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PubMedDate not supplied

Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency. METHODS: After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons). RESULTS: One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty. Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%. Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops. Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful. Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes. Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills. CONCLUSIONS: Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.

Attitude of Health Personnel↗
PubMed2005

Teaching communication skills to medical students, a challenge in the curriculum?

INTRODUCTION: As communication skills become more and more important in medical practice, the new medical curriculum at Ghent University (1999) implemented a communication curriculum. METHOD: Communication training or experiences in 'real life' settings are provided every year of the medical curriculum. The training starts with simple basic skills but gradually slips into medical communication or consultation training and results in communication in different contextual situations or with special groups of patients. Rehearsal is important and seen as inevitable. Poorly performing students get extra training. Several didactical methods are used: the skills are demonstrated by means of videotapes and paper cases of patient stories. Skills are trained in small groups (10-15 students), with focus on role-playing with colleague students or simulated patients (SP). Videotapes of real consultations give an idea of the performance of each student. Every year the students are assessed by means of an OSCE (objective structured clinical examination). CONCLUSION: After 6 years of experience with the new curriculum, several remarks and questions need to be answered. Small group training gives a huge workload and with different trainers discrepancies between groups can appear. Choosing the most suitable trainer for communication skills is not easy; several options are available: specialists in communication like psychologists with interest in medical practice, GPs with interest in medical communication, medical specialists for communication topics concerning medical problems within their domain. As the most important didactical approach lies in practising the skills, the selection and training of simulated patients remains a challenge. PRACTICE IMPLICATION: A communication continuum during the whole curriculum seems to be worthwhile. Students with specific communicative problems are detected early, remediation is provided. Rehearsal every year seems to lead to better acquisition. The most positive point is that communication is embedded in a global patient-, student- and community-oriented curriculum and that communication skills are seen as core elements of good doctoring.

Belgium↗
PubMed2001

Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting.

For life-threatening illnesses such as cancer that require a long-term treatment regimen, communication is particularly important between doctors and patients. While it is assumed that the more serious the illness, the greater the need to relieve patients' anxiety, physicians' communication styles can directly influence patients' anxiety levels. The purpose of this study was to examine the relationship between outpatients' perceptions of physicians' communication styles and the patients' anxiety levels in oncology settings. Patient anxiety level was measured using the State Trait Anxiety Inventory before and after the consultation. The Perceived Physician's Communication Style Scale was developed in this study. Analysis of responses to the scale resulted in four factors--"acceptive", "patient-centered", "attentive", and "facilitative"--of the physician's communication style and explained 63.7% of the variance. The inter-correlation for overall scale items was 0.95. Patient satisfaction with the medical encounter was also measured to validate the physician's communication style scale. Moderate correlation between the physician's communication style and satisfaction was observed and confirms the relationship between a favorable communication style and a patient's satisfaction. After the consultation, the patients' anxiety levels dropped 5.0 +/- 1.5 points (p<0.001), and the physician's communication style was shown in many cases to be linked to patient anxiety levels after the consultation. The effect of the physician's communication style on patients' post-consultation anxiety levels was small among the patients with an advanced disease status. Also, the findings showed that patients' post-consultation anxiety levels remained low even among those patients with unfavorable examination results if the patients evaluated their physician's communication style as high. This study suggested that the physician's communication style is important not only for moderating patients' anxiety, but could also be helpful for moderating physicians' own stress levels when communicating bad news to patients.

Anxiety↗
PubMed1996

Patient's experiences of communication during the respirator treatment period.

This paper reports a study of the patients' experiences of communication during the respirator treatment period (RT period) in the intensive care unit (ICU). This descriptive and exploratory study was designed to answer the question. How do respirator treated patients experience communication? Eight individuals who had experienced being treated with a respirator in two ICUs in Iceland, took part in audiotape-recorded, open interviews. They described their subjective experiences of communication during the RT period. The descriptions were analysed phenomenologically, using Colaizzi's method, described by Hycner (1985). The results revealed 57 themes within four categories, namely 'the patients' experiences of communication during the RT period', 'problems of communication experienced', 'additional problems of communication experienced' and 'nursing interventions experienced'. In this paper the themes within the categories of the patients' experiences of communication and problems of communication will be reported. The participants remembered their experience of communication clearly. The patients' experiences of communication were generally described as negative; they experienced communication as impaired, which evoked various negative emotions, and sometimes they had the feeling of giving up. Participants generally described being tired or exhausted during the intubation period. They emphasised the importance of the information and explanation provided by the nurses. The presence and support provided by family members was also valuable to them. The results add to the cumulative knowledge base of communication between nurses and patients by generating new meanings of the nature and essences of communication during the RT period from the patients' perspectives. In this article, the findings of the study are described and discussed in relation to earlier published research and clinical literature on the subject.

