Patient–provider communication data: linking process and outcomes in oncology care

Lisa Kennedy Sheldon1,2, Fangxin Hong3,4, Donna Berry4,51University of Massachusetts Boston, Boston, MA, USA; 2St Joseph Hospital, Nashua, NH, USA; 3Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, MA, USA; 4Dana-Farber Cancer Institute, Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Boston, MA, USA; 5Harvard Medical School, Boston, MA, USAOverview: Patient–provider communication is vital to quality patient care in oncology settings and impacts health outcomes. Newer communication datasets contain patient symptom reports, real-time audiofiles of visits, coded communication data, and visit outcomes. The purpose of this paper is to: (1) review the complex communication processes during patient–provider interaction during oncology care; (2) describe methods of gathering and coding communication data; (3) suggest logical approaches to analyses; and (4) describe one new dataset that allows linking of patient symptoms and communication processes with visit outcomes.Challenges: Patient–provider communication research is complex due to numerous issues, including human subjects’ concerns, methods of data collection, numerous coding schemes, and varying analytic techniques.Data collection and coding: Coding of communication data is determined by the research question(s) and variables of interest. Subsequent coding and timestamping the behaviors provides categorical data and determines the interval between and patterns of behaviors.Analytic approaches: Sequential analyses move from descriptive statistics to explanatory analyses to direct analyses and conditional probabilities. In the final stage, explanatory modeling is used to predict outcomes from communication elements. Examples of patient and provider communication in the ambulatory oncology setting are provided from the new Electronic Self Report Assessment-Cancer II dataset.Summary: More complex communication data sets provide opportunities to link elements of patient–provider communication with visit outcomes. Given more complex datasets, a step-wise approach is necessary to analyze and identify predictive variables. Sequential analyses move from descriptive results to predictive models with communication data, creating links between patient symptoms and concerns, real-time audiotaped communication, and visit outcomes. The results of these analyses will be useful in developing evidence-based interventions to enhance communication and improve psychosocial outcomes in oncology settings.Keywords: communication, analysis, distress, cancer, outcome

When study site contributes to outcomes in a multi-center randomized trial: a secondary analysis of decisional conflict in men with localized prostate cancer

Purpose Evaluate baseline factors that may explain the influence of study site on decisional conflict (DC) in men from the Personal Patient Profile: Prostate (P3P) randomized trial. Materials and methods 476 cases from 5 P3P sites were included. Participants completed baseline demographic assessments, 4 subscales of the DC scale at baseline (uncertainty, informed, values clarity, and support), the Expanded Prostate Cancer Index Composite (short form) and the State-Trait Anxiety Inventory. Site data regarding typical practices were collected. Linear regressions were used to model the relation between baseline DC scores and study site adjusting for the list of variables. Results: Baseline decisional uncertainly (p = 0.001) and informed (p = 0.03) subscales were significantly different across sites. Participant demographic and baseline measures were significantly different (p < 0.05) between sites except for trait anxiety. We identified participant level factors that explained study site differences at baseline for the decisional uncertainty and values clarity subscales: a preferred treatment choice at study entry, whether the study program was accessed at home vs. in clinic, number of doctors consulted pre-study, working status, state anxiety, information from the media or a health care provider, and perceived knowledge level. State anxiety was associated with higher DC across all subscales. Conclusions: Individual characteristics of men seeking consultation for LPC were associated with DC at baseline, not the site alone; anxiety contributed to higher conflict. These findings will inform future development and implementation of the P3P and other decision support interventions. Trial registration NCT00692653

Patient self-appraisal of change and minimal clinically important difference on the European organization for the research and treatment of cancer quality of life questionnaire core 30 before and during cancer therapy

