Marij A. Hillen

How to create and administer scripted video-vignettes in an experimental study on disclosure of a palliative breast cancer diagnosis

OBJECTIVE Scripted consultations provide the opportunity to vary and study the effect of specific elements of medical communication. These scripted consultations are role-played, videotaped and then judged by analogue patients. Most studies applying this methodology have provided little insight into how they created internally and externally valid written and role-played scripts. In this paper we aim to address this gap by providing a detailed description of a scripted video-vignette studys methodology. METHODS Following the five phases of creating and implementing scripted video-vignettes the current studys methodology is described: (1) deciding if video-vignettes are appropriate, (2) developing a valid script, (3) designing valid manipulations, (4) converting the scripted consultations to video, (5) administering the videos in an experiment. RESULTS Following these phases and four validation steps internally and externally valid vignettes were developed. CONCLUSIONS The detailed description of the current studys methodology produced general recommendations for scripted video-vignette studies, such as the importance of validating both the written as well as the role-played scripts and involving both experts and lay people in validating the scripts. For other choices no golden standard exists. PRACTICE IMPLICATIONS The presented methodology and recommendations may serve as a source of inspiration for future scripted video-vignette studies.

The inherent tensions and ambiguities of hope: Towards a post-formal analysis of experiences of advanced-cancer patients:

Sociological and anthropological analyses of hope in health-care contexts have tended to address institutional processes, especially the power dynamics that function through such systems or political economies of hope, which in turn shape interactions through which hopes are managed. This article extends this approach through a more detailed consideration of the experience of hoping itself. Our post-formal analysis denotes the tensions that are intrinsic and defining features of lifeworlds around hope, emphasising the dissonance and fragility of hoping. Drawing upon interview and observational data involving patients with advanced-cancer diagnoses who were taking part in clinical trials, we explore three main tensions which emerged within the analysis: tensions involving time and liminality between future and present; ontological tensions involving the concrete and the possible, the ‘realistic’ and the positive; and tensions in taken-for-grantedness between the reflective and the mundane, the specific and the ambiguous. Rather than three separate sets of tensions, those involving time, ontology and taken-for-grantedness are very much interwoven. In denoting the influence of social processes in engendering tensions, we bridge sociological and anthropological approaches with a more definition-oriented literature, developing understandings of hoping and its key characteristics in relation to other processes of coping amidst vulnerability and uncertainty.

Oncologists’ non-verbal behavior and analog patients’ recall of information

Abstract Background Information in oncological consultations is often excessive. Those patients who better recall information are more satisfied, less anxious and more adherent. Optimal recall may be enhanced by the oncologist’s non-verbal communication. We tested the influence of three non-verbal behaviors, i.e. eye contact, body posture and smiling, on patients’ recall of information and perceived friendliness of the oncologist. Moreover, the influence of patient characteristics on recall was examined, both directly or as a moderator of non-verbal communication. Material and methods Non-verbal communication of an oncologist was experimentally varied using video vignettes. In total 194 breast cancer patients/survivors and healthy women participated as ‘analog patients’, viewing a randomly selected video version while imagining themselves in the role of the patient. Directly after viewing, they evaluated the oncologist. From 24 to 48 hours later, participants’ passive recall, i.e. recognition, and free recall of information provided by the oncologist were assessed. Results Participants’ recognition was higher if the oncologist maintained more consistent eye contact (β = 0.17). More eye contact and smiling led to a perception of the oncologist as more friendly. Body posture and smiling did not significantly influence recall. Older age predicted significantly worse recognition (β = −0.28) and free recall (β = −0.34) of information. Conclusion Oncologists may be able to facilitate their patients’ recall functioning through consistent eye contact. This seems particularly relevant for older patients, whose recall is significantly worse. These findings can be used in training, focused on how to maintain eye contact while managing computer tasks.

EEG Beta Power but Not Background Music Predicts the Recall Scores in a Foreign-Vocabulary Learning Task.

As tantalizing as the idea that background music beneficially affects foreign vocabulary learning may seem, there is—partly due to a lack of theory-driven research—no consistent evidence to support this notion. We investigated inter-individual differences in the effects of background music on foreign vocabulary learning. Based on Eysenck’s theory of personality we predicted that individuals with a high level of cortical arousal should perform worse when learning with background music compared to silence, whereas individuals with a low level of cortical arousal should be unaffected by background music or benefit from it. Participants were tested in a paired-associate learning paradigm consisting of three immediate word recall tasks, as well as a delayed recall task one week later. Baseline cortical arousal assessed with spontaneous EEG measurement in silence prior to the learning rounds was used for the analyses. Results revealed no interaction between cortical arousal and the learning condition (background music vs. silence). Instead, we found an unexpected main effect of cortical arousal in the beta band on recall, indicating that individuals with high beta power learned more vocabulary than those with low beta power. To substantiate this finding we conducted an exact replication of the experiment. Whereas the main effect of cortical arousal was only present in a subsample of participants, a beneficial main effect of background music appeared. A combined analysis of both experiments suggests that beta power predicts the performance in the word recall task, but that there is no effect of background music on foreign vocabulary learning. In light of these findings, we discuss whether searching for effects of background music on foreign vocabulary learning, independent of factors such as inter-individual differences and task complexity, might be a red herring. Importantly, our findings emphasize the need for sufficiently powered research designs and exact replications of theory-driven experiments when investigating effects of background music and inter-individual variation on task performance.