Adult↗
PubMed1996

Modulation of gap junctional intercellular communication by EGF in human kidney epithelial cells.

Modulation of gap junctional intercellular communication (GJIC) was studied in a multistep model of human renal epithelial carcinogenesis. We report that the majority of primary human kidney epithelial cells (NHKE) grown from fetal kidney explants did not communicate through gap junctions. Communication could, however, be observed within a subpopulation of the cells. Ni(II)-immortalized cells (IHKE) showed GJIC at a level of 10-20 communicating cells, but with heterogeneous regions on the dish, with regard to both communication and distribution of connexin43. The heterogeneity was less pronounced in a ras-transfected tumourigenic cell line (THKE), which also showed communication of approximately 10-20 dye-coupled cells. Communication within the IHKE sub-clone K7 decreased from 55 dye-coupled cells communicating on day 1 after seeding to approximately 13 in cells grown for 4 days. Daily change of growth medium reduced the decrease in GJIC. EGF enhanced communication following a lag period which depended on days in culture. The largest increase in GJIC was observed in 2-day-old cultures, where the number of communicating cells in some experiments increased from approximately 45 to 130 dye-coupled cells 4 h following change to medium with EGF. The induction was concentration dependent and communication was enhanced gradually between 2 and 7 h after exposure to EGF. A 15 min pulse of EGF was sufficient to induce the GJIC increase if the total incubation period was unchanged. Cycloheximide completely blocked the EGF-induced enhancement of communication, while actinomycin D had no effect. EGF exposure resulted in an increase in the cellular level of connexin43 protein in parallel with the enhancement in communication. Together, these results indicate that the EGF-induced enhancement of GJIC in human kidney epithelial cells was mediated through translational control of connexin43 expression.

Cell Communication↗
PubMed2006

Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance.

PURPOSE: A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient-doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area. METHODS: A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes. RESULTS: Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes. CONCLUSIONS: Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further.

Age Factors↗
PubMed2005

Unmet desire for caregiver-patient communication and increased caregiver burden.

OBJECTIVES: To examine the adequacy of caregiver-patient communication in serious illness and its relationship to caregiver burden. DESIGN: Cross-sectional cohort study. SETTING: Participants' homes. PARTICIPANTS: One hundred ninety-three persons aged 60 and older seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers. MEASUREMENTS: Communication concerns, measured in terms of agreement with statements regarding desire for and difficulty with communication about the patient's illness. Caregiver burden, measured using a 10-item subset of the Zarit Burden Inventory, with scores ranging from 0 to 40 and higher scores indicating greater burden. RESULTS: Of caregivers, 39.9% desired more communication, and 37.3% reported that communication was difficult. Of patients, 20.2% desired more communication, and 22.3% reported that communication was difficult. Disagreement regarding communication concerns was frequent in caregiver-patient pairs; of caregivers who desired more communication, 83.1% of patients did not, and of patients who desired more communication, 66.7% of caregivers did not. Caregivers who desired more communication had significantly higher caregiver burden scores than did caregivers who did not (9.2 vs 4.7, P<.001), even after adjusting for patient's diagnosis, income, and functional status and caregivers' age, sex, and relationship to the patient. CONCLUSION: A large proportion of caregivers and seriously ill older persons had an unmet desire for increased communication, although they frequently disagreed with each other about this desire. Caregivers' desire for increased communication may be a modifiable determinant of caregiver burden.

Aged↗
PubMed1991

Contact-dependent intercellular communication of bovine luteal cells in culture.

