Rebecca J. W. Cline

Discussing Bad News in the Outpatient Oncology Clinic: Rethinking Current Communication Guidelines

Aware that his pancreatic cancer had metastasized to his liver, Mr B and his adult son and daughter traveled several hundred miles to see an oncologist at a regional comprehensive cancer center. As the oncologist explained the treatment options, Mr B and his family occasionally interrupted with questions, statements, or expressions of emotion. During the interaction, Mr B and his family learned that surgery was not a treatment option, as they had hoped. They also learned that Mr B was not eligible for any clinical trials. The only available option was chemotherapy, but it carried the potential for severe adverse effects, had less than a 10% chance of shrinking the tumor, and had no chance of “melting the tumor away.” In response to one of the son’s questions, the oncologist said that complementary or alternative medicines were not available at this center. As part of his response to the daughter’s question about the urgency of a treatment decision, the oncologist mentioned that the cancer had been in Mr B’s body for a number of years. Mr B and both of his children asked several questions about this piece of information, indicating their surprise and dismay. Mr B shook his head and exclaimed, “And I go to the doctor all the time!” As the discussion concluded, the oncologist provided details about how chemotherapy might be delivered and repeated that there was no urgency to the decision.

Marketing drugs, marketing health care relationships: a content analysis of visual cues in direct-to-consumer prescription drug advertising.

Proponents and opponents of direct-to-consumer advertising (DTCA) of prescription drugs argue that it promotes greater participation in health care by consumers with significant implications for public health and health care outcomes. This article (a) proposes a social cognitive theoretical framework to explain DTCAs effects, and (b) reports the first in a series of studies on DTCAs observational learning functions that may influence consumer behavior and the physician-patient relationship. This investigation addresses visual features of print DTCA. Results focus on the prevalence and nature of models featured in the ads and how visual cues may offer identity and relational motivators while reinforcing the value of prescription drug treatments. Further, DTCA may market disenfranchising images that increase disparity in health care information and access, despite their argued educational function.

Studying the process of clinical communication: issues of context, concepts, and research directions.

Much cancer-related health communication research has involved studies of the effects of media campaigns and strategies on secondary prevention. Cancer diagnosis rates, however, continue to affect millions of people. The need exists for communication studies to address the quality of the clinical interaction, the point of actual care delivery in addressing diagnosis, treatment, and survivorship. Using examples from a 6-year communication and behavioral oncology research program established at the Karmanos Cancer Institute (KCI) in Detroit, Michigan, we describe selected empirical issues; models, particularly the “convergence model” (adapted from Rogers & Kincaid, 1981); and associated constructs that are relevant and promising foundations for building future research in cancer clinical settings. Two examples from our empirical research program are described.

Community-Level Social Support Responses in a Slow-Motion Technological Disaster: The Case of Libby, Montana

Social support is an important resource for communities experiencing disasters. However, a disaster’s nature (rapid- versus slow-onset, natural versus technological) may influence community-level responses. Disaster research on social support focuses primarily on rapid-onset natural disasters and, to a lesser extent, rapid-onset technological disasters. Little research has addressed slow-onset disasters. This study explores social support processes in Libby, MT, a community experiencing a “slow-motion technological disaster” due to widespread amphibole asbestos exposure. A comprehensive social support coding system was applied to focus-group and in-depth-interview transcripts. Results reveal that, although the community has a history of normative supportiveness during community and individual crises, that norm has been violated in the asbestos disaster context. Results are interpreted as a failure to achieve an “emergent altruistic community.” Specifically, community-level conflict appears to interfere with previously established social support patterns. The observed phenomenon can be understood as the deterioration of a previously supportive community.

Threat, efficacy, and uncertainty in the first 5 months of national print and electronic news coverage of the H1N1 virus.

The authors conducted a content analysis, investigating the first 5 months of national print and electronic news coverage of the H1N1 virus. They collected all stories about H1N1 appearing in 6 national news outlets between April and September 2009. Of these stories meeting the analysis criteria, the authors randomly selected 200 for inclusion. Using models of fear appeal message processing, this study investigated the nature and prevalence of threat and efficacy messages in news coverage of the virus. Such models have traditionally been applied to strategic health message contexts (e.g., campaigns) rather than to health news coverage. Results suggest that most stories made reference to the threat of the H1N1 virus, sometimes overemphasizing and sensationalizing virus-related death. With regard to efficacy, approximately half mentioned actions individuals or organizations/communities could take to protect themselves from the virus, but almost none provided evidence that such methods are effective, and some explicitly questioned their effectiveness. In addition, a number of stories referenced uncertainty about the threat of the virus (38%) and/or solutions to the potential threat (18%). The authors discuss the implications from the perspective of fear appeal message processing models.

