p < .05), with 20 of the 21 differences due to higher SP in-person evaluation scores. Items most divergent between SPs and observers included items related to empathic communication and nonverbal communication. Conclusion Differences between SP and observer ratings should be further investigated to determine if additional rater training is needed or if a revised evaluation measure is needed. Educators may benefit from adjusting evaluation criteria to decrease the number of items raters must complete and may do so by encompassing more global questions regarding various criteria. Furthermore, evaluation measures may be strengthened by undergoing reliability and validity testing. Innovation This study highlights the strengths and limitations to rater types (observers or SPs), as well as evaluation methods (recorded or in-person).
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Affiliation(s)
- Easton N. Wollney
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor S. Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Dept. of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL USA
| | - Julia Close
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lynne E. Meyer
- Graduate Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lou Ann Cooper
- Dept. of Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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17
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Huynh K, Brito JP, Bylund CL, Prokop LJ, Ospina NS. Understanding diagnostic conversations in clinical practice: A systematic review. Patient Educ Couns 2023; 116:107949. [PMID: 37660463 PMCID: PMC11002943 DOI: 10.1016/j.pec.2023.107949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Summarize frameworks to understand diagnostic conversations and assessments of diagnostic conversations in practice. METHODS We systematically searched MEDLINE, Scopus, Cochrane, and other databases from inception to July 2022 for reports of diagnostic conversations. Two authors independently reviewed studies for eligibility, assessed methodological quality with the mixed methods appraisal tool and extracted information related to study characteristics, frameworks and components evaluated in assessments of diagnostic conversations and results. RESULTS Eight studies were included. One study reported an empiric framework of diagnostic conversations that included the following components: identifying the problem that requires diagnosis, obtaining information, and delivering the diagnosis and treatment plan. Thematic analyses highlighted communication between patients and clinicians as central in diagnostic conversations as it allows a) patient's presentation of their symptoms which guide subsequent diagnostic steps, b) negotiation of the significance of the patient's symptoms through conversation and c) introducing and resolving diagnostic uncertainty. CONCLUSION Despite the importance of diagnostic conversation only one empiric framework described its components. Additionally, limited available evidence suggests patients can have an important role in the diagnostic process that expands beyond patients as an information source. PRACTICE IMPLICATIONS Patients should be included as active partners in co-development of diagnostic plans of care.
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Affiliation(s)
- Ky Huynh
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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18
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Hutten RJ, Weil CR, King AJ, Barney B, Bylund CL, Fagerlin A, Gaffney DK, Gill D, Scherer L, Suneja G, Tward JD, Warner EL, Werner TL, Whipple G, Evans J, Johnson SB. Multi-Institutional Analysis of Cancer Patient Exposure, Perceptions, and Trust in Information Sources Regarding Complementary and Alternative Medicine. JCO Oncol Pract 2023; 19:1000-1008. [PMID: 37722084 DOI: 10.1200/op.23.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/02/2023] [Accepted: 07/11/2023] [Indexed: 09/20/2023] Open
Abstract
PURPOSE Complementary and alternative medicine (CAM) use during cancer treatment is controversial. We aim to evaluate contemporary CAM use, patient perceptions and attitudes, and trust in various sources of information regarding CAM. METHODS A multi-institutional questionnaire was distributed to patients receiving cancer treatment. Collected information included respondents' clinical and demographic characteristics, rates of CAM exposure/use, information sources regarding CAM, and trust in each information source. Comparisons between CAM users and nonusers were performed with chi-squared tests and one-way analysis of variance. Multivariable logistic regression models for trust in physician and nonphysician sources of information regarding CAM were evaluated. RESULTS Among 749 respondents, the most common goals of CAM use were management of symptoms (42.2%) and treatment of cancer (30.4%). Most CAM users learned of CAM from nonphysician sources. Of CAM users, 27% reported not discussing CAM with their treating oncologists. Overall trust in physicians was high in both CAM users and nonusers. The only predictor of trust in physician sources of information was income >$100,000 in US dollars per year. Likelihood of trust in nonphysician sources of information was higher in females and lower in those with graduate degrees. CONCLUSION A large proportion of patients with cancer are using CAM, some with the goal of treating their cancer. Although patients are primarily exposed to CAM through nonphysician sources of information, trust in physicians remains high. More research is needed to improve patient-clinician communication regarding CAM use.
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Affiliation(s)
- Ryan J Hutten
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
| | - Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
| | - Andy J King
- Department of Communication, University of Utah, Salt Lake City, UT
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Brandon Barney
- Department of Radiation Oncology, Intermountain Cancer Centers, Salt Lake City, UT
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
| | - David Gill
- Department of Medical Oncology, Intermountain Cancer Centers, Salt Lake City, UT
| | - Laura Scherer
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Jonathan D Tward
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Theresa L Werner
- Department of Medicine, Oncology Division, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Gary Whipple
- Department of Radiation Oncology, Intermountain Cancer Centers, Salt Lake City, UT
| | - Jaden Evans
- Department of Radiation Oncology, Intermountain Cancer Centers, Salt Lake City, UT
| | - Skyler B Johnson
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
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19
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Vasquez TS, Eggly S, Sae-Hau M, DeMairo K, Figueroa L, Gambatese M, Ortiz-Ravick L, Carpenter C, Sadler MD, Weiss E, Bylund CL. Preparing Patients to Communicate with Their Doctors About Clinical Trials as a Treatment Option: Impact of a Novel Video Intervention for Patients with a Blood Cancer and Their Caregivers. J Cancer Educ 2023; 38:1562-1570. [PMID: 37097340 DOI: 10.1007/s13187-023-02300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Abstract
Cancer clinical trials (CCTs) are imperative for advancing cancer treatment and providing treatment options for patients; however, many barriers exist to offering and enrolling interested and eligible patients. It is crucial to equip patients and caregivers with communication skills that help them initiate and navigate conversations about the option of receiving treatment within a CCT. The aim was to assess the acceptability and impact of a novel video training for patients and caregivers that models strategies for patient-provider communication using the PACES method of healthcare communication and provides information about CCTs. The three-module training was implemented among blood cancer patients and caregivers. Using a single-arm pre-post study design, self-report surveys assessed changes in knowledge, confidence in using the PACES method, and perceived importance of, confidence in, and behavioral intention related to talking with doctors about CCTs. The Patient Report of Communication Behavior (PRCB) scale was administered. Among 192 participants, post-intervention knowledge gains were evident (p < 0.001). Confidence, importance, and likelihood to communicate about CCTs and confidence about using PACES also increased (p < 0.001); females who had never previously spoken to a provider about CCTs demonstrated greater impact (p = 0.045) than other genders. PRCB mean scores increased among patients 65+ who had never spoken to a provider about CCTs, with greater change than patients <65 (p = 0.001). This educational intervention for patients and caregivers increased knowledge about CCTs, skills in communicating with doctors about care and CCTs, and readiness to initiate conversations about CCTs as a potential treatment option.