Mammalian gap junctions permit exchange of nutrients, ions, and regulatory molecules of less than 1.5 kDa among contacting communication-competent cells and may be important for regulation of luteal function and maintenance of luteal homeostasis. The present studies were designed to evaluate gap junction-mediated intercellular communication between bovine luteal cells in culture. Using a dye-coupling technique along with interactive laser cytometry, selected luteal cells were studied for the rate of contact-dependent fluorescence redistribution after photobleaching. The rate of communication, reported as the rate of fluorescence recovery (percentage per min), was determined for steroidogenic cells as follows: 1) small luteal cells contacting only small luteal cells, 2) large luteal cells contacting only small luteal cells, and 3) large luteal cells contacting only large luteal cells. In addition, the effects of known regulators of luteal function [LH, prostaglandin F2 alpha (PGF), and forskolin] on the rate of intercellular communication were determined. Small luteal cells communicated rapidly with each other, exhibiting an initial rate of fluorescence recovery of 4.1 +/- 0.1%/min (n = 187). The rate of small cell-small cell communication was unaffected by LH and PGF. For large luteal cells contacting small luteal cells, however, LH and PGF stimulated (P less than 0.02) the rate of communication compared with no hormone [1.6 +/- 0.2 (n = 18) and 1.5 +/- 0.6 (n = 20) vs. 0.8 +/- 0.3%/min (n = 27), respectively]. LH and PGF in combination, however, did not enhance the rate (0.6 +/- 0.2%/min; n = 19) of large cell-small cell communication. In contrast, forskolin significantly stimulated both small cell-small cell and large cell-small cell communication rates compared with no forskolin [34% increase (n = 48) and 50% increase (n = 23), respectively]. Large luteal cells did not communicate with each other under any condition tested. Transmission electron microscopy revealed the presence of numerous gap junction-like structures in bovine luteal cells in culture. These data suggest that luteal cells are capable of intercellular communication and that the rate of communication may be influenced by hormones. Contact-dependent intercellular communication among luteal cells may, therefore, play a significant role in the regulation of luteal function.

Animals↗
PubMedDate not supplied

Frequency, satisfaction and quality dimensions of perceived parent-adolescent communication among Chinese adolescents in Hong Kong.

Chinese adolescents (N=88) responded to instruments measuring three dimensions of parent-adolescent communication (frequency of parent-adolescent communication, satisfaction with parent-adolescent communication and quality of parent-adolescent communication) and adolescent psychological well-being (mastery and life satisfaction). Results showed that Chinese adolescents perceived sharp distinction between fathers and mothers in terms of these three dimensions: fathers were perceived to have less communication with adolescents than did the mothers; the satisfaction and quality ratings for father-adolescent communication were lower than those based on mother-adolescent communication. Results also showed that relative to the frequency of parent-adolescent communication, satisfaction with and quality of parent-adolescent communication were more strongly related to adolescent psychological well-being. Although global quality of father-adolescent communication and mother-adolescent communication were related to adolescent life satisfaction, global quality of father-adolescent communication appeared to have a stronger relationship with adolescent mastery than did mother-adolescent communication.

Adolescent↗
PubMed2004

Communication ability, method, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in the intensive care unit.

OBJECTIVE: To describe the communication ability, methods, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in an intensive care unit. METHODS: Fifty patients who received mechanical ventilation and died during hospitalization were randomly selected from all adult patients (N = 396) treated in 8 ICUs in a tertiary medical center during a 12-month period. Clinicians' notes, use of physical restraints, and medication records were reviewed retrospectively. Data on communication method, use of sedation/analgesia (within 4 hours of communication event), and use of physical restraints were recorded on an investigator-developed communication event record for the first 10 communication episodes documented in each patient's record (n = 275). Message content and method were recorded for every documented communication episode (n = 694), resulting in a total of 812 content and 771 method data codes. RESULTS: Most charts (72%) had documentation of communication by patients at some time during mechanical ventilation. Most documented communication exchanges were between patients and nurses. Primary methods of communication were head nods, mouthing words, gesture, and writing. Physical restraints were used in half of the patients. However, most of the documented communication episodes (127/202, 62.9%) occurred when physical restraints were not in use. Communication content was primarily related to pain, symptoms, feelings, and physical needs. Patients also initiated communication about their homes, families, and conditions. CONCLUSIONS: A clinically significant proportion of nonsurviving patients treated with mechanical ventilation in the intensive care unit communicate to nurses, other clinicians, andfamily members primarily through gesture, head nods, and mouthing words.

Adult↗
PubMed2006

Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview.