Background: Clinical interpretation of health related quality of life (HRQOL) scores is challenging. The purpose of this analysis was to interpret score changes and identify minimal clinically important differences (MCID) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) before (T1) and during (T2) cancer treatment. Methods: Patients (N = 627) in stem cell transplant (SCT) and medical (MED) or radiation (RAD) oncology at two comprehensive cancer centers, enrolled in the Electronic Self-Report Assessment-Cancer study and completed the QLQ-C30 at T1 and T2. Perceived changes in five QOL domains, physical (PF), emotional (EF), social (SF), cognitive functioning (CF) and global quality of life (QOL), were reported using the Subject Significance Questionnaire (SSQ) at T2. Anchored on SSQ ratings indicating “improvement”, “the same”, or “deterioration”, means and effect sizes were calculated for QLQ-C30 score changes. MCID was calculated as the mean difference in QLQ-C30 score changes reflecting one category change on SSQ rating, using a two-piece linear regression model. Results: A majority of SCT patients (54%) perceived deteriorating global HRQOL versus improvement (17%), while approximately equal proportions of MED/RAD patients perceived improvement (25%) and deterioration (26%). Global QOL decreased 14.2 (SCT) and 2.0 (MED/RAD) units, respectively, among patients reporting “the same” in the SSQ. The MCID ranged 5.7-11.4 (SCT) and 7.2-11.8 (MED/RAD) units among patients reporting deteriorated HRQOL; ranged 2.7-3.4 units among MED/RAD patients reporting improvement. Excepting for the global QOL (MCID =6.9), no meaningful MCID was identified among SCT patients reporting improvement. Conclusions: Cancer treatment has greater impact on HRQOL among SCT patients than MED/RAD patients. The MCID for QLQ-C30 score change differed across domains, and differed for perceived improvement and deterioration, suggesting different standards for self-evaluating changes in HRQOL during cancer treatment. Specifically, clinical attention can be focused on patients who report at least a 6 point decrease, and for patients who report at least a 3 point increase on QLQ-C30 domains. Trial registration The trial was registered with ClinicalTrials.gov: NCT0085285

Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.

BackgroundPictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices.ObjectiveOur objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones.MethodsCard sorting was used to identify existing pictographs that focus group members found "not easy" to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited.ResultsAmong the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages.ConclusionLow literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research

Indicators, Trends and Promising Interventions in Dropout Prevention: A Review of Literature

The focus of this review of literature is dropout prevention and promoting retention of students at the secondary level. Brief background information is presented summarizing the history and current state of dropouts in the United States, including graduation and dropout rates and how these rates are calculated. Several of the most significant factors associated with students who dropout are described, in order to assist schools identify students who may be at risk for dropping out. Current trends in dropout research are reviewed, as well as recommended interventions

Promoting writing amongst peers: establishing a community of writing practice for early career academics

In the current research-focused climate, academics are facing increasing pressure to produce research outputs. This pressure can prove particularly daunting for early career (EC) academics, who are simultaneously attempting to master new teaching and administrative demands while establishing their own independent research trajectories. Previous reports suggest that academic writing retreats can be an effective way of increasing research outputs. Such retreats generally involve academics from a range of career stages and require expert facilitators. Through organising a series of structured writing events, this project aims to cultivate an enduring community of practice for academic writers. Reflecting on our EC retreat and subsequent writing days with academics from different career stages, we suggest that success hinged on three key factors: (1) A formal structure comprising bounded periods of intense writing, flanked by group reviewing and goal-setting; (2) Co-located writing with participants based in a shared space, away from their usual workstation and distractions; (3) Peer discussions involving participants at a similar career stage. Specifically we found that writing amongst ‘equals’ increased productivity and confidence amongst EC academics

Individual differences in susceptibility to false memories: The effect of memory specificity