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Affiliation(s)
- Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.
| | | | | | | | | | | | | | | | | | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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20
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Banerjee SC, Malling CD, Shen MJ, Williamson TJ, Bylund CL, Studts JL, Mullett T, Carter-Bawa L, Hamann HA, Parker PA, Steliga M, Feldman J, Pantelas J, Borondy-Kitts A, Rigney M, King JC, Fathi JT, Rosenthal LS, Smith RA, Ostroff JS. Getting ready for prime time: Recommended adaptations of an Empathic Communication Skills training intervention to reduce lung cancer stigma for a national multi-center trial. Transl Behav Med 2023; 13:804-808. [PMID: 37579304 PMCID: PMC10538471 DOI: 10.1093/tbm/ibad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients' experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N = 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest. ClinicalTrials.gov Identifier: NCT05456841.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte D Malling
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy Mullett
- Division of Cardiothoracic Surgery, UK Markey Cancer Center, Lexington, KY, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Steliga
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | | | | | | | - Robert A Smith
- American Cancer Society National Lung Cancer Roundtable, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. Patient Educ Couns 2023; 114:107811. [PMID: 37244131 PMCID: PMC10526983 DOI: 10.1016/j.pec.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. METHODS We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US. RESULTS Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses. CONCLUSION The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present. PRACTICE IMPLICATIONS Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, United States.
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, United States
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, United States; Department of Population Health Sciences, Duke University School of Medicine, United States
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22
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Parker ND, Wollney EN, Bylund CL, Amin TB, Mullis MD, Bagautdinova D, Sae-Hau M, Weiss ES, Thomas LA, Fisher CL. Living with a blood cancer in later life: The complex challenges and related support needs of adults aged 75 and older. Palliat Support Care 2023:1-7. [PMID: 37606295 DOI: 10.1017/s1478951523001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES This study investigated the challenges and support needs of adults aged 75 and older during and after treatment for a blood cancer to aid targeted supportive resource development. METHODS Adults aged 75 and older with a blood cancer participated in in-depth, semi-structured interviews about challenges and unmet support needs. Participants recruited through The Leukemia & Lymphoma Society were (1) in treatment or previously in treatment for a blood cancer at age 75 or older and (2) living in the United States or its territories. A thematic analysis was conducted with findings compared between 2 groups: (1) chronic -living with a chronic blood cancer; (2) acute -living with an acute blood cancer or both an acute and chronic blood cancer. RESULTS Participants (n = 50) ranged from 75 to 91 years old. Both groups described similar experiences and identified 5 challenges and support needs: (1) socioemotional impact, (2) activities of daily living and instrumental activities of daily living (ADLs/iADLs), (3) uncertainty management, (4) treatment-related stressors, and (5) COVID-19-related strain. Properties for these themes illustrate challenges and support needs, with some differences between groups. For instance, those living with a chronic blood cancer highlighted financial strain with treatment-related stressors, while those with an acute blood cancer focused more on iADLs. SIGNIFICANCE OF RESULTS Findings inform an agenda for targeted resource development for older adults with a blood cancer nearing the end of the life span. Results demonstrate the need for supportive services and family communication interventions to help patients manage iADLs and navigate socioemotional needs and challenges.
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Affiliation(s)
- Naomi D Parker
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tithi B Amin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | | | - Lyndsey A Thomas
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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23
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Bagautdinova D, Wang S, Brito JP, Bylund CL, Edwards C, Silver N, Danan D, Treise D, Maraka S, Hargraves I, Singh Ospina N. Thyroid Cancer Risk Communication in Patients with Thyroid Nodules. J Cancer Educ 2023; 38:1234-1240. [PMID: 36602695 PMCID: PMC10319912 DOI: 10.1007/s13187-022-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 05/05/2023]
Abstract
The objective of this study is to evaluate thyroid cancer risk clinician-patient communication among patients receiving usual counseling and counseling enhanced by a conversation aid. A secondary analysis of clinical visit recordings and post-visit surveys obtained during a trial assessing the impact of a conversation aid for patients with thyroid nodules was conducted. We assessed how thyroid cancer risk was communicated, different risk communication strategies between groups, and predictors of accurate cancer risk perception. Fifty-nine patients were analyzed. Most were women (90%) and middle-aged (median 57 years). A verbal description of thyroid cancer risk was present most frequently (83%) and was more frequent in the conversation aid than the usual care group (100% vs. 63%, p < 0.001). A numerical description using percentages was present in 41% of visits and was more frequent in the conversation aid group (59% vs. 19%, p = 0.012). Natural frequencies (7%) and positive/negative framing (10%) were utilized less commonly. Uncertainty about risks was not discussed. No predictors of accurate risk perception were identified. Clinicians most commonly present a verbal description of thyroid cancer risk. Less commonly, natural frequencies, negative/positive framing, or uncertainty is discussed. Clinicians caring for patients with thyroid nodules should be aware of different strategies for communicating thyroid cancer risk.
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Affiliation(s)
- Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Shu Wang
- Center & Department of Biostatistics, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, University of Florida, 1600 SW Archer Road, Room H2, Gainesville, FL, 32606, USA
| | - Natalie Silver
- Center for Immunotherapy & Precision Immuno-Oncology, Head & Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Danan
- Ear, Nose & Throat, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Spyridoula Maraka
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Endocrine Section, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology and Metabolism, Department of Medicine, University of Florida, 1600 SW Archer Road, Room H2, Gainesville, FL, 32606, USA.