Does source of patient recruitment affect the impact of communication on trust

OBJECTIVES To investigate how comparable outcomes of medical communication research are when using different patient accrual methods by comparing cancer patients organization members with outpatient clinic patients. METHODS In an experimental video-vignettes study, the impact of oncologist communication on trust was tested. Background characteristics (socio-demographics, trait anxiety, health locus of control and attachment style), reported trust, and the impact of communication on trust were compared between the two groups. RESULTS Cancer patient organization members (n=196) were younger and higher educated than clinical patients (n=148). Members felt more personal control over their health (p<.01) but were also more anxious (p<.05). They reported lower trust in general health care (p<.05), in their own oncologist (p<.001) and in the oncologist in the videos (p<.05). The impact of oncologist communication on trust was similar for both groups. CONCLUSIONS Despite considerable differences in trust levels, both groups appear equally affected by oncologist communication. Thus, although including cancer patient organization members may impact the generalizability of some findings, using these participants to investigate communication appears justified. PRACTICE IMPLICATIONS Cancer patient organization members may regard their oncologist more critically. Research including both members and patients recruited through hospital clinics could take group membership into account as a possible confounder. Nonetheless, communicating competence, honesty and caring may benefit the relation with these patients similarly as with other patients.

Advice for junior researchers - Lessons learned from the 2011 Y-EACH Junior Investigators' Workshop

M. Gemma Cherry *, Anne-Linda Frisch , Marij A. Hillen , Valentina Martinelli , Peter F. Pype , Isabelle Scholl , Nete Schwenessen , Kimberly A. Gudzune h Centre for Excellence in Evidence Based Teaching and Learning (CEEBLT), School of Medical Education, University of Liverpool, Liverpool, UK b Institute of Communication and Health (ICH), Department of Communication Sciences, Universita Della Svizzera Italiana, Lugano, Switzerland Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands d Section of Psychiatry, Department of Health Sciences, University of Pavia, Italy Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany g Steno Health Promotion Center, Patient Education Research Team, Gentofte, Denmark Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Tolerance of uncertainty: A systematic review of health and healthcare-related outcomes

BACKGROUND Uncertainty tolerance (UT) is thought to be a characteristic of individuals that influences various outcomes related to health, healthcare, and healthcare education. We undertook a systematic literature review to evaluate the state of the evidence on UT and its relationship to these outcomes. METHODS We conducted electronic and bibliographic searches to identify relevant studies examining associations between UT and health, healthcare, or healthcare education outcomes. We used standardized tools to assess methodological quality and analyzed the major findings of existing studies, which we organized and classified by theme. RESULTS Searches yielded 542 potentially relevant articles, of which 67 met inclusion criteria. Existing studies were heterogeneous in focus, setting, and measurement approach, were largely cross-sectional in design, and overall methodological quality was low. UT was associated with various trainee-centered, provider-centered, and patient-centered outcomes which were cognitive, emotional, and behavioral in nature. UT was most consistently associated with emotional well-being. CONCLUSIONS Uncertainty tolerance is associated with several important trainee-, provider-, and patient-centered outcomes in healthcare and healthcare education. However, low methodological quality, study design limitations, and heterogeneity in the measurement of UT limit strong inferences about its effects, and addressing these problems is a critical need for future research.

Trust and Perceptions of Physicians' Nonverbal Behavior Among Women with Immigrant Backgrounds

Previous findings suggest immigrant patients have lower trust in their physicians, and perceive nonverbal communication differently compared to non-immigrant patients. We tested discrepancies in trust and the impact of non-verbal behavior between immigrants and non-immigrants in The Netherlands. Nonverbal communication of an oncologist was systematically varied in an experimental video vignettes design. Breast cancer patients (n = 34) and healthy women (n = 34) viewed one of eight video versions and evaluated trust and perceived friendliness of the oncologist. In a matched control design, women with immigrant and non-immigrant backgrounds were paired. Immigrant women reported stronger trust. Nonverbal communication by the oncologist did not influence trust differently for immigrants compared to for non-immigrants. However, smiling strongly enhanced perceived friendliness for non-immigrants, but not for immigrants. Immigrant patients’ strong trust levels may be formed a priori, instead of based on physicians’ communication. Physicians may need to make extra efforts to optimize their communication.

Studying medical communication with video vignettes: a randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients’ engagement

BackgroundVideo vignettes are used to test the effects of physicians’ communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants’ engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants’ engagement with a video vignette showing a bad news consultation.MethodsIntroduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient’s situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants’ electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction.ResultsThe audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, ηpartial2