Prescription drug abuse information in D.A.R.E

This investigation was designed to examine prescription drug-related content and learning objectives in Drug Abuse Resistance Education (D.A.R.E.) for upper elementary and middle schools. Specific prescription-drug topics and context associated with content and objectives were coded. The coding system for topics included 126 topics organized within 14 categories. A two-dimensional coding system for context identified Use versus Abuse and Explicit versus Implicit references to prescription drugs. Results indicated that content and objectives found in D.A.R.E. represent a very narrow breadth of prescription drug topics. Moreover, all prescription-drug related content and objectives were presented in an Abuse-Implicit context. Although some educational material in D.A.R.E. modules potentially is related to prescription drugs, none of the content or objectives explicitly identify drugs discussed as prescription drugs. If elementary and middle schools rely on D.A.R.E. modules to teach students about drug abuse, students are likely to be under-informed about prescription drug risks.

Social Support Functions During a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby, Montana.

Previous research concluded that victims of rapid-onset natural disasters (e.g., hurricanes) receive and provide high levels of instrumental support. However, different kinds of disasters (natural or human caused [technological, environmental, intentional/terrorism], rapid or slow onset, short or long duration) may create different stressors and thus influence the types of social support most needed and provided. We explored social support functions during an ongoing “slowly-evolving environmental disaster” in Libby, Montana due to widespread exposure to amphibole asbestos. Analyses of focus groups and in-depth interviews focused on the relative salience of support functions (emotional, informational, instrumental, and spiritual) identified as needed or provided. Dominant themes emerged around each function. Results indicated that informational support is particularly salient in this type of disaster. Although not all community members had experienced the disaster’s health consequences (asbestos-related disease [ARD]), all had been affected by the disaster and had informational needs. The nature of those informational needs (e.g., medical vs. financial) varied based on experience with ARD. Experience with ARD was associated with awareness of disaster-related emotional and instrumental support needed or provided. Results have implications for future research on slowly-evolving environmental disasters and institutional and community responses to them.

The Role of Social Toxicity in Responses to a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby, Montana, USA

Experiencing a disaster has significant negative effects on psychological adjustment. Case study accounts point to two consistent trends in slowly-evolving environmental disasters: (a) patterns of negative social dynamics, and (b) relatively worse psychological outcomes than in natural disasters. Researchers have begun to explicitly postulate that the social consequences of slowly-evolving environmental disasters (e.g., community conflict) have their own effects on victims’ psychological outcomes. This study tested a model of the relationship between those social consequences and psychological adjustment of victims of a slowly-evolving environmental disaster, specifically those whose health has been compromised by the amphibole asbestos disaster in Libby, MT. Results indicate that experiencing greater community conflict about the disaster was associated with greater family conflict about the disaster which, in turn, was associated with greater social constraints on talking with others about their disease, both directly and indirectly through experiencing stigmatization. Experiencing greater social constraints was associated with worse psychological adjustment, both directly and indirectly through failed social support. Findings have implications for understanding pathways by which social responses create negative effects on mental health in slowly-evolving environmental disasters. These pathways suggest points for prevention and response (e.g., social support, stigmatization of victims) for communities experiencing slowly-evolving environmental disasters.

A Typology of Communication Dynamics in Families Living a Slow-Motion Technological Disaster

With increasing numbers of communities harmed by exposures to toxic substances, greater understanding of the psychosocial consequences of these technological disasters is needed. One community living the consequences of a slow-motion technological disaster is Libby, Montana, where, for nearly 70 years, amphibole asbestos-contaminated vermiculite was mined and processed. Former mine employees and Libby area residents continue to cope with the health consequences of occupational and environmental asbestos exposure and with the psychosocial challenges accompanying chronic and often fatal asbestos-related diseases (ARD). Nine focus groups were conducted with Libby area residents. Transcripts were analyzed to explore patterns of family communication about ARD. The following five patterns emerged: Open/Supportive, Silent/Supportive, Open/Conflictual, Silent/Conflictual, and Silent/Denial. Open/Supportive communication included encouragement to be screened for ARD, information about ARD and related disaster topics, and emotional support for people with ARD. In contrast, communication patterns characterized by silence or conflict have the potential to hinder health-promoting communication and increase psychological distress.

Reaching future scientists, consumers, & citizens: What do secondary school textbooks say about genomics & its impact on health?

Abstract An understanding of how genomics information, including information about risk for common, multifactorial disease, can be used to promote personal health (personalized medicine) is becoming increasingly important for the American public. We undertook a quantitative content analysis of commonly used high school textbooks to assess how frequently the genetic basis of common multifactorial diseases was discussed compared with the “classic” chromosomal—single gene disorders historically used to teach the concepts of genetics and heredity. We also analyzed the types of conditions or traits that were discussed. We identified 3957 sentences across 11 textbooks that addressed multifactorial and “classic” genetic disorders. “Classic” gene disorders were discussed relatively more frequently than multifactorial diseases, as was their genetic basis, even after we enriched the sample to include five adult-onset conditions common in the general population. Discussions of the genetic or hereditary components of multifactorial diseases were limited, as were discussions of the environmental components of these conditions. Adult-onset multifactorial diseases are far more common in the population than chromosomal or single-gene disorders; many are potentially preventable or modifiable. As such, they are targets for personalized medical approaches. The limited discussion in biology textbooks of the genetic basis of multifactorial conditions and the role of environment in modifying genetic risk may limit the publics understanding and use of personalized medicine.