Sandra L. Ragan

Communicating a terminal prognosis in a palliative care setting: Deficiencies in current communication training protocols

The goal of this study was to understand the use and effectiveness of current communication protocols in terminal prognosis disclosures. Data were gathered from an interdisciplinary palliative care consultation service team at a Veterans Hospital in Texas, USA. Medical communication guidelines, a consistent component in United States palliative care education, propose models for delivery of bad news. However, there is little empirical evidence that demonstrates the effectiveness of these guidelines in disclosures of a terminal prognosis. Based on ethnographic observations of terminal prognosis meetings with dying patients, palliative care team meetings, and semi-structured interviews with palliative care team practitioners, this study notes the contradictory conceptualizations of current bad news communication guidelines and highlights that communicating a terminal prognosis also includes (1) adaptive communication based on the patients acceptability, (2) team based/family communication as opposed to physician-patient dyadic communication, and (3) diffusion of topic through repetition and definition as opposed to singularity of topic. We conclude that environmentally based revision to communication protocol and practice in medical school training is imperative.

Negotiating Interpersonal and Medical Talk: Frame Shifts in the Gynaecologic Exam

Extending from previous research on code switching and conversational framing, the present study focuses on the interaction between a nurse practitioner and her patients during gynaecologic exams. Specifically, this research found that the nurse practitioner and her patients initiated and responded to cues that shifted the medical encounter from medical to personoriented and then back to medical frames. Further, this research indicates that such frame shifts serve a rhetorical function in the encounter which facilitates the actual medical examination. Finally, these interactions exemplify the efficient and empathic integration of both interpersonal and medical dimensions of the medical examination.

The Shift to Early Palliative Care

For the current study, clinical observations of communication between patients, families, and clinicians during chronic, serious, or terminal illness in a cancer care trajectory were examined for patterns and trends. Five communication characteristics were concluded, which informed a typology of illness journeys experienced by patients with cancer and their families. The isolated journey characterizes an illness path in which communication about terminal prognosis and end-of-life care options are not present; communication is restricted by a curative-only approach to diagnosis as well as the structure of medical care. The rescued journey signifies a transition between curative care (hospital narrative) to noncurative care (hospice narrative), challenging patients and their families with an awareness of dying. The rescued journey allows communication about prognosis and care options, establishes productive experiences through open awareness, and affords patients and families opportunities to experience end-of-life care preferences. Finally, palliative care prior to hospice provides patients and families with an illness journey more readily characterized by open awareness and community, which facilitates a comforted journey. Nurses play a pivotal role in communicating about disease progression and plans of care. The typology presented can inform a structured communication curriculum for nurses and assist in the implementation of early palliative care.

Women, Menopause, and (Ms.)Information: Communication About the Climacteric

This research utilizes a communication perspective to examine the dissemination of information about menopause in terms of womens attitudes, beliefs, and knowledge. Specifically, this study uses a grounded theory approach (Glaser & Strauss, 1967) to explore the communicative processes of misinformation concerning womens lived experiences in relation to the climacteric. Five emergent themes extracted from premenopausal, perimenopausal, and postmenopausal womens discourse are identified and described through qualitative data analysis. Findings suggest that due to a lack of consistent communication, women are generally either unknowledgeable or misinformed about menopause and its related issues. Inaccurate information concerning a health-related experience that all women undergo has negative implications for women, their practitioners, and society. Moreover, a clearer understanding of womens experiences concerning menopause may enhance communication in physician-patient interactions (PPIs).

Palliative care communication in oncology nursing.

Oncology nurses consistently exhibit distress when communicating about end-of-life topics with patients and families. Poor communication experiences and processes correlate with emotional distress, moral distress, and work-related stress. The National Consensus Project (NCP) for Quality Palliative Care developed clinical practice guidelines to establish quality standards for the practice of palliative care. NCPs guidelines are expressly intended as an interdisciplinary document and are representative of the inherent interdisciplinary nature of palliative care. Communications value to palliative and oncology nursing is unique because those two specialties include a high frequency of challenging interactions for patients, families, and healthcare professionals. The COMFORT communication curriculum, a holistic model for narrative clinical communication in practice developed for use in early palliative care, is posed as a resource for oncology nurses with a series of practice case examples presented against the backdrop of NCPs eight domains of quality palliative care.

The Impact of Argumentativeness and Verbal Aggression on Communicator Image: The Exchange between George Bush and Dan Rather.

In previous research argumentativeness and verbal aggressiveness have been conceptually differentiated. This study sought to determine the effect of each concept on the image of participants in an actual public argument, the CBS news interview of George Bush by Dan Rather in January, 1988. Results indicate that both argumentativeness and verbal aggressiveness have a significant relationship to communicator image, but unexpected results occur when comparing the images of the two participants. Verbal aggressiveness negatively affected Bushs communicator image, but positively influenced Rathers. Results also suggest differences in the effects of argumentativeness and verbal aggressiveness on specific characteristics of communicator image.

Political argumentation and violations of audience expectations: An analysis of the bush‐rather encounter

This research analyzed the 1988 encounter between George Bush and Dan Rather on the CBS Evening News as an attack‐rebuttal sequence. The experimental study considered reactions to the 5½‐minute mini‐documentary (attack) preceding the actual interview and to the live interview (rebuttal) itself. Respondents seeing the mini‐documentary only had more negative views of Bush; exposure to the mini‐documentary and interview together enhanced Bushs image while Rathers evaluations decreased. Violations of audience expectations about television news structure and conversational norms may have accounted for strong viewer reactions.

Medical Students’ Views and Ideas About Palliative Care Communicatio Training:

This study focused on the undergraduate medical student to identify views and ideas held toward palliative care communication training, pedagogical approaches to this training, and its perceived effectiveness and use in the medical field. Two focus groups consisting of fourth-year medical students were conducted, and their responses were analyzed using grounded theory categorization. Results indicated that students: (a) prefer to learn nonverbal communication techniques, (b) believe that natural ability and experience outweigh communication curriculum, (c) view the skill of breaking bad news as largely dependent on knowledge and expertise, and (d) prefer curriculum on palliative care and hospice to consist of information (eg, advance directives) rather than communication skills. Implications for these interpretive themes are discussed as well as future research and practice.

Promoting improved family caregiver health literacy: evaluation of caregiver communication resources.

Family caregivers of cancer patients have a vital role in facilitating and sharing information about cancer, revealing a need to develop caregiver health literacy skills to support caregiver communication. The goal of this study was to investigate caregiver print materials and develop and assess a new caregiver communication resource titled A Communication Guide for CaregiversTM.

Exploring Nurse Communication About Spirituality

Objective: Although spiritual care is considered one of the pillars of palliative care, many health-care providers never receive formal training on how to communicate about spirituality with patients and families. The aim of this study was to explore the spiritual care experiences of oncology nurses in order to learn more about patient needs and nurse responses. Methods: A survey was circulated at a communication training course for oncology nurses in June 2015. Nurses recalled a care experience that included the initiation of a spiritual care topic and their response to the patient/family. Data were analyzed using thematic analysis. Results: Nurses reported that communication about spirituality was primarily initiated by patients, rather than family members, and spiritual topics commonly emerged during the end of life or when patients experienced spiritual distress. Nurses’ experiences highlighted the positive impact spiritual conversations had on the quality of patient care and its benefit to families. Spiritual communication was described as an important nursing role at the end of patients’ lives, and nonverbal communication, listening, and discussing patients’ emotions were emphasized as important and effective nurse communication skills during spiritual care conversations. Approximately one-third of nurses in the sample reported sharing their own personal spiritual or religious backgrounds with patients, and they reported that these sharing experiences strengthened their own faith. Conclusion: It is evident that patients want to discuss spiritual topics during care. Study findings illustrate the need to develop a spiritual communication curriculum and provide spiritual care communication training to clinicians.