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24
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Fisher CL, Campbell-Salome G, Bagautdinova D, Wright KB, Forthun LF, Bacharz KC, Mullis MD, Wolf B, Pereira DB, Spiguel L, Bylund CL. Young Adult Caregiving Daughters and Diagnosed Mothers Navigating Breast Cancer Together: Open and Avoidant Communication and Psychosocial Outcomes. Cancers (Basel) 2023; 15:3864. [PMID: 37568680 PMCID: PMC10417340 DOI: 10.3390/cancers15153864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/01/1970] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
For many diagnosed mothers and their daughters, breast cancer is a shared experience. However, they struggle to talk about cancer. This is particularly true when the daughter is in adolescence or young adulthood, as they tend to be more avoidant, which is associated with poorer biopsychosocial outcomes. When daughters are their mother's caregivers, daughters' burden and distress are heightened. Young adult caregiving daughters (YACDs) are the second most common family caregiver and encounter more distress and burden than other caregiver types. Yet, YACDs and their diagnosed mothers receive no guidance on how to talk about cancer. Thirty-nine mother/YACD pairs participated in an online survey to identify challenging topics and strategies for talking about cancer, and to explore associations between openness/avoidance and psychosocial outcomes. YACDs and mothers reported the same challenging topics (death, treatment-related issues, negative emotions, relational challenges, YACDs' disease risk) but differed on why they avoided the topic. YACDs and mothers identified the same helpful approaches to navigate conversations (openness, staying positive, third-party involvement, avoidance). Avoidance was correlated with more distress whereas openness was correlated with better psychosocial outcomes. These results provide a psychosocial map for a mother-YACD communication skills intervention, which is key to promoting healthy outcomes.
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Affiliation(s)
- Carla L. Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
| | | | - Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA;
| | - Kevin B. Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA;
| | - Larry F. Forthun
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL 32611, USA;
| | - Kelsey C. Bacharz
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA; (K.C.B.); (D.B.P.)
| | - M. Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
| | - Bianca Wolf
- Department of Communication Studies, University of Puget Sound, Tacoma, WA 98416, USA;
| | - Deidre B. Pereira
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA; (K.C.B.); (D.B.P.)
| | - Lisa Spiguel
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
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25
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Mullis MD, Fisher CL, Kastrinos AL, Sae-Hau M, Weiss ES, Rajotte M, Bylund CL. Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers. J Cancer Surviv 2023:10.1007/s11764-023-01422-0. [PMID: 37420150 PMCID: PMC11024982 DOI: 10.1007/s11764-023-01422-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. METHODS We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. RESULTS Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). CONCLUSIONS Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. IMPLICATIONS FOR CANCER SURVIVORS Tailored supportive resources are needed for caregivers throughout survivorship transitions.
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Affiliation(s)
- M Devyn Mullis
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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Staras SAS, Salloum RG, Osegueda E, Bylund CL, Chi X, Mohan V, Sage E, Huo T, Young A, Thompson LA. North-Central Florida Clinicians' Human Papillomavirus Vaccine Recommendation Priorities and Practices for 11- to 12-Year-Olds: A Discrete Choice Experiment. J Adolesc Health 2023; 73:172-180. [PMID: 37029049 DOI: 10.1016/j.jadohealth.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. METHODS In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements. RESULTS Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11- to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n = 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11 years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p = .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), importance at 11-12 years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12 years, and 8% bundling vaccines). DISCUSSION HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Eduardo Osegueda
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Vikasni Mohan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Emily Sage
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Alyson Young
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida; Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
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Wright KB, Bylund CL, Vasquez TS, Mullis MD, Sae-Hau M, Weiss ES, Bagautdinova D, Fisher CL. Adult-Child Caregivers' Family Communication Experiences after an Older Parent's Blood Cancer Diagnosis: A Survey Exploring Their Openness, Avoidance, and Social Support. Cancers (Basel) 2023; 15:3177. [PMID: 37370787 DOI: 10.3390/cancers15123177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Adult-child caregivers of an aging parent living with a blood cancer describe struggling to communicate with one another and within the family system. They may avoid critical care conversations, which may impede care and their ability to receive social support. We examined what approaches adult-child caregivers of a parent diagnosed with a blood cancer use to enhance their family communication, the topics they find most challenging to discuss, and the roles of openness and support. We used qualitative and quantitative approaches to analyze data from a larger online survey study. In partnership with the Leukemia & Lymphoma Society, we recruited 121 adult-child caregivers. Responses to one open-ended item were analyzed to capture strategies used to enhance communication with their parent and family. They reported utilizing digital communication modalities, prioritizing frequent communication, engaging in openness, establishing boundaries, kinkeeping, and enacting support. Within the quantitative data, we further explored two of these themes (openness and support) and their relationships to other variables using t-tests and regression analysis. Adult-child caregivers and diagnosed parents avoid talking about mortality and negative feelings. Openness in the family about cancer was linked to caregivers' perceptions of receiving social support. Findings demonstrate that cultivating openness between midlife adult children and diagnosed parents may enhance opportunities to receive support.
