Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

The Impact of Cervical Cancer Treatment on Sexual Function and Intimate Relationships: Is Anyone Listening?

The purpose of this research was to describe women’s narrative accounts of the impact of cervical cancer treatment on their sexual function and intimate relationships, and to evaluate what changes in care and education are needed to enhance quality of life and intimacy after treatment. The research approach was a narrative design, using semi-structured, in-depth interviews. Narratives were examined within and across interviews, and thematic content analysis completed. The study was done in a gynecologic oncology clinic at a public hospital in the Midwest United States. The sample consisted of twelve women, ranging in age from 27 to 59, who had completed the cervical cancer treatment with chemo-radiation or radiation and surgery, and were now followed by their gynecologic oncologists. Across narratives, five major themes were identified, including unexpected physical complications, not “getting back to normal,” emotional pain and isolation, lack of available information, and inadequate health care provider response to treatment complications and sexual relationship problems. Women’s stories reveal that sex and intimacy issues for cervical cancer survivors remain within a culture of silence. In many situations, health professionals did not provide information that realistically prepared women and partners for probable consequences of treatment, did not assess sexual issues before or after treatment, did not recognize various symptoms as being complications of cancer treatment, did not make referrals, and/or recognized complications, but accepted them as “normal” and without solution. Ethical implications for health professionals and the need for education, communication, and the development of new lines of research are discussed.

Patient Perceptions of Current Disease Control in Poorly Controlled Diabetes

Background: Studies suggest that patients do not understand the hemoglobin A1c value (A1c). However, clinicians may communicate information about glycemic control in other ways. Given this, this study evaluates patients’ understanding of current diabetes control, independent of the A1c, and the factors affecting this understanding. Method: Cross-sectional survey of patients with poorly controlled diabetes seen in urban clinics in fall of 2010. Results: 177 people completed the survey. 73.5% were women, 83.0% were African-American and the average age was 56.5 years. 80.2% of respondents reported having had diabetes for at least five years. 39% reported past participation in a diabetes education course. Average A1c was 9.9(S.D. 1.7)%;no differences were noted based on income, education, disease duration, or complication history. 23.7% described their disease control as “good” or “excellent” in spite of an average A1c of 9.5% (1.2). Notably, most of this group reported diabetes for over five years and did not differ in history of diabetes-related complications or educational attainment compared to those with more accurate perceptions of control. Conclusion: The high proportion of participants who reported “good” or “excellent” control in spite of mean A1c greater than 9.5% raises serious questions about the effectiveness of current communication methods for patients with poorly controlled diabetes.

Assessment of Weight and Health in the Emergency Department: A Cross-Sectional Study

Introduction: The prevalence of obesity and obesity-related diseases continues to rise. A key aspect of prevention and treatment of these disorders requires clear communication about weight and health between patients and healthcare providers. Objective: We sought to examine the prevalence rate of obesity and associated comorbid illnesses in an emergency department (ED) population. A second aim was to assess patients’ perceptions of their weight and their overall health. Methods: This is a cross-sectional study performed in an academic tertiary-care center using a representative sample of patients (≥18 yr) who presented to the ED. Pregnant patients, patients who were medically unstable, cognitively impaired or who were unable or unwilling to provide informed consent were excluded. Anthropometric measurements were taken which include BMI (the ratio of a patient’s weight and height expressed as kg/m2) and waist circumference. In addition, the prevalence rates of all enrolled patients who 1) feel their health is affecting their weight and 2) who have had or recall discussions about their health and weight with their provider were examined by using a two-question validated survey. Results: The overall prevalence rate of obesity in this study was 38.6%. Only 71.8% (95% CI, 63.2% - 80.6%) of overweight patients (BMI = 25.0 - 29.9) and 28.4% (95% CI, 21.6% - 35.2%) of obese patients (BMI ≥ 30.0) believe their present weight is damaging to their health. Further, only 15.5% (95% CI, 8.5% - 22.6%) and 59.4% (95% CI, 53% - 67%) of those overweight and obese, respectively, recall being informed by their healthcare provider they are overweight. For morbidly obese patients (BMI ≥ 40.0), 79.6% (95% CI, 12.2 - 28.6) feel their weight is damaging their health and 83.7% (95% CI, 9.4 - 23.2) recall having a conversation about weight with their healthcare provider. Conclusion: Many obese and overweight patients believe their weight does not impact their health and have not had discussion about weight and health with their healthcare provider.

Use and Attitudes towards Teleconsultation in Dentistry

An electronic (web-based) questionnaire was devised to find out the extent of teleconsultation and e-mail use for patient-provided communications in dentistry. This project was carried out in 2011 inthe health care district of South-Ostrobothnia, in South-Western Finland.The questionnaire was sent by e-mail to all 120 regional dentists, to which 76 replies were obtained (response rate 63%). The responses indicated a surprisingly positive attitude towards teleconsultation. A clear majority of 91% indicated that it could bring additional benefits to the current consultation methods.This study revealed that a slight majority of dentists in the region use e-mail for patient communication and 53% used e-mail for consultation. Approximately 10% use videoconferencing for consultation.The study also revealed that the majority of those who do not yet use electronic consultation are willing to try them out in the future. Security issues are a concern for many dentists. Practically all respondents wish for written instructions on the use of electronic consultation.

Factors influencing communication of traditional Chinese medicine use between patients and doctors:A multisite cross-sectional study

Objective: In Singapore, the use of traditional Chinese medicine(TCM) alongside Western medicine(WM)is common. There are risks of adverse herb-drug interactions when taken concurrently. Current literature suggests that TCM use is not regularly reported to WM doctors in Singapore, but the underlying reasons are not understood.Methods: A cross-sectional study was conducted across Singapore by administering questionnaires to TCM-using patients and WM-practising general practitioners(GPs). The questionnaire examined the following themes:(1) demographics and TCM use pattern;(2) respondents'(patients and GPs) knowledge and beliefs about TCM and the factors influencing the discussion of TCM during the WM consultation;and(3) respondents' qualitative suggestions to increase disclosure rate.Results: A total of 484 patients and 334 GPs were surveyed. Factors associated with patients' initiation of TCM discussion include length of consultation(odds ratio [OR]: 2.1;P < 0.001), comfort level in discussing TCM(OR: 1.6;P < 0.001) and belief in importance of discussion(OR: 1.4;P = 0.017). Doctor's initiation of discussion(74%) was the top patient-ranked factor influencing their discussion of TCM. For doctors,knowledge of TCM indications(OR: 2.2;P < 0.001), belief in importance of discussion(OR: 2.1;P < 0.001) and comfort level in discussing TCM(OR: 1.9;P = 0.001) were associated with their initiation of TCM use discussion. Possible WM-TCM interactions(58%) was the top doctor-ranked factor influencing their discussion of TCM.Conclusion: The discussion of TCM in a WM setting is multifactorial. Interventions include doctors' active screening for TCM use in patients and equipping doctors with TCM knowledge. Improving communication between patients and doctors is key to avoiding harmful herb-drug interactions.