Pamela Williams-Piehota

Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach

Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institutes Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.

Matching health messages to monitor-blunter coping styles to motivate screening mammography.

This study examined whether providing messages matched to womens monitor-blunter coping styles is effective in encouraging mammography utilization. Female callers to a cancer information hotline were assessed at the end of their regular telephone call and classified as monitors or blunters. A randomly assigned message promoting mammography utilization, tailored for monitors or blunters, was delivered on the telephone, and a similarly tailored brochure and refrigerator magnet were mailed to participants immediately after their call. Women were telephoned 6 and 12 months later to determine whether they had obtained a mammogram. Messages matched to a womans monitor-blunter coping style encouraged mammography after 6 months more effectively than mismatched messages and were significantly more effective for blunters but not for monitors.

Field Experiments in Social Psychology Message Framing and the Promotion of Health Protective Behaviors

In this article, the authors present the case for field experimentationin social psychology primarily by describing a program of research concerned with psychological aspects of health communication and persuasion. In particular, the authors are most interested in when and for whom are messages emphasizing the benefits of a health behavior (these are called gain-framed messages) more persuasive and motivating than messages emphasizing the costs of not engagingin a behavior(these are called loss-framed messages), andvice-versa. This line of research is as theoretically driven as most laboratory investigations in social psychology, and it involves experimental approaches with random assignment, control groups, and the like. However, most of this work recruits participants in ecologically interesting contexts such as community clinics and housing developments. These especially vulnerable individuals are followed for sufficient periods of time to allow for the assessment of the influence of these health messages on relevant health behaviors such as obtaining a mammogram or acquiring condoms.

Matching health messages to health locus of control beliefs for promoting mammography utilization

This field experiment examined the persuasiveness of matching health messages to individuals’ health locus of control beliefs in an effort to promote screening mammography. Women (N = 499) who called the New England regional office of the Cancer Information Service were stratified by their health locus of control and randomly assigned to receive a telephone message and follow-up print materials matched to either an internal or external health locus of control orientation. As expected, women who received information consistent with their health locus of control beliefs generally were more likely to obtain a mammogram 6 and 12 months after the intervention than women who received information that was not consistent with their health locus of control orientation.

Need for Cognition and Message Complexity in Motivating Fruit and Vegetable Intake Among Callers to the Cancer Information Service

This field experiment examined the impact of an individuals need for cognition (NFC; the tendency to enjoy thinking deeply about issues), complex versus simple messages, and the interaction of NFC and message type on encouraging fruit and vegetable consumption. Callers to the Cancer Information Service of the National Cancer Institute (N = 517) were asked to participate in the experiment at the end of their call. Individual NFC was assessed, and participants were assigned randomly to receive a telephone message promoting fruit and vegetable consumption that was either complex and multifaceted or simple and straightforward. Similarly constructed brochures were mailed immediately following the call, and additional brochures were mailed 2 and 3 months later. Although NFC did not predict intake, complex messages were more effective than simple messages in motivating fruit and vegetable consumption 1 and 4 months later.

Validation of a scale for the assessment of food cravings among smokers

Weight gain associated with smoking cessation impedes attempts to quit smoking and may lead to obesity. One factor that might contribute to weight gain is cravings for sweet or rich foods. To date, no reliable measure exists for evaluating these cravings. The purpose of the current study was to validate an assessment of craving for sweet or rich foods for use among smokers. With a sample of 385 smokers enrolled in a clinical trial for smoking cessation, the study examined the factor structure, internal consistency, and convergent and predictive validity of the Questionnaire on Craving for Sweet or Rich Foods (QCSRF). A two-factor model best represented the data. Factor 1 contained six items assessing perceptions about the ability of sweet or rich foods to relieve negative affect and about self-control over eating. Factor 2 contained three items assessing the intensity of cravings. Both factors demonstrated high internal consistency and good convergent and predictive validity. These results suggest the QCSRF is a reliable and valid measure for examining cravings for sweet or rich foods among smokers.