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Affiliation(s)
- Kevin B Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Taylor S Vasquez
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - M Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa S Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
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Bylund CL, Thompson LA, Hansen M, Staras SAS. A Pilot Test of a Workshop for Pediatric Clinicians About Communicating with Parents About the HPV Vaccine Using the C-LEAR Approach. J Cancer Educ 2023; 38:798-804. [PMID: 35941410 PMCID: PMC9360739 DOI: 10.1007/s13187-022-02188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 06/02/2023]
Abstract
Low HPV vaccinations rates lead to missed opportunities to prevent cancer. Specifically, some parents (12-76%) report never receiving a recommendation for their child to receive the vaccine. Current models for talking about HPV vaccination fall short in that they focus primarily on how to introduce the vaccine with limited guidance on how to follow through with the conversation, particularly with those parents who may be hesitant. We developed the C-LEAR approach, an easy to remember, evidence-informed mnemonic to guide clinicians through the process of introducing and discussing the HPV vaccine with parents. We pilot tested this approach with a total of 20 pediatric clinicians (n = 13 residents; n = 7 attendings) in 60-min Zoom workshops that included a short didactic session, a demonstration of skills, and a small group, facilitator-led role play session. On an immediate post-training survey, all participants stated that the training was helpful and easy to understand. Ninety-four percent responded that they would implement what they had learned in their clinic. Participants reported appreciation for the small group sessions. While not specifically asked or required to incorporate the material into their practice, 1 year following the training, 8/9 (88%) participants reported using the C-LEAR approach in their clinics "most" or "all of the time." We are further testing this model through teaching our workshop in a large, randomized trial across the state of Florida.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Hansen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Bagautdinova D, Bylund CL, Kastrinos A, Hampton CN, Vasquez TS, Weiss ES, Sae-Hau M, Fisher CL. Adult sibling-related experiences while caring for a parent diagnosed with a blood cancer. Fam Syst Health 2023; 41:140-148. [PMID: 36222643 PMCID: PMC10321271 DOI: 10.1037/fsh0000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION An older parent's blood cancer diagnosis impacts the entire family system, including adult siblings, an often overlooked subsystem of the family. Yet, adult siblings are typically involved in their parents' care needs. We explored sibling-related experiences adult child caregivers identify while caring for a parent diagnosed with a blood cancer to capture information useful for caregiving intervention development. METHOD Fifteen adult child caregivers with at least 1 sibling participated in an in-depth, semistructured interview. Participants were 87% white and 80% daughters. A majority of caregivers were in midlife (M age = 44), with parents diagnosed between age 56 and 90. A thematic analysis was conducted on transcripts using the constant comparative method. RESULTS Caregivers described 3 types of sibling-related experiences that centered on (a) caregiving responsibilities (e.g., sharing/not sharing tasks; challenging feelings about lack of involvement); (b) expectations about the caregiver role (e.g., gender, family status, and birth order expectations); and (c) coping together and apart (e.g., receiving information together, enhanced relationships, divergent maladaptive coping). DISCUSSION Findings illustrate how a parent's blood cancer diagnosis can enhance the sibling bond and family system as well as contribute to tension, particularly regarding the experiences of not sharing caregiving tasks or having divergent approaches to coping. Findings also provide insight into areas in which supportive interventions or resources are needed (e.g., helping siblings talk about caregiving involvement) to promote healthy family functioning after a blood cancer diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
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Patel Chavez CP, Godinez Leiva E, Bagautdinova D, Hidalgo J, Hartasanchez S, Barb D, Danan D, Dziegielewski P, Edwards C, Hughley B, Srihari A, Subbarayan S, Castro MR, Dean D, Morris J, Ryder M, Stan MN, Hargraves I, Shepel K, Brito JP, Bylund CL, Treise D, Montori V, Singh Ospina N. Patient feedback receiving care using a shared decision making tool for thyroid nodule evaluation-an observational study. Endocrine 2023; 80:124-133. [PMID: 36534326 PMCID: PMC10292116 DOI: 10.1007/s12020-022-03277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To characterize the feedback of patients with thyroid nodules receiving care using a shared decision making (SDM) tool designed to improve conversations with their clinicians related to diagnostic options (e.g. thyroid biopsy, ultrasound surveillance). METHODS Investigators qualitatively analyzed post-encounter interviews with patients to characterize their feedback of a SDM tool used during their clinical visits. Additionally, investigators counted instances of diagnostic choice awareness and of patients' expression of a diagnostic management preference in recordings of clinical encounters of adult patients presenting for evaluation of thyroid nodules in which the SDM tool was used. RESULTS In total, 53 patients (42 (79%) women); median age 62 years were enrolled and had consultations supported by the SDM tool. Patients were favorable about the design of the SDM tool and its ability to convey information about options and support patient-clinician interactions. Patients identified opportunities to improve the tool through adding more content and improve its use in practice through training of clinicians in its use. There was evidence of diagnostic choice awareness in 52 (98%) of these visits and patients expressed a diagnostic management preference in 40 (76%). CONCLUSION User centered design including feedback from patients and real life observation supports the use of the SDM tool to facilitate collaboration between patients and clinicians.
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Affiliation(s)
| | - Eddison Godinez Leiva
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Hartasanchez
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Diana Barb
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | | | - Catherine Edwards
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Ashok Srihari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sreevidya Subbarayan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Diana Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - John Morris
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mabel Ryder
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Kathryn Shepel
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Victor Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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Bylund CL, Mullis MD, Alpert J, Markham MJ, Onega T, Fisher CL, Johnson SB. Clinician Communication With Patients About Cancer Misinformation: A Qualitative Study. JCO Oncol Pract 2023; 19:e389-e396. [PMID: 36626708 DOI: 10.1200/op.22.00526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on clinician-patient conversations about cancer-related misinformation. As a first step, the objective of this study was to describe how cancer clinicians report communicating with patients about online cancer misinformation. METHODS We used convenience and snowball sampling to contact 59 cancer clinicians by e-mail. Contacted clinicians predominately worked at academic centers across the United States. Clinicians who agreed participated in semistructured interviews about communication in health care. For this study, we focused specifically on clinicians' experiences discussing online cancer-related misinformation with patients. We conducted a thematic analysis using a constant comparative approach to identify how clinicians address misinformation during clinical visits. RESULTS Twenty-one cancer clinicians participated in the study. Nineteen were physicians, one was a physician assistant, and one was a nurse practitioner. The majority (62%) were female. We identified four themes that describe how cancer clinicians address misinformation: (1) work to understand the misinformation; (2) correct misinformation through education; (3) advise about future online searches, and (4) preserve the clinician-patient relationship. CONCLUSION Our study identified four strategies that clinicians use to address online cancer-related misinformation with their patients. These findings provide a foundation for future research, allowing us to test these strategies in larger samples to examine their effectiveness.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Michaela D Mullis
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Jordan Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Tracy Onega
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Skyler B Johnson
- Department of Radiation Oncology, School of Medicine, University of Utah, Salt Lake City, UT
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Johnson SB, King AJ, Warner EL, Aneja S, Kann BH, Bylund CL. Using ChatGPT to evaluate cancer myths and misconceptions: artificial intelligence and cancer information. JNCI Cancer Spectr 2023; 7:7078555. [PMID: 36929393 PMCID: PMC10020140 DOI: 10.1093/jncics/pkad015] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
Data about the quality of cancer information that chatbots and other artificial intelligence systems provide are limited. Here, we evaluate the accuracy of cancer information on ChatGPT compared with the National Cancer Institute's (NCI's) answers by using the questions on the "Common Cancer Myths and Misconceptions" web page. The NCI's answers and ChatGPT answers to each question were blinded, and then evaluated for accuracy (accurate: yes vs no). Ratings were evaluated independently for each question, and then compared between the blinded NCI and ChatGPT answers. Additionally, word count and Flesch-Kincaid readability grade level for each individual response were evaluated. Following expert review, the percentage of overall agreement for accuracy was 100% for NCI answers and 96.9% for ChatGPT outputs for questions 1 through 13 (ĸ = ‒0.03, standard error = 0.08). There were few noticeable differences in the number of words or the readability of the answers from NCI or ChatGPT. Overall, the results suggest that ChatGPT provides accurate information about common cancer myths and misconceptions.
