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PubMed1993

Communication between patients with breast cancer and health care providers. Determinants and implications.

BACKGROUND: This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. METHODS: Ninety-seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. RESULTS: A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression anger, and confusion at the 3-month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. CONCLUSION: Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

Adaptation, Psychological↗
PubMed1993

Regulation of the 12-O-tetradecanoyl-phorbol-13-acetate-induced inhibition of intercellular communication.

Effects of the tumor promoter 12-O-tetradecanoyl-phorbol-13-acetate (TPA) and protein kinase C (PKC) inhibitors on cell-cell communication were studied in a normal rat liver cell line, clone 9. Communication was observed and quantitated with microspectofluorometric and image analysis techniques following scrape-loading of the cells with lucifer yellow. Lucifer yellow migrated as far as ten cells away from the scraped edge in control populations. Two minute TPA (25-50 micrograms/ml) treatment inhibited dye movement such that the dye remained mainly in the cells at the cut edge. The TPA-induced inhibition of cell-cell communication could be partially blocked by 15 min treatment of the cell populations with the PKC inhibitors trifluoperazine (30 micrograms/ml), staurosporine (2 x 10(-8) or 2 x 10(-6) M), sangivamycin (15 or 200 microM), or a PKC inhibitor peptide (20 micrograms/ml) scraped in at the same time as lucifer yellow. Normal communication was observed in cultures treated only with PKC inhibitors. Lower concentrations of TPA (50 ng/ml-1 micrograms/ml) used for 2 min did not inhibit dye communication. Our results demonstrate the phorbol ester-induced interruption of cell-cell communication. The inhibition of PKC by inhibitors eliminates the effect of TPA on communication. Our data are consistent with a role of PKC in the control of junctional communication.

Alkaloids↗
PubMed1993

Concurrent analysis of intracellular glutathione content and gap junctional intercellular communication.

The potential for performing dual analysis of intracellular glutathione levels and assessment of gap junctional intercellular communication with thiol-specific fluorescent probes in anchored cells was evaluated. Gap junction-mediated diffusion of monochlorobimane and 5-chloromethylfluorescein diacetate following intracellular loading and conjugation with glutathione was compared with 5-carboxyfluorescein diacetate (which is routinely used in laser cytometry to monitor intercellular communication) by means of fluorescence recovery after photobleaching using a variety of communication-competent and communication-incompetent cells. The rate of diffusion of fluorescence among communication-competent cells was inversely proportional to the size of the fluorescent probe employed. The thiol-specific probes were also employed to monitor depletion and synthesis of glutathione following treatments to inhibit glutathione synthesis or consume glutathione by adduct formation. Analysis of gap junctional intercellular communication following glutathione depletion revealed a direct correlation between glutathione levels and intercellular communication. These studies support the utility of the thiol-specific probes to monitor the respective role of cellular glutathione and intercellular communication in the mechanisms of cellular injury.

Animals↗
PubMed2003

Communication options for children with hearing loss.

This article examines the communication options that are available for use within families of infants and young children who are hard-of-hearing or deaf. The need for language development, regardless of the specific communication mode, is stressed. The demands of the current environment of early identification and intervention often put families in a position of needing to decide among communication methods before they are fully knowledgeable and/or emotionally ready. Specific communication options are delineated and considered within a continuum of spoken and visual language. Available research related to early acquisition of language by infants and young children who are hard-of-hearing and deaf is reviewed; outcomes, when available, are presented for specific methods from reports of older children. Factors that influence families' decisions regarding the selection of a communication option are highlighted in the context of the existing literature. An ongoing evaluative process that respects the choices of families is advocated; a context in which change(s) in communication mode through childhood is viewed as a positive circumstance. The ultimate goal in the selection of any communication approach is to ensure that infants and young children who are hard of hearing or deaf and their families are language proficient and fluent communicators.

Child↗
PubMed1998

Exploring teenagers' accounts of bad communication: a new basis for intervention.

Interventions to enhance young people's communication are rarely based on research into adolescent communication, but take a more general, analytic, skills-based approach. This paper argues that evidence of young people's communication experiences is an important resource to inform the targeting and content of interventions, which has hitherto been overlooked. An exploratory, hypothesis-generating study of teenagers' accounts of their communication experiences was carried out. Four thousand and forty-eight adolescents aged 13-19 described a recent communication experience with (i) a family member, (ii) a friend or (iii) a non-family adult (professional or official). Self-reported bad communication experiences outweighted good ones only in adolescents' communications with adults outside the family, and there were significant variations across contexts in terms of the purposes, explanations and attributions for perceived bad communication. Implications of the research for future interventions are discussed.

Adolescent↗
PubMed1995

Compact and scattered gap junctions in diffusion mediated cell--cell communication.