Previous research has highlighted the wide individual variability in susceptibility to the false memories produced by the Deese/Roediger-McDermott (DRM) procedure [Deese, J. (1959). On the prediction of occurrence of particular verbal intrusions in immediate recall. Journal of Experimental Psychology, 58, 17–22; Roediger, H. L., III, & McDermott, K. B. (1995). Creating false memories: Remembering words not presented in lists. Journal of Experimental Psychology: Learning, Memory, & Cognition, 21, 803–814]. The current study investigated whether susceptibility to false memories is influenced by individual differences in the specificity of autobiographical memory retrieval. Memory specificity was measured using the Sentence Completion for Events from the Past Test (SCEPT) [Raes, F., Hermans, D., Williams, J. M. G., & Eelen, P. (2007). A sentence completion procedure as an alternative to the Autobiographical Memory Test for assessing overgeneral memory in non-clinical populations. Memory, 15, 495-507]. Memory specificity did not correlate with correct recognition, but a specific retrieval style was positively correlated with levels of false recognition. It is proposed that the contextual details that frequently accompany false memories of nonstudied lures are more accessible in individuals with specific retrieval styles

Assessing Parental Self-Efficacy for Obesity Prevention Related Behaviors

Background: Reliable, valid and theoretically consistent measures that assess a parent’s self-efficacy for helping a child with obesity prevention behaviors are lacking. Objectives: To develop measures of parental self-efficacy for four behaviors: 1) helping their child get at least 60 minutes of moderate intensity physical activity every day, 2) helping one’s child consume five servings of fruits and vegetables each day, 3) limiting sugary drinks to once a week, and 4) limiting consumption of fruit juice to 6 ounces every day. Methods: Sequential methods of scale development were used. An item pool was generated based on theory and qualitative interviews, and reviewed by content experts. Scales were administered to parents or legal guardians of children 4–10 years old. The item pool was reduced using principal component analysis. Confirmatory factor analysis tested the resulting models in a separate sample. Subjects: 304 parents, majority were women (88%), low-income (61%) and single parents (61%). Ethnic distribution was 40% Black and 37% white. Results: All scales had excellent fit indices: Comparative fit index \u3e .98 and chi-squares (Pediatrics 120 Suppl 4:S229-253, 2007) = .85 – 7.82. Alphas and one-week test-retest ICC’s were ≥ .80. Significant correlations between self-efficacy scale scores and their corresponding behaviors ranged from .13-.29 (all p \u3c .03). Conclusions: We developed four, four-item self-efficacy scales with excellent psychometric properties and construct validity using diverse samples of parents

Eye gaze and Ageing:Selective and combined effects of working memory and inhibitory control

Eye-tracking is increasingly studied as a cognitive and biological marker for the early signs of neuropsychological and psychiatric disorders. However, in order to make further progress a more comprehensive understanding of the age-related effects on eye-tracking is essential. The antisaccade task requires participants to make saccadic eye movements away from a prepotent stimulus. Speculation on the cause of the observed age-related differences in the antisaccade task largely centres around two sources of cognitive dysfunction: inhibitory control and working memory. The inhibitory control account views cognitive slowing and task errors as a direct result of the decline of inhibitory cognitive mechanisms. An alternative theory considers that a deterioration of working memory is the cause of these age-related effects on behaviour. The current study assessed inhibitory control and working memory processes underpinning saccadic eye movements in young and older participants. This was achieved with three experimental conditions that systematically varied the extent to which working memory and inhibitory control were taxed in the antisaccade task; a memory-guided task was used to explore the effect of increasing the working memory load; a Go/No-go task was used to explore the effect of increasing the inhibitory load; a ‘standard’ antisaccade task retained the standard working memory and inhibitory loads. Saccadic eye movements were also examined in control condition: the standard prosaccade task where the load or working memory and inhibitory control was minimal or absent. Saccade latencies, error rates and the spatial accuracy of saccades of older participants were compared to the same measures in healthy young controls across the conditions. The results revealed that ageing is associated with changes in both inhibitory control and working memory. Increasing the inhibitory load was associated with increased reaction times in the older group, whilst the increased working memory load and the inhibitory load contributed to an increase in the anti-saccade errors. These results reveal that ageing is associated with changes in both inhibitory control and working memory