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Affiliation(s)
- Skyler B Johnson
- Correspondence to: Skyler B. Johnson, MD, Department of Radiation Oncology, University of Utah Huntsman Cancer Institute, 1950 Circle of Hope Dr, Salt Lake City, UT 84112, USA (e-mail: )
| | - Andy J King
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sanjay Aneja
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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Bagautdinova D, Bacharz KC, Bylund CL, Sae-Hau M, Weiss ES, Rajotte M, Lincoln G, Vasquez TS, Parker ND, Wright KB, Fisher CL. Understanding the Impact of COVID-19 on Chronic Lymphocytic Leukemia (CLL) Caregiving and Related Resource Needs. J Clin Med 2023; 12:jcm12041648. [PMID: 36836183 PMCID: PMC9965960 DOI: 10.3390/jcm12041648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) caregivers play a central role in disease management-a role that has been heightened during the COVID-19 pandemic given the healthcare system's reliance on frontline family caregivers and CLL patients' increased risk of infection and mortality. Using a mixed-method design, we investigated the impact of the pandemic on CLL caregivers (Aim 1) and their perceived resource needs (Aim 2): 575 CLL caregivers responded to an online survey; 12 spousal CLL caregivers were interviewed. Two open-ended survey items were thematically analyzed and compared with interview findings. Aim 1 results showed that two years into the pandemic, CLL caregivers continue to struggle with coping with distress, living in isolation, and losing in-person care opportunities. Caregivers described experiencing increasing caregiving burden, realizing the vaccine may not work or didn't work for their loved one with CLL, feeling cautiously hopeful about EVUSHELD, and dealing with unsupportive/skeptical individuals. Aim 2 results indicate that CLL caregivers needed reliable, ongoing information about COVID-19 risk, information about and access to vaccination, safety/precautionary measures, and monoclonal infusions. Findings illustrate ongoing challenges facing CLL caregivers and provide an agenda to better support the caregivers of this vulnerable population during the COVID-19 pandemic.
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Affiliation(s)
- Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
- Correspondence:
| | - Kelsey C. Bacharz
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | | | - Greg Lincoln
- P.K. Younge Developmental Research School, University of Florida, Gainesville, FL 32601, USA
| | - Taylor S. Vasquez
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Naomi D. Parker
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Kevin B. Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA
| | - Carla L. Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Johnson SB, Bylund CL. Identifying Cancer Treatment Misinformation and Strategies to Mitigate Its Effects With Improved Radiation Oncologist-Patient Communication. Pract Radiat Oncol 2023:S1879-8500(23)00033-4. [PMID: 36736620 DOI: 10.1016/j.prro.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
Accurate information about cancer treatment is critical for individuals to make informed decisions about their health. Unfortunately, the rise of the Internet and social media combined with patients' desire for autonomy as well as the increased availability and marketing of unproven or disproven therapies has made it easy for misinformation about cancer to spread. This can have grave consequences for patients, as individuals who rely on misinformation may make decisions that put their health at risk, including choosing to forego effective treatment in favor of unproven or disproven therapies. To address these serious issues, it is important to understand what constitutes cancer treatment misinformation and the available mitigation strategies. This knowledge can inform efforts to counteract the spread of cancer treatment misinformation and promote accurate information about cancer.
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Affiliation(s)
- Skyler B Johnson
- Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, Utah; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Jacksonville, Florida
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Finset A, Street RL, Bylund CL. Patient Education and Counseling and PEC Innovation: A brief status report. Patient Educ Couns 2023; 107:107593. [PMID: 36521343 DOI: 10.1016/j.pec.2022.107593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Arnstein Finset
- Department of Behavioral Medicine, University of Oslo, Oslo, Norway.
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
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Bylund CL, Eggly S, LeBlanc TW, Kurtin S, Gandee M, Medhekar R, Fu A, Khurana M, Delaney K, Divita A, McNamara M, Baile WF. Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma. Transl Behav Med 2023; 13:255-267. [PMID: 36688466 DOI: 10.1093/tbm/ibac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | - Rohan Medhekar
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Alan Fu
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Monica Khurana
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Staras SAS, Bylund CL, Mullis MD, Thompson LA, Hall JM, Hansen MD, Fisher CL. Messaging preferences among Florida caregivers participating in focus groups who had not yet accepted the HPV vaccine for their 11- to 12-year-old child. BMC Public Health 2022; 22:2413. [PMID: 36550434 PMCID: PMC9779937 DOI: 10.1186/s12889-022-14852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the United States, human papillomavirus (HPV) vaccination rates remain low. The President's Cancer Panel suggests that effective messaging about the HPV vaccination focus on the vaccine's safety, efficacy, ability to prevent cancer, and recommendation at ages 11- to 12-years. We aimed to develop messages about HPV vaccine that include the President Cancer Panel's suggestions and were acceptable to caregivers of adolescents. METHODS From August to October 2020, we conducted one-hour, Zoom videoconference focus groups with caregivers who lived in Florida, had an 11- to 12-year-old child, and had not had any of their children receive the HPV vaccine. Focus group moderators asked caregivers to react to three videos of clinician (i.e., MD, DO, APRN, PA) recommendations and three text message reminders. Thematic analysis was conducted using the constant comparative method and led by one author with qualitative analysis expertise. Two additional authors validated findings. RESULTS Caregivers (n = 25 in six groups) were primarily non-Hispanic white (84%) and educated (64% had at least an Associate's degree). Approximately a third of caregivers had delayed (44%) or decided against a vaccine for their child (36%). Caregivers described six preferred message approaches: recognize caregivers' autonomy, balanced benefits and risks, trustworthy sources, increased feasibility of appointment scheduling, information prior to decision point, and preferred personalized information. Caregivers expressed a desire to have the follow-up doses mentioned in the introduction. CONCLUSIONS HPV vaccine messages, whether delivered by a clinician or via text message, will be more acceptable to caregivers if they approach HPV vaccination as the caregivers' decision, and include information from trusted sources to help caregivers make an informed choice.