UNLABELLED: Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview BACKGROUND: Communication programmes are well established in nurse education. The focus of programmes is most often on communicating with patients with less attention paid to inter-professional communication or skills essential for working in specialised settings. Although there are many anecdotal reports of communication within the operating theatre, there are few empirical studies. This paper explores communication behaviours for effective practice in the operating theatre as perceived by nurses and serves as a basis for developing training. METHODS: A focus group interview was conducted with seven experienced theatre nurses from a large London teaching hospital. The interview explored their perceptions of the key as well as unique features of effective communication skills in the operating theatre. Data was transcribed and thematically analysed until agreement was achieved by the two authors. RESULTS: There was largely consensus on the skills deemed necessary for effective practice including listening, clarity of speech and being polite. Significant influences on the nature of communication included conflict in role perception and organisational issues. Nurses were often expected to work outside of their role which either directly or indirectly created barriers for effective communication. Perceptions of a lack of collaborative team effort also influenced communication. CONCLUSION: Although fundamental communication skills were identified for effective practice in the operating theatre, there were significant barriers to their use because of confusion over clarity of roles (especially nurses' roles) and the implications for teamwork. Nurses were dissatisfied with several aspects of communication. Future studies should explore the breadth and depth of this dissatisfaction in other operating theatres, its impact on morale and importantly on patient safety. Interprofessional communication training for operating theatre staff based in part on the key issues identified in this study may help to create clarity in roles and focus attention on effective teamwork and promote clinical safety.

Journal Article↗
PubMed2006

Dental nurses on perceived gender differences in their dentist's communication and interaction style.

OBJECTIVES: To investigate if dental nurses perceive gender differences in the communication and interaction style used by their dentist in general practice. METHODS: Data were collected from 64 Northern Irish dental nurses (70% response), and from 549 Dutch nurses (41% response). Respondents completed the Communication and Working Styles Questionnaire (CWSQ), a self-report questionnaire with 20 items on staff communication and working styles. Using principal component analysis, six distinguishable factors could be extracted: [1] gender-related (four items, Cronbach's alpha = 0.78), [2] friendly relation (four items, alpha = 0.66), [3] teamwork (four items, alpha = 0.44), [4] playfulness (two items, alpha = 0.69), [5] personal attention (three items, alpha = 0.60), and [6] business-like (two items, alpha = 0.32). Factors [3] and [6] were additionally analysed at item level given their low internal consistencies. RESULTS: MANOVA indicated a main effect for dentist's gender [F(6,541) = 4.649, p < 0.001], and for country [F(6,541) = 37.601, p < 0.001] on the communication style scales. No interaction effect of gender with country was found. Nurses working with a male dentist had higher scores for the 'gender-related' communications styles, whereas those working with a female dentist had higher scores for 'friendly-relation' and 'personal attention' communication styles. Dutch nurses had higher scores on 'playfulness', whereas Northern Irish nurses had higher scores on 'friendly relation' and 'personal attention' communication styles. Some additional differences were found at item level. The age of the dental nurse explained some differences in communication and working styles [F(6,541) = 2.341, p = 0.031); younger dental nurses scored significantly higher for 'gender- related' communication and working style. CONCLUSION: Gender of the dentist does influence dental nurses' perceptions of the communication styles used in the primary dental care setting. Dental nurses working with female dentists report a style predominantly characterized by 'friendly-relation' and 'personal attention', whereas those working with a male dentist report 'gender-related' communication and working styles. Given the steadily growing percentage of females entering the dental profession, it is recommended to raise both dentists' and nurses' awareness on gender influences in professional communication by introducing these topics in their respective education.

Adolescent↗
PubMed1983

Communicating nutrition to high school students in Kenya.

The success of school health programs depends upon effective communication. The characteristics of the communicator is an important component in the communication process. Research indicates that the expertise of the communicator and communicator-audience similarity are both characteristics that influence the acceptance of health information. The goal of this study was to determine which combination of expertise and similarity is most effective in improving the nutrition knowledge and attitudes of high school students in Kenya, East Africa. To examine this problem, Gusii students from Kenya received communications advocating improved nutrition from sources varying in expertise and similarity. Results of the investigation indicated that a communicator similar to his or her audience (low expert/high similar communicator) was effective in persuading the students as an expert (high expert/low similar communicator). The implications for school health programs, especially in developing countries, is that in utilizing a culturally similar, locally-trained person (low expert/high similar communicator) as a communicator source, the school is obtaining an effective communicator as well as utilizing limited resources in the most effective manner. If a culturally dissimilar person is the source of the information, then this individual would be effective only if he or she is an expert.