Gap junctions have been thought of as prime sites for the passive communication of small molecules between two adjacent cells. The sizes of a gap junction plaque may range from a few junctional particles to several thousands particles on the interface of two cells, with little being known about the relative contribution of different patterns of junctional plaques on diffusion mediated cell--cell communication. In this paper, by constructing a simple cubic lattice model of a two-cell system, the effects on communication efficiency of two extreme distribution patterns of individual junctional particles rae investigated. This model indicates that scattered gap junctions are an order of magnitude higher in communication efficiency than compact junctional plaques of equal number of total junctional particles. Thus, it is possible that modulation of cell-cell communication may rely on the interconversion of these two states with compact plaques existing as an inactive communication form. Any correlation of gap junctional membrane with cell-cell communication should therefore also take into account its configuration. It is possible that an increase in number and area of tightly packed gap junctional plaques may actually decrease, instead of increase, cell-cell communication.

Animals↗
PubMed1986

Effects of tumor promoters, genotoxic carcinogens and hepatocytotoxins on mouse hepatocyte intercellular communication.

Intercellular communication via gap junctions may be an important mechanism of cellular growth control. Tumor promoters can inhibit intercellular communication between cultured cells, while genotoxic carcinogens apparently lack this capability. The inhibition of intercellular communication by tumor promoters may be an essential mechanism by which tumor promotion occurs in vivo. In this study, the liver tumor promoters phenobarbital, lindane (1,2,3,4,5,6-hexachlorocyclohexane, gamma-isomer), DDT (1,1-Bis[4-chlorophenyl]-2,2,2-trichloroethane), Aroclor 1254 (a polychlorinated biphenyl mixture) and dieldrin inhibited intercellular communication between male B6C3F1 mouse hepatocytes in primary culture. Intercellular communication was detected as the passage of [5-3H]uridine nucleotides from pre-labelled donor hepatocytes to non-labelled recipient hepatocytes. Mouse hepatocyte intercellular communication was also inhibited by the skin tumor promoter TPA (12-0-tetradecanoyl-phorbol-13-acetate), but not by the bladder tumor promoter saccharin. The genotoxic hepatocarcinogens dimethylnitrosamine, diethylnitrosamine, benzo[a]pyrene and 2-acetylaminofluorene, and the hepatocytotoxins bromobenzene, acetaminophen, carbon tetrachloride, chloroform and methotrexate had no effect on mouse hepatocyte intercellular communication at non-cytotoxic levels. These results suggest that the ability to inhibit mouse hepatocyte intercellular communication is an effect specific to tumor promoters.

Animals↗
PubMed1993

In situ regulation of cell-cell communication by the cAMP-dependent protein kinase and protein kinase C.

The effects of cAMP-dependent protein kinase A and protein kinase C on cell-cell communication have been examined in primary ovarian granulosa cells microinjected with purified components of these two regulatory cascades. These cells possess connexin43 (alpha 1)-type gap junctions, and are well-coupled electrotonically and as judged by the cell-to-cell transfer of fluorescent dye. Within 2-3 min after injection of the protein kinase A inhibitor (PKI) communication was sharply reduced or ceased, but resumed in about 3 min with the injection of the protein kinase A catalytic subunit. A similar resumption also occurred in PKI-injected cells after exposure to follicle stimulating hormone. Microinjection of the protein kinase C inhibitor protein caused a transient cessation of communication that spontaneously returned within 15-20 min. Treatment of cells with activators of protein kinase C, TPA or OAG for 60 min caused a significant reduction in communication that could be restored within 2-5 min by the subsequent injection of either the protein kinase C inhibitor or the protein kinase A catalytic subunit. With a longer exposure to either protein kinase C activator communication could not be restored and this appeared to be related to the absence of aggregates of connexin43 in membrane as detected immunologically. In cells injected with alkaline phosphatase communication stopped but returned either spontaneously within 20 min or within 2-3 min of injecting the cell with either the protein kinase A catalytic subunit or with protein kinase C. When untreated cells were injected with protein kinase C communication diminished or ceased within 5 min. Collectively these results demonstrate that cell-cell communication is regulated by both protein kinase A and C, but in a complex interrelated manner, quite likely by multiple phosphorylation of proteins within or regulating connexin-43 containing gap junctions.

Animals↗
PubMed2004

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness.

BACKGROUND: Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills. PURPOSE: To assess the effectiveness of different communication skills training courses for health professionals in cancer care. METHODS: We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format. RESULTS: A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals' self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15-2) and one found deterioration in the outcomes measured. CONCLUSION: Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.

Communication↗
PubMed2004

Communication training for health professionals who care for patients with cancer: a systematic review of training methods.

BACKGROUND: Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer. AIM: The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals. METHOD: We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format. RESULTS: A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals' self-report. CONCLUSIONS: The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.

Communication↗
PubMed2006

Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum.

BACKGROUND: Ineffective physicians' communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians' key communication skills, contributing to improvements in patients' satisfaction with care and physicians' professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients. CURRICULUM DESCRIPTION: The 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians' knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice. CONCLUSIONS: The BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.