Bridging the Digital Divide by Increasing Computer and Cancer Literacy: Community Technology Centers for Head-Start Parents and Families

This article describes the establishment of two community technology centers affiliated with Head Start early childhood education programs focused especially on Latino and African American parents of children enrolled in Head Start. A 6-hour course concerned with computer and cancer literacy was presented to 120 parents and other community residents who earned a free, refurbished, Internet-ready computer after completing the program. Focus groups provided the basis for designing the structure and content of the course and modifying it during the project period. An outcomes-based assessment comparing program participants with 70 nonparticipants at baseline, immediately after the course ended, and 3 months later suggested that the program increased knowledge about computers and their use, knowledge about cancer and its prevention, and computer use including health information-seeking via the Internet. The creation of community computer technology centers requires the availability of secure space, capacity of a community partner to oversee project implementation, and resources of this partner to ensure sustainability beyond core funding.

The Value of Partnerships in State Obesity Prevention and Control Programs

State health departments funded by the Centers for Disease Control and Prevention’s Nutrition, Physical Activity, and Obesity Program collaborate with multiple partners to develop and implement comprehensive obesity prevention and control programs. A mixed-methods evaluation of 28 state programs over a 5-year period assessed states’ progress on program requirements, including developing statewide partnerships and coordinating with partners to support obesity prevention and control efforts. States with greater partnership involvement leveraged more funding support for their programs, passed more obesity-related policies, and were more likely to implement obesity interventions in multiple settings. Case studies provided guidance for establishing and maintaining strong partnerships. Findings from this study offer emerging evidence to support assumptions about the centrality of partnerships to states’ success in obesity program development and implementation and related health promotion activities.

Communication Message Strategies for Increasing Knowledge About Prostate Cancer Screening

Background. This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test. Methods. A quasi-experimental longitudinal design with 2 intervention and 1 control group. Results. Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months. Presenting information in the context of other men’s health issues was associated with greater increases in knowledge relative to PSA only. Conclusions. Community-based interventions can increase knowledge about prostate cancer screening. Clinicians need to take careful account of what their patients understand and correct misperceptions.

Behind Closed Doors: What Happens when Patients and Providers Talk about Prostate-Specific Antigen Screening?

AbstractBackground: Prostate-specific antigen (PSA) screening is controversial because of uncertainty about whether it reduces mortality and whether the potential benefits outweigh the harms. Given these uncertainties, many medical associations recommend using an informed decision-making (IDM) process for making decisions about PSA screening, so that men can make well informed decisions that reflect their values and preferences. Objective: The aim of this paper was to describe the communication exchange between men and their providers regarding PSA screening and the outcomes associated with having a discussion about screening from the patient perspective. Methods: We evaluated survey results obtained at baseline and approximately 12 months post-intervention. Baseline data collection took place in community-based organizations, and follow-up data were collected by mail. Men between 40 and 80 years of age who had not been diagnosed with prostate cancer were eligible for the study. We implemented a multicomponent, community-based intervention designed to help men make informed decisions about PSA screening. Primary outcome measures included characteristics of patient-provider discussions, screening behavior, feeling informed and satisfied, and patients’ preferred and actual levels of involvement in screening decisions and concordance between the two. Results: Overall, 59% of men (220 of 373) had a discussion with a healthcare professional about the PSA screening test. Older men (those aged ≥50 years), Black men, and those who were married were more likely to talk to a provider. When a discussion did occur, two out of three men said that the discussion affected their decision making, and one-quarter changed their screening choice as a result. According to patients, there was apparent variation regarding the extent to which providers recommended the PSA test: 68% of providers recommended it and 3% did not recommend it. One in ten men said that the provider ordered the test without making a recommendation, while 15% of men said that providers did not make a recommendation and wanted the patient to decide.We found that the discussion between the patient and the provider about PSA screening was significantly associated with a greater probability of feeling informed and higher levels of satisfaction with the decision that was made. Most men preferred to be and were involved in the PSA screening decision collaboratively with their providers. When preferred and actual levels of involvement were concordant (i.e. men participated at their preferred level) and when men asked questions, men reported feeling more informed and satisfied about the screening decision. Conclusion: Ongoing education about the US Preventive Services Task Force (USPSTF) recommendation with respect to PSA screening should occur not only at the patient level but also at the provider level. More widespread adoption of the IDM process, which inherently involves building a patient’s self-efficacy and skills needed to engage in it, is likely to take time.