Adolescent↗
PubMed2003

Personalised risk communication for informed decision making about entering screening programs.

BACKGROUND: There is a trend towards greater patient involvement in health care decisions. Adequate discussion of the risks and benefits associated with different choices is often required if involvement is to be genuine and effective. Achieving adequate involvement of consumers and informed decision making are now seen as important goals for any screening programme. Individualised risk estimates have been shown to be effective methods of risk communication in general, but the effectiveness of different strategies has not previously been examined. OBJECTIVES: To assess the effects of different types of individualised risk communication for consumers making decisions about participating in screening. SEARCH STRATEGY: We searched the Cochrane Consumers and Communication Review Group specialised register (searched March 2001), MEDLINE (1985 to 2001), EMBASE (1985 to 2001), CancerLit (1985 to 2001), CINAHL (1985 to 2001), ClinPSYC (1989 to 2001), and the Science Citation Index Expanded (searched March 2002). Follow-up searches involved hand searching Preventive Medicine, citation searches on seven authors, and searching reference lists of articles. SELECTION CRITERIA: Randomised controlled trials addressing the decision by consumers of whether or not to undergo screening, incorporating an intervention with a 'personalised risk communication element' and reporting cognitive, affective, or behavioural outcomes. A 'personalised risk communication element' is based on the individual's own risk factors for a condition (such as age or family history). It may be calculated from an individual's risk factors using formulae derived from epidemiological data, and presented as an absolute risk or as a risk score, or it may be categorised into, for example, high, medium or low risk groups. It may be less detailed still, involving a listing, for example, of a consumer's risk factors as a focus for discussion and intervention. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Data about the nature and setting of the intervention, and the relevant outcome data were extracted, along with items relating to methodological quality. MAIN RESULTS: Thirteen studies were included. Personalised risk communication (whether written, spoken or visually presented) was associated with increased uptake of screening tests (odds ratio (OR) 1.5 (95% confidence interval (CI) 1.11 to 2.03). There was no evidence from these studies that this increase in uptake of tests was related to informed decision making by consumers. More detailed personalised risk communication was associated with a smaller increase in uptake of tests. That is, for personalised risk communication which used and presented numerical calculations of risk, the OR for test uptake was 1.22 (95% CI 0.56 to 2.68). For risk estimates or calculations which were categorised into high, medium or low strata of risk, the OR was 1.42 (95% CI 1.07 to 1.88). For risk communication that simply listed risk personal risk factors the OR was 1.7 (95% CI 1.17 to 2.48). Most of the included studies addressed mammography programmes. These studies showed slightly smaller effects than the overall dataset, again with numerical calculated risk estimates being associated with lower ORs for uptake of tests (OR 1.13; 95% CI 0.98 to 1.29) than the other categories of (less detailed) personalised risk communication. The four studies examining risk communication in high risk individuals showed larger odds ratios for uptake of tests than the other studies. The OR for numerical calculated risk estimates was 1.48 (95% CI 1.06 to 2.07), compared to 4.66 (95% CI 2.24 to 9.69) for categorised risk estimates and 2.64 (95% CI 1.42 to 4.9) for listed personal risk factors. There were insufficient data from the included studies to report odds ratios on other key outcomes such as: intention to take tests, anxiety, satisfaction with decisions, decisional conflict, knowledge and risk perception. REVIEWER'S CONCLUSIONS: Personalised risk communication (as currently implemented in the included studies) is associated with increased uptake of screening programmes, but this may not be interpretable as evidence of informed decision making by consumers.

Communication↗
PubMed2006

Personalised risk communication for informed decision making about taking screening tests.