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Affiliation(s)
- Stephanie A. S. Staras
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Carma L. Bylund
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Michaela D. Mullis
- grid.15276.370000 0004 1936 8091Department of Advertising, College of Journalism and Communications, University of Florida, 2096 Weimer Hall 1885 Stadium Rd, PO BOX 118400, Gainesville, FL 32611 USA
| | - Lindsay A. Thompson
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Department of Pediatrics, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610 USA
| | - Jaclyn M. Hall
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Marta D. Hansen
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Carla L. Fisher
- grid.15276.370000 0004 1936 8091Department of Advertising, College of Journalism and Communications, University of Florida, 2096 Weimer Hall 1885 Stadium Rd, PO BOX 118400, Gainesville, FL 32611 USA
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Wollney EN, Armstrong MJ, Bedenfield N, Rosselli M, Curiel-Cid RE, Kitaigorodsky M, Levy X, Bylund CL. Barriers and Best Practices in Disclosing a Dementia Diagnosis: A Clinician Interview Study. Health Serv Insights 2022; 15:11786329221141829. [PMID: 36506598 PMCID: PMC9729996 DOI: 10.1177/11786329221141829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
The vast majority of individuals with dementia want to receive a diagnosis. Research suggests, however, that only a fraction of individuals with dementia receive a diagnosis and patients and families often feel the information is poorly explained. We thus aimed to assess clinician-reported barriers to dementia disclosure and recommendations for giving a dementia diagnosis. To accomplish this, we performed telephone interviews with 15 clinicians from different specialties using a semi-structured interview guide. Transcripts were analyzed thematically. Clinician-reported barriers fit 3 categories: patient and caregiver-related barriers, clinician-related barriers, and barriers related to the triadic interaction. Patient and caregiver-related barriers included lack of social support, misunderstanding the diagnosis, and denial. Clinician barriers included difficulty giving bad news, difficulty communicating uncertainty, and lack of time. Triadic interaction barriers included challenges meeting multiple goals or needs and family requests for non-disclosure. Recommendations for best practice included for clinicians to foster relationships, educate patients and family, and take a family-centered approach. Clinicians described recommendations for fostering relationships such as using empathic communication and developing and maintaining connection. Educating patients and families included tailoring communication, explaining how the diagnosis was reached, and following up. Family approaches included meeting with family members prior to delivering the diagnosis and involving the caregiver in the discussion. Findings may inform updated recommendations for best practices when communicating a dementia diagnosis.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA,Easton N Wollney, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, USA.
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Noheli Bedenfield
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ximena Levy
- Clinical Research Unit, Division of Research, Florida Atlantic University, Boca Raton, FL, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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Staras SA, Bylund CL, Desai S, Harle CA, Richardson E, Khalil GE, Thompson LA. A novel method for evaluating physician communication: A pilot study testing the feasibility of parent-assisted audio recordings via Zoom. PEC Innov 2022; 1:100020. [PMID: 36212508 PMCID: PMC9534382 DOI: 10.1016/j.pecinn.2022.100020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/22/2021] [Accepted: 01/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits. METHODS Across four academic pediatric primary care clinics, we invited all physicians with a patient panel (n=20). For participating physicians, we identified scheduled patients from medical records. We invited parents to participate via text message and phone calls. During their adolescent's appointment, parents used their mobile phone to connect to Zoom for remote research staff to audio record. RESULTS In Spring 2021, five of 20 (25%) physicians participated. During a nine-week period, we invited parents of all 54 patients seen by participating physicians of which 15 (28%) completed adult consent and adolescent assent and 10 (19%) participated. For 9 recordings, at least 45% of the conversation was audible. CONCLUSIONS It was feasible and acceptable to directly observe physician consultations virtually with Zoom, although participation rates and potentially audio quality were lower. INNOVATION Patients used their cellular phone calling features to connect to Zoom where research staff audio-recorded their physician consultation to evaluate communication quality.
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Affiliation(s)
- Stephanie A.S. Staras
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
- Institute for Child Health Policy, University of Florida, Gainesville, USA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
- Institute for Child Health Policy, University of Florida, Gainesville, USA
| | - Shivani Desai
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Christopher A. Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Eric Richardson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Georges E. Khalil
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
- Institute for Child Health Policy, University of Florida, Gainesville, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, USA
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Bylund CL, Heyn LG, Kerr AM, Koenig CJ. Volume 1: Editorial - PEC Innovation. PEC Innov 2022; 1:100105. [PMID: 37213784 PMCID: PMC10194238 DOI: 10.1016/j.pecinn.2022.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Vasquez TS, Bylund CL, Fisher CL, Paige SR. Validation of the transactional eHealth literacy instrument with cancer caregivers. PEC Innov 2022; 1:100075. [PMID: 37213773 PMCID: PMC10194196 DOI: 10.1016/j.pecinn.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 05/23/2023]
Abstract
Objective Family members are important sources of support for patients with cancer. They access, evaluate, and engage with online information and discuss it with a cancer clinician. This study validates the 4-dimensions, 18-item Transactional eHealth Literacy Instrument (TeHLI) and proposed to include Clinical eHealth Literacy as a 5th dimension. Methods The Leukemia & Lymphoma Society (LLS) disseminated an online survey to 121 family member caregivers between March-June 2020. We conducted confirmatory factor analyses (1) to examine model fit for the 4-factor TeHLI in the cancer caregiver population, and (2) to examine the model fit when adding the 5th factor. Results The 4-dimension model yielded acceptable model fit (RMSEA = 0.09; 90% CI = 0.08-0.11; CFI = 0.98; TLI = 0.98; SRMR = 0.07). The 5-dimension model also yielded acceptable model fit (RMSEA = 0.08; 90% CI = 0.07-0.10; CFI = 0.97; TLI = 0.97; SRMR = 0.08), supporting the expansion of the TeHLI within this population. Conclusion The five-dimension TeHLI is a valid and reliable measure of eHealth literacy among blood cancer caregiver populations. Innovation The TeHLI can be used as an outcome measure for communication skills training for caregivers, patients, and clinicians.