Adaptation, Psychological↗
PubMed2005

Does psychological characteristic influence physicians' communication styles? Impact of physicians' locus of control on interviews with a cancer patient and a relative.

CONTEXT: Physicians' psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication. OBJECTIVE: Our aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an "external" locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an "internal" LOC (who believe that life outcomes are controlled by their own characteristics or actions). DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: Eighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative. MAIN OUTCOME MEASURES: Physicians' communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t test. RESULTS: In actual interviews, physicians with an "external" LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an "internal" LOC. In simulated interviews, physicians with an "external" LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an "internal" LOC. CONCLUSION: These results provide evidence that physicians' LOC can influence their communication styles. Physicians' awareness of this influence constitutes a step towards a tailoring of their communication skills to every patient's and relative's concerns and needs and thus towards a patient-centred communication.

Adult↗
PubMed2002

Computerized approaches to communication retraining after stroke.

Augmentative and alternative communication (AAC) strategies traditionally have been designed for individuals for whom oral speech is not a viable option. Common clinical practice has expanded AAC use to a tool for cognitive retraining or remediation. Although technologic developments offer the potential for vastly improved communication and inclusion for some individuals with severe communication disorders, technology alone does not result in successful communication. Although AAC interventions have become increasingly common across the age range, the research base underlying the design of AAC technology, intervention strategies, and treatment potential across communication disorders remains quite limited. To move beyond the traditional application of AAC strategies as a communication modality for persons with severe motor disorders to applications for persons with cognitive/linguistic disorders, three interrelated areas of research requiring further investigations are discussed. These include the following: use of AAC as a research tool to provide theoretical insights into the nature of normal and impaired language and cognition; development of AAC strategies as treatment tools to facilitate language recovery and use (production and comprehension); and studies that evaluate the efficacy of applying AAC strategies as communication modalities for individuals with acquired cognitive/linguistic communication disorders.

Clinical Trials as Topic↗
PubMed1983

The communication process in clinical settings.

The communication of information in clinical settings is fraught with problems despite avowed common aims of practitioners and patients. Some reasons for the problematic nature of clinical communication are incongruent frames of reference about what information ought to be shared, sociolinguistic differences and social distance between practitioners and patients. Communication between doctors and nurses is also problematic, largely due to differences in ideology between the professions about what ought to be communicated to patients about their illness and who is ratified to give such information. Recent social changes, such as the Patient Bill of Rights and informed consent which assure access to information, and new conceptualizations of the nurse's role, warrant continued study of the communication process especially in regard to what constitutes appropriate and acceptable information about a patient's illness and who ought to give such information to patients. The purpose of this paper is to outline characteristics of communication in clinical settings and to provide a literature review of patient and practitioner interaction studies in order to reflect on why information exchange is problematic in clinical settings. A framework for presentation of the problems employs principles from interaction and role theory to investigate clinical communication from three viewpoints: (1) the level of shared knowledge between participants; (2) the effect of status, role and ideology on transactions; and (3) the regulation of communication imposed by features of the institution.

Communication↗
PubMed1995

Health promotion in primary care: physician-patient communication and decision making about prescription medications.

To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we are interested in how communication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in enabling patients to increase control over their health involves developing their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report focuses on communication and decision making about prescription medications, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instruments were employed to collect data about physicians, patients and their consultations: a Video Analysis, which allowed assessment of actual communication behavior; a Patient Questionnaire designed to gauge perceptions of the encounter and collect demographic information; a Medical-Record Review, which provided information on utilization, diagnosis and treatment; a Telephone Interview, conducted 14 days after the consultation to obtain follow-up information (e.g. experience with the prescribed medication); and a Doctor Questionnaire that focused on attitudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering their opinion or initiating discussion about any aspect of the treatment. We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abilities to follow through with the treatment plans. The research design proved useful in highlighting discrepancies between perceived and actual communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicited patients' opinion about the prescribed medication and discussed risks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when, in fact, they had not been mentioned at all. The pattern of results illustrates the complexity of health promotion in primary care, and underscores the importance of attending to both perceived and actual communication in medical encounters.

Adolescent↗
PubMed1996

The dilemma of Saussurean communication.

A Saussurean communication system exists when an entire communicating population uses a single 'language' that maps states unambiguously onto symbols and then back into the original states. This paper describes a number of simulations performed with a genetic algorithm to investigate the conditions necessary for such communication systems to evolve. The first simulation shows that Saussurean communication evolves in the simple case where direct selective pressure is placed on individuals to be both good transmitters and good receivers. The second simulation demonstrates that, in the more realistic case where selective pressure is only placed on doing well as a receiver, Saussurean communication fails to evolve. Two methods, inspired by research on the Prisoner's Dilemma, are used to attempt to solve this problem. The third simulation shows that, even in the absence of selective pressure on transmission, