Terrance L. Albrecht

Physician Referral for Fertility Preservation in Oncology Patients: A National Study of Practice Behaviors

PURPOSEnCancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States.nnnMETHODSnThis study examined oncologists referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians.nnnRESULTSnForty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those with favorable attitudes (P = .043), and those whose patients routinely ask about FP (odds ratio = 2.09; 95% CI, 1.31 to 3.33).nnnCONCLUSIONnLess than half of US physicians are following the guidelines from the American Society of Clinical Oncology, which suggest that all patients of childbearing age should be informed about FP.

Strategic Physician Communication and Oncology Clinical Trials

PURPOSEnClinical trials are the primary means for determining new, effective treatments for cancer patients, yet the number of patients that accrue is relatively limited. The purpose of this study was to explore the relationship between physician behavior and patient accrual to a clinical trial by videotaping the interaction.nnnPATIENTS AND METHODSnForty-eight patient-physician interactions involving 12 different oncologists were videotaped in several clinics at the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL). The purpose of each interaction was to present the possibility of a clinical trial to the patient. A coding system, the Moffitt Accrual Analysis System, was developed by the authors to code behaviors that represented both the legal-informational and social influence models of communication behavior. Thirty-two patients agreed to participate in the clinical trial.nnnRESULTSnVideotaping was found to be a viable, valid, and reliable method for studying the interaction. Physicians who were observed to use both models of influence were found to enroll more patients. Thus, patients were more likely to accrue to the trial when their physician verbally presented items normally included in an informed consent document and when they behaved in a reflective, patient-centered, supportive, and responsive manner. Discussion of benefits, side effects, patient concerns and resources to manage the concerns were all associated with accrual.nnnCONCLUSIONnThis research has implications for modifying physician behavior and, thus, increasing the numbers of patients accruing to oncology clinical trials.

Facilitating talk about new ideas: The role of personal relationships in organizational innovation

This research focuses on the relational and network conditions conducive to talk about new ideas. Although talk about new ideas does not guarantee implementation, it is a necessary and essential element in the overall innovation process. This paper includes two studies grounded in a perspective informed by politeness theory and the fundamental concern individuals have for the maintenance of personal face. The studies highlight the importance of relationships characterized by high content and role multiplexity, the relational attributions underlying the ties in which this type of talk occurs, and more. Discussion of the implications of these findings as well as directions for future research are also included.

Advances in Segmentation Modeling for Health Communication and Social Marketing Campaigns

Large-scale communication campaigns for health promotion and disease prevention involve analysis of audience demographic and psychographic factors for effective message targeting. A variety of segmentation modeling techniques, including tree-based methods such as Chi-squared Automatic Interaction Detection and logistic regression, are used to identify meaningful target groups within a large sample or population (N = 750-1,000+). Such groups are based on statistically significant combinations of factors (e.g., gender, marital status, and personality predispositions). The identification of groups or clusters facilitates message design in order to address the particular needs, attention patterns, and concerns of audience members within each group. We review current segmentation techniques, their contributions to conceptual development, and cost-effective decision making. Examples from a major study in which these strategies were used are provided from the Texas Women, Infants and Children Programs Comprehensive Social Marketing Program.

Communication and consumer decision making about cancer clinical trials

Communication between patients and physicians likely mediates traditional patient and physician predispositions in determining patient outcomes, including perceptions and decision making. However, the extent to which a mediating effect occurs is unclear. The purpose of this essay is to outline the need for conceptualizing more holistic models of consumer-provider interaction that demonstrate the role of the therapeutic relationship in treatment outcomes. We focus on an important communicative context for exploring this question: the situation where patients, with the help of oncologists, are faced with making treatment choices, particularly whether to enroll in a clinical trial in response to their life-threatening cancer diagnosis. We explore the question from the perspectives of the medical provider, the patient, and the accompanying family member, in order to better frame the complex interactional dynamics occurring during the interaction.

Current and evolving strategies for colorectal cancer screening

BACKGROUNDnColorectal cancer is a major cause of cancer mortality and morbidity. Screening can potentially prevent most colorectal cancers by detection and removal of precursor adenomas.nnnMETHODSnThe literature and clinical practice guidelines are reviewed, with an emphasis on advances of the last 10 years and evolving screening methods.nnnRESULTSnColonoscopy has come to be used for screening in persons at average risk for colorectal cancer because of the comparative ineffectiveness of other methods, although these methods continue to be recommended. Virtual colonoscopy and fecal DNA testing are emerging technologies with promise to be more effective than fecal occult blood testing or sigmoidoscopy in selecting those persons who should undergo colonoscopy. Next to age, family history is the most common risk factor for colorectal cancer and one that warrants more aggressive screening and, in some instances, genetic counseling and testing. Hereditary nonpolyposis colorectal cancer accounts for as many as 1 in 20 colorectal cancers, but to take advantage of recent advances in genetic testing for this disorder, a high level of clinical suspicion must be maintained.nnnCONCLUSIONSnIf we are to reduce mortality and morbidity from colorectal cancer, practicing clinicians need to be aware of current and evolving strategies for colorectal screening, and assertively recommend the appropriate strategy to their patients.

Message design logic, social support, and mixed‐status relationships

This study explores the relationship between superiors and subordinates message design logic types and reported amounts of relational social support, trust, discussion of innovation, personal control, expected performance ratings, and burnout. We sought to determine whether relational patterns in design logics exist enabling the identification and prediction of mixed‐status relationships where social support is enhanced. Findings obtained from a voluntary sample of nurses suggest that those relationships where the nurse‐manager employs a “rhetorical” message design logic and the staff nurse does not report the highest levels of relational support, trust, talk on innovation, personal control, expected positive performance rating, and lowest levels of burnout result.

The impact of supportive communication networks on test anxiety and performance

Test anxious students experience worries and fears that prevent them from performing well on exams. In this study we describe the communication networks of students in a large lecture course and test the hypothesis that naturally occurring supportive communication reduces uncertainty and helps test anxious students improve exam performance. Findings indicate the relationship between support and test performance depends on a students level of test anxiety and on the source of support. For students with high test anxiety, support from people outside of class is positively related to exam grades, and support from peers in class is negatively related to exam grades. The reverse is true for students with low test anxiety. The mediating role of uncertainty was not supported.

Communication, accrual to clinical trials, and the physician‐patient relationship: Implications for training programs

BACKGROUNDnPrevious studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an alliance building that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy.nnnMETHODS AND RESULTSnThe authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes.nnnCONCLUSIONSnThe authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Differences in audiotaped versus videotaped physician-patient interactions

Most medical interaction studies have been conducted on audiotaped recordings of physician-patient encounters. Empirical studies have not previously demonstrated whether coders scores differ on audio-only versus videotaped data. Data from a convenience sample of forty-seven physician-patient interactions were analyzed using the same coding systems to judge audio-only versus video-based data formats. All coding conditions demonstrated acceptable reliability, using intraclass correlation coefficients. However, MANOVA analyses show that ratings of audiotaped physician-patient interactions are not equivalent to ratings of videotaped encounters. Exploratory factor analyses show differences in the underlying structures of the data derived from the audio-only versus the video information. The differences in the video-based factor solutions account for more total variance and are more consistent with theoretical expectations.