Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets

BackgroundImproving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology.MethodsSystematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000-October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework.FindingsEighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies.ConclusionsMost communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains

A Pilot Study of Lay Health Worker Outreach and Colorectal Cancer Screening Among Chinese Americans

The research team recruited eight Chinese American (seven females, one male) lay health workers (LHWs). They received 12 h of training about colorectal cancer (CRC), its screening, and basic health education techniques. Each LHW were asked to recruit ten participants and conduct two educational sessions. Of the 81 participants recruited, 73 had not received colorectal cancer screening. Their mean age was 63.0 years, and 72.6% were women. Knowledge of colorectal cancer, its causes, and its screening increased significantly. Receipt of first colorectal cancer screening test increased from 0.0% at baseline to 55.7% for fecal occult blood tests, 7.1% for sigmoidoscopy, and 7.1% for colonoscopy. LHW outreach is feasible and may be effective in promoting CRC screening among Chinese Americans

Decision-making in pediatric hematopoeitic cell transplantation

Title on title page: Decision-making in pediatric hematopoeitic cell transplantion, Title on signature page: Decision-making in pediatric hematopoeitic cell transplantation[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Hematopoietic cell transplantation (HCT) is a treatment option utilized to cure many childhood disorders, with cancer, sickle cell disease (SCD), and aplastic anemia being a few. The decision of whether or not to pursue HCT involves uncertainty and risk. Pediatric patients with SCD and their families undergo a decision-making process distinct from patients with childhood cancer. Patients with sickle cell disease (SCD) realize an awareness of unpredictable disease progression and conflict when considering HCT, while patients with cancer perceive an urgency for survival. We applied Connor's Framework of Decisional Conflict and a multiple-case study approach to describe the level and source of decisional conflict in patients with SCD and their families in a real-life decision choice of HCT. The contribution of the pediatric patient in the decision was also described in our four families. Observation, survey, and interview methods allowed us to gain an in-depth understanding of their conflict. Through pattern-matching and cross-case synthesis, we found that the level and sources of conflict among 11 participants varied within and across family members. Some experienced levels that resulted in a delayed decision or feeling unsure. The patients and their family members ultimately navigated their uncertainties together to come to consensus on whether to proceed with HCT. Future studies should implement individualized interventions from a family research perspective to decrease the decisional conflict this population faces

Clinicians\u27 Perspectives on the Functions of Communication in Pediatric Oncology

Parents previously identified eight core functions of communication with clinicians in pediatric oncology. To determine clinicians\u27 views on communication functions in pediatric oncology. In 10 focus groups with 59 clinicians at two academic centers, we asked open-ended questions about communication goals and purposes. Then we presented definitions of eight communication functions previously described by parents and explored clinicians\u27 perspectives. We performed separate focus groups for nurses, nurse practitioners, physicians, and psychosocial professionals. Thematic analysis of focus group transcripts. Clinicians identified six functions in response to open-ended questions. After reviewing the eight functions described by parents, all clinicians agreed with the framework: building relationships, exchanging information, making decisions, enabling family self-management, managing uncertainty, responding to emotions, supporting hope, and providing validation. Pediatric oncology clinicians corroborated this functional communication framework. Clinicians and researchers can utilize this framework to guide care and research in the future

Clinicians\u27 perspectives on the functions of communication in pediatric oncology

Parents previously identified eight core functions of communication with clinicians in pediatric oncology. To determine clinicians\u27 views on communication functions in pediatric oncology. In 10 focus groups with 59 clinicians at two academic centers, we asked open-ended questions about communication goals and purposes. Then we presented definitions of eight communication functions previously described by parents and explored clinicians\u27 perspectives. We performed separate focus groups for nurses, nurse practitioners, physicians, and psychosocial professionals. Thematic analysis of focus group transcripts. Clinicians identified six functions in response to open-ended questions. After reviewing the eight functions described by parents, all clinicians agreed with the framework: building relationships, exchanging information, making decisions, enabling family self-management, managing uncertainty, responding to emotions, supporting hope, and providing validation. Pediatric oncology clinicians corroborated this functional communication framework. Clinicians and researchers can utilize this framework to guide care and research in the future

Interdependent functions of communication with adolescents and young adults in oncology

BACKGROUND: Communication is central to patient-centered care in adolescent and young adult (AYA) cancer. Previously, we developed a functional communication model from perspectives of parents whose children had cancer. No prior studies have established a framework for the breadth of communication functions in AYA oncology. We aimed to identify these communication functions from AYAs\u27 perspectives. METHODS: Semistructured interviews with 37 AYAs with cancer aged 12-24 years at diagnosis from two pediatric centers during treatment or survivorship. We performed thematic analysis, using a functional communication model as an a priori framework, but remaining open to novel themes. RESULTS: We identified eight interdependent functions of communication in AYA oncology that were consistent with those previously identified among parents: building relationships, exchanging information, enabling family self-management, making decisions, managing uncertainty, responding to emotions, providing validation, and supporting hope. AYAs held varying preferences for engagement in different communication functions. While some AYAs preferred very passive or active roles, most AYAs described an interdependent process of communication involving them, their parents, and their clinicians. Parents often served as a conduit and buffer of communication between the AYA and clinician. CONCLUSIONS: Interviews with AYAs provided evidence for eight interdependent communication functions in AYA oncology. Many AYAs described the integral role of parents in communication regardless of their age. Clinicians can use this framework to better understand and fulfill the communication needs of AYA patients. Future work should aim to measure and intervene upon these functions to improve communication experiences for AYAs with cancer

Supplementary_table__HCT_SCD_Psychosocial_Final_Manuscript – Supplemental material for Early Identification of Barriers and Facilitators to Self-Management Behaviors in Pediatric Patients With Sickle Cell Disease to Minimize Hematopoietic Cell Transplantation Complications

<p>Supplemental material, Supplementary_table__HCT_SCD_Psychosocial_Final_Manuscript for Early Identification of Barriers and Facilitators to Self-Management Behaviors in Pediatric Patients With Sickle Cell Disease to Minimize Hematopoietic Cell Transplantation Complications by Ginny L. Schulz, Rebecca H. Foster, Valerie Kennedy Lang, Alison Towerman, Shalini Shenoy, Brea-Anne Lauer, Elizabeth Molzon, and Megan Holtmann in Journal of Pediatric Oncology Nursing</p