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Affiliation(s)
- Taylor S. Vasquez
- University of Florida, College of Journalism and Communications, USA
- Corresponding author at: University of Florida, 1885 Stadium Road, Gainesville, FL 32607, USA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
| | - Carla L. Fisher
- University of Florida, College of Journalism and Communications, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
| | - Samantha R. Paige
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
- Johnson & Johnson, Inc., Health & Wellness Solutions, New Brunswick, New Jersey, USA
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. Acad Med 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Mroz EL, McDarby M, Arnold RM, Bylund CL, Kutner JS, Pollak KI. Empathic Communication in Specialty Palliative Care Encounters: An Analysis of Opportunities and Responses. J Palliat Med 2022; 25:1622-1628. [PMID: 35426742 PMCID: PMC9836699 DOI: 10.1089/jpm.2021.0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Although empathic responding is considered a core competency in specialty palliative care (PC), patterns of empathic communication in PC encounters are not well understood. Objectives: In this secondary analysis, we delineate types and frequency of empathic communication and examine relationships between patient empathic opportunities and clinician responses. Design: We used the Empathic Communication Coding System to analyze empathic opportunities across three types: emotion (i.e., negative affective state), progress (i.e., stated recent positive life event or development), and challenge (i.e., stated problem or recent, negative life-changing event) and clinician responses. Setting/Subjects: Transcripts from a pilot randomized trial of communication coaching in specialty PC encounters (N = 71) audio-recorded by 22 PC clinicians at two sites in the United States: an academic health system and a community-based hospice and PC organization. Results: Empathic opportunities were frequent across encounters; clinicians often responded empathically to those opportunities (e.g., confirming or acknowledging patients' emotions or experiences). Even though challenge empathic opportunities occurred most frequently, clinicians responded empathically more often to progress opportunities (i.e., 93% of the time) than challenge opportunities (i.e., 75% of the time). One in 12 opportunities was impeded by the patient or a family member changing the topic before the clinician could respond. Conclusions: PC patients frequently express emotions, share progress, or divulge challenges as empathic opportunities. Clinicians often convey empathy in response and can differentiate their empathic responses based on the type of empathic opportunity. PC communication research and training should explore which empathic responses promote desired patient outcomes.
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Affiliation(s)
- Emily L. Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Meghan McDarby
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robert M. Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carma L. Bylund
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathryn I. Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Alpert JM, Hampton CN, Raisa A, Markham MJ, Bylund CL. Integrating patient-centeredness into online patient-clinician communication: a qualitative analysis of clinicians' secure messaging usage. Support Care Cancer 2022; 30:9851-9857. [PMID: 36260178 PMCID: PMC9580446 DOI: 10.1007/s00520-022-07408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
Purpose Patient-centered communication (PCC) in cancer care is helpful to nurture the patient-clinician relationship and respond to patients’ emotions. However, it is unknown how PCC is incorporated into electronic patient-clinician communication. Methods In-depth, semi-structured qualitative interviews with clinicians were conducted to understand how PCC was integrated into asynchronous communication between patients and clinicians; otherwise, known as secure messaging. The constant comparative method was used to develop a codebook and formulate themes. Results Twenty clinicians in medical and radiation oncology participated in audio-recorded interviews. Three main themes addressed how clinicians incorporate PCC within messages: (1) being mindful of the patient-clinician relationship, (2) encouraging participation and partnership, and (3) responding promptly suggests accessibility and approachability. Clinicians recommended that patients could craft more effective messages by being specific, expressing concern, needs, and directness, summarized by the acronym S.E.N.D. Conclusions Clinicians value secure messaging to connect with patients and demonstrate their accessibility. They acknowledge that secure messaging can influence the patient-clinician relationship and make efforts to include considerate and supportive language. As secure messaging is increasingly relied upon for patient-clinician communication, patients’ message quality must improve to assist clinicians in being able to provide prompt responses inclusive of PCC.
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Affiliation(s)
- Jordan M Alpert
- Center for Value-Based Care Research, Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA.
| | - Chelsea N Hampton
- College of Journalism and Communications, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA
| | - Aantaki Raisa
- College of Journalism and Communications, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA
| | | | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Vasquez TS, Bylund CL, Alpert J, Close J, Le T, Markham MJ, Taylor GB, Paige SR. Comparing Transactional eHealth Literacy of Individuals With Cancer and Surrogate Information Seekers: Mixed Methods Study. JMIR Form Res 2022; 6:e36714. [PMID: 36170007 PMCID: PMC9557759 DOI: 10.2196/36714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background
The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships with one another. One role that a member of a support network may enact is that of a surrogate seeker, who seeks information in an informal capacity on behalf of others. Individuals with cancer and surrogate seekers often use the internet to learn about cancer, but differences in their skills and strategies have received little empirical attention.
Objective
This study aimed to examine the eHealth literacy of individuals with cancer and surrogate information seekers, including an investigation of how each group evaluates the credibility of web-based cancer information. As a secondary aim, we sought to explore the differences that exist between individuals with cancer and surrogate seekers pertaining to eHealth literacies and sociodemographic contexts.
Methods
Between October 2019 and January 2020, we conducted a web-based survey of 282 individuals with cancer (n=185) and surrogate seekers (n=97). We used hierarchical linear regression analyses to explore differences in functional, communicative, critical, and translational eHealth literacy between individuals with cancer and surrogate seekers using the Transactional eHealth Literacy Instrument. Using a convergent, parallel mixed methods design, we also conducted a thematic content analysis of an open-ended survey response to qualitatively examine how each group evaluates web-based cancer information.
Results
eHealth literacy scores did not differ between individuals with cancer and surrogate seekers, even after adjusting for sociodemographic variables. Individuals with cancer and surrogate seekers consider the credibility of web-based cancer information based on its channel (eg, National Institutes of Health). However, in evaluating web-based information, surrogate seekers were more likely than individuals with cancer to consider the presence and quality of scientific references supporting the information. Individuals with cancer were more likely than surrogate seekers to cross-reference other websites and web-based sources to establish consensus.
Conclusions
Web-based cancer information accessibility and evaluation procedures differ among individuals with cancer and surrogate seekers and should be considered in future efforts to design web-based cancer education interventions. Future studies may also benefit from more stratified recruitment approaches and account for additional contextual factors to better understand the unique circumstances experienced within this population.