BACKGROUND: There is a trend towards greater patient involvement in healthcare decisions. Adequate discussion of the risks and benefits associated with different choices is often required if involvement is to be genuine and effective. Achieving both the adequate involvement of consumers and informed decision making are now seen as important goals for any screening programme. Personalised risk estimates have been shown to be effective methods of risk communication in general, but the effectiveness of different strategies has not previously been examined. OBJECTIVES: To assess the effects of different types of personalised risk communication for consumers making decisions about taking screening tests. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1985 to December 2005), EMBASE (1985 to December 2005), CINAHL (1985 to December 2005), and PsycINFO (1989 to December 2005). Follow-up searches involved hand searching Preventive Medicine, citation searches on seven authors, and searching reference lists of articles. For the original version of this review (Edwards 2003c) we also searched CancerLit (1985 to 2001) and Science Citation Index Expanded (searched March 2002). SELECTION CRITERIA: Randomised controlled trials addressing the decision by consumers of whether or not to undergo screening, incorporating an intervention with a 'personalised risk communication element' and reporting cognitive, affective, or behavioural outcomes. A 'personalised risk communication element' is based on the individual's own risk factors for a condition (such as age or family history). It may be calculated from an individual's risk factors using formulae derived from epidemiological data, and presented as an absolute or relative risk or as a risk score, or it may be categorised into, for example, high, medium or low risk groups. It may be less detailed still, involving a listing, for example, of a consumer's risk factors as a focus for discussion and intervention. DATA COLLECTION AND ANALYSIS: Two authors independently assessed each trial for quality and extracted data. We extracted data about the nature and setting of the intervention, and relevant outcome data, along with items relating to methodological quality. We then used standard statistical methods of the Consumers and Communication Review Group to combine data using MetaView, including analysis according to different levels of detail of personalised risk communication, different condition for screening, and studies based only on high risk participants rather than people at 'average' risk. MAIN RESULTS: Twenty-two studies were included, nine of which were added in the 2006 update of this review. There was weak evidence, consistent with a small effect, that personalised risk communication (whether written, spoken or visually presented) increases uptake of screening tests (odds ratio (OR) 1.31 (random effects, 95% confidence interval (CI) 0.98 to 1.77). In three studies the interventions showed a trend towards more accurate risk perception (OR 1.65 (95% CI 0.96 to 2.81), and three other trials with heterogenous outcome measures showed improvements in knowledge with personalised risk interventions. There was little other evidence from these studies that the interventions promoted or achieved informed decision making by consumers about participation in screening. More detailed personalised risk communication may be associated with a smaller increase in uptake of tests. That is, for personalised risk communication which used and presented numerical calculations of risk, the OR for test uptake was 0.82 (95% CI 0.65 to 1.03). For risk estimates or calculations which were categorised into high, medium or low strata of risk, the OR was 1.42 (95% CI 1.07 to 1.89). For risk communication that simply listed personal risk factors the OR was 1.42 (95% CI 0.95 to 2.12). Over half of the included studies assessed interventions in the context of mammography. These studies showed similar effects to the overall dataset. The five studies examining risk communication in high risk individuals (individuals at higher risk due to, for example, a family history of breast cancer or other conditions) showed larger odds ratios for uptake of tests than the other studies (random effects OR 1.74; 95% CI 1.05 to 2.88). There were insufficient data from the included studies to report odds ratios on other key outcomes such as: intention to take tests, anxiety, satisfaction with decisions, decisional conflict, knowledge and resource use. AUTHORS' CONCLUSIONS: Personalised risk communication (as currently implemented in the included studies) may have a small effect on increasing uptake of screening tests, and there is only limited evidence that the interventions have promoted or achieved informed decision making by consumers.

Communication↗
PubMed1990

Comparative effects of phenobarbital, DDT, and lindane on mouse hepatocyte gap junctional intercellular communication.

Gap junctional intercellular communication appears to be important in the regulation of cellular homeostasis, differentiated cell functions, and growth control in adult tissues. Interruption of intercellular communication by chemical compounds has been shown to be a sublethal response to a number of tumor promoters. The mechanism by which tumor promoters inhibit intercellular communication remains unresolved. In the present study the kinetics of inhibition of mouse hepatocyte gap junctional intercellular communication (measured by dye coupling) by three well-established hepatic tumor promoters [phenobarbital, 1,1-bis(4-chlorophenyl)-2,2,2-trichloroethane (DDT), and gamma-hexachlorocyclohexane (lindane)] are compared. All three compounds inhibited intercellular communication in a time- and dose-dependent manner in both freshly plated and 24-hr-old hepatocyte cultures. Following removal of the tumor promoters from the culture medium, intercellular communication was reestablished within 0.5 hr (phenobarbital) to 1.5 hr (DDT and lindane). Prolonged treatment of hepatocytes for up to 48 hr with the three promoters resulted in the continued inhibition of intercellular communication by lindane and DDT, but the development of refractoriness to phenobarbital-induced inhibition of intercellular communication. Concomitant treatment with combinations of the three promoters showed an additive effect of the compounds on inhibition of intercellular communication. Inhibition of intercellular communication by phenobarbital was prevented by addition of the cytochrome P450 enzyme inhibitor SKF-525A. SKF-525A had no effect on the inhibition of intercellular communication induced by lindane or DDT. Coincubation of the three promoters with the cAMP analog 8-bromo-cAMP prevented the promoter-induced inhibition of intercellular communication.