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Affiliation(s)
- Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jordan Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Julia Close
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tien Le
- College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Merry Jennifer Markham
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Greenberry B Taylor
- Department of Communication, Flagler College, St. Augustine, FL, United States
| | - Samantha R Paige
- College of Medicine, University of Florida, Gainesville, FL, United States
- Johnson & Johnson, Inc, Health & Wellness Solutions, New Brunswick, NJ, United States
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Staras SAS, Kastrinos AL, Wollney EN, Desai S, O'Neal LTJ, Johnson-Mallard V, Bylund CL. Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study. Implement Sci Commun 2022; 3:95. [PMID: 36068605 PMCID: PMC9450315 DOI: 10.1186/s43058-022-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A greater understanding of the county-level differences in human papillomavirus (HPV) vaccination rates could aid targeting of interventions to reduce HPV-related cancer disparities. METHODS We conducted a mixed-methods study to compare the stakeholder-reported barriers and efforts to increase HPV vaccination rates between counties within the highest, middle, and lowest HPV vaccine initiation (receipt of the first dose) rates among 22 northern Florida counties. Between August 2018 and April 2019, we recruited stakeholders (n = 68) through purposeful and snowball sampling to identify potential participants who were most knowledgeable about the HPV vaccination activities within their county and would represent a variety of viewpoints to create a diverse picture of each county, and completed semi-structured interviews. County-level HPV vaccine initiation rates for 2018 were estimated from the Florida Department of Health's immunization registry and population counts. Implementation strategies were categorized by level of importance and feasibility using the Expert Recommendations for Implementing Change (ERIC) taxonomy. We compared the barriers and implementation strategies for HPV vaccination between tercile groups of counties by HPV vaccine initiation rates: highest (18 stakeholders), middle (27 stakeholders), and lowest (23 stakeholders). RESULTS The majority of the 68 stakeholders were female (89.7%), non-Hispanic white (73.5%), and represented a variety of clinical and non-clinical occupations. The mentioned barriers represented five themes: healthcare access, clinician practices, community partnerships, targeted populations, and cultural barriers. Within themes, differences emerged between county terciles. Within healthcare access, the highest rate county stakeholders focused on transportation, lowest rate county stakeholders focused on lack of clinicians, and middle county stakeholders mentioned both. The number of ERIC quadrant I strategies, higher feasibility, and importance described decreased with the tercile for HPV vaccination: highest = 6, middle = 5, and lowest =3 strategies. CONCLUSIONS The differing barriers and strategies between the highest, middle, and lowest vaccination rate counties suggest that a tailored and targeted effort within the lowest and middle counties to adopt strategies of the highest rate counties may reduce disparities.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Room 2238, Gainesville, FL, 32610, USA.
- The Institute for Child Health Policy, University of Florida, Gainesville, FL, USA.
| | - Amanda L Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Room 2238, Gainesville, FL, 32610, USA
| | - Shivani Desai
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Room 2238, Gainesville, FL, 32610, USA
| | - La Toya J O'Neal
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, FL, USA
| | | | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Room 2238, Gainesville, FL, 32610, USA
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Bylund CL. Understanding and improving empathy and emotion handling skills among medical students. Patient Educ Couns 2022; 105:2803-2804. [PMID: 35811258 DOI: 10.1016/j.pec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA.
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Wuensch A, Boden MJ, Pärschke PP, Peltzer S, de Figueiredo MN, Bylund CL, Zimmer H, Vitinius F. Com‐On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists. Eur J Cancer Care (Engl) 2022; 31:e13684. [DOI: 10.1111/ecc.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander Wuensch
- University Hospital, Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy University of Freiburg Freiburg Germany
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich Munich Germany
| | - Maren J. Boden
- Department of Psychology University of Cologne Cologne Germany
- Department of Hematology, Oncology and Palliative Care, Medical Department, St Josef‐Hospital Ruhr University Bochum Germany
| | - Pia P. Pärschke
- Department of Psychology University of Cologne Cologne Germany
| | - Samia Peltzer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany
| | - Marcelo Niglio de Figueiredo
- University Hospital, Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy University of Freiburg Freiburg Germany
| | - Carma L. Bylund
- College of Medicine University of Florida Gainesville Florida USA
| | - Heinz Zimmer
- Department of Psychology University of Cologne Cologne Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany
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Johnson SB, Parsons M, Dorff T, Moran MS, Ward JH, Cohen SA, Akerley W, Bauman J, Hubbard J, Spratt DE, Bylund CL, Swire-Thompson B, Onega T, Scherer LD, Tward J, Fagerlin A. Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report. J Natl Cancer Inst 2022; 114:1036-1039. [PMID: 34291289 PMCID: PMC9275772 DOI: 10.1093/jnci/djab141] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/04/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
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).
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Affiliation(s)
- Skyler B Johnson
- Correspondence to: Skyler B. Johnson, MD, Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, 1950 Circle of Hope Dr, Rm 1570, Salt Lake City, UT 84112, USA (e-mail: )
| | - Matthew Parsons
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tanya Dorff
- Department of Medical Oncology and Developmental, Therapeutics, City of Hope, Duarte, CA, USA
- Department of Medicine, University of Southern California (USC) Keck School of Medicine and Norris Comprehensive Cancer Center (NCCC), Los Angeles, CA, USA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - John H Ward
- Oncology Division, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stacey A Cohen
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jessica Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Carma L Bylund
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Briony Swire-Thompson
- Network Science Institute, Northeastern University, Boston, MA, USA
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tracy Onega
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
| | - Laura D Scherer
- Department of Medicine, Division of Cardiology, University of Colorado, Denver, CO, USA
- VA Denver Center of Innovation, Denver, CO, USA
| | - Jonathan Tward
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Angela Fagerlin
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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50
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Bylund CL, Wollney EN, Campbell-Salome G, Applebaum AJ, Paige SR, DeGruccio K, Weiss E, Sae-Hau M, Arnold J, Durante D, Amin TB, Hampton CN, Fisher CL. Improving Clinical and Family Communication for Adult Child Caregivers of a Parent With a Blood Cancer: Single-Arm Pre-Post Pilot Intervention. JMIR Cancer 2022; 8:e38722. [PMID: 35788019 PMCID: PMC9297135 DOI: 10.2196/38722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Easton N Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | | | | | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Kennan DeGruccio
- School of Social Work, Columbia University, New York, NY, United States
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Jason Arnold
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Domenic Durante
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Tithi B Amin
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Chelsea N Hampton
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Carla L Fisher
- Department of Advertising, University of Florida, Gainesville, FL, United States
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