Animals↗
PubMedDate not supplied

Ethics and communication between physicians and their patients with cancer, HIV/AIDS, and rheumatoid arthritis in Mexico.

BACKGROUND: Despite evidence that open communication concerning diagnosis of a disease substantially improves the doctor-patient relationship, in developing countries physicians often provide partial information. METHODS: We carried out a cross-sectional study with 379 physicians practicing at 11 hospitals in Mexico City and in the central Mexican state of Morelos to quantify their communication patterns with patients with cancer, HIV/AIDS, and rheumatoid arthritis. Communication patterns were defined as physician self-reported communication with patients with regard to their diagnosis, prognosis, and treatment. Logistic, ordinal, multivariate models were constructed for analysis. RESULTS: Assigning a high level of value to communication (odds ratio [OR] 5.5, 95% confidence interval [95% CI] 2.1-14.8), and bioethics training (OR 1.5, 95% CI 1.0-2.3) were principal predictors of explicit communication with cancer patients. We found a very strong association between explicit communication with HIV/AIDS patients and an accepting attitude of the physician toward death (OR 34.6, 95% CI 8.5-141.0). As for communication with rheumatoid arthritis patients, we observed an association between a very paternalistic attitude on the part of the physician (OR 6.8, 95% CI 1.9-24.1) and complete communication. CONCLUSIONS: In Mexico, physicians exercise power and authority over patients in an effort that they perceive as beneficial or preventing harm. In most cases, physicians do not seem to recognize or respect their patients' autonomy; therefore, communication is generally partial and vague. Our study established the need among physicians for bioethics and communication training. A discussion of this topic is necessary to transform the doctor-patient relationship and to establish a consensus for policies and norms for communication that benefits patients.

Adult↗
PubMedDate not supplied

Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study.

BACKGROUND: The inability to speak during mechanical ventilation is recognized as a terrifying and isolating experience that is related to feelings of panic, insecurity, anger, worry, fear, sleep disturbances, and stress among critically ill patients. Alternative methods of communicating with temporarily nonspeaking patients in the intensive care unit (ICU) have received little study. Although electronic voice output communication aids (VOCAs) are available for disabled children and adults, the effectiveness of VOCA systems with adult medical ICU patients who may have multisystem illness, prolonged intubation, and longer ICU stays has not been explored. OBJECTIVES: The purpose of this pilot study was to describe (1) the characteristics of intubated MICU patients who use VOCAs, (2) the usage patterns (message categories, frequency, assistance required), (3) communication quality (ease, user satisfaction), and (4) barriers to communication with VOCAs. METHODS: This pilot study used participant observation, semi-structured interviews, questionnaires, and clinical record review in a complementary design to obtain data on communication events and VOCA use with 11 critically ill adults. RESULTS: Study participants, 45.5 +/- 16.0 years of age with 13 +/- 1.9 years of education and moderately severe illness (APACHE III=27.5 +/- 16.1), used the VOCA for 5.7 +/- 4.6 days. Ease of Communication Scale measurements showed significantly less difficulty with communication after device use (t>2.62; P=.047). Almost half (n=5) of the participants demonstrated some independent use of the device. VOCAS were used in one quarter of observed communication events. Patients used VOCAs most often to communicate with family visitors and initiated communication interactions more often when VOCAs were used than when communicating by other nonvocal methods. Poor device positioning, deterioration in patient condition, staff time constraints, staff unfamiliarity with device, and complex message screens were primary barriers to VOCA use. CONCLUSIONS: This study showed that use of VOCAs is possible with selected critically ill adults and may contribute to greater ease of communication during respiratory tract intubation particularly with family members. Further clinical research using control or comparison groups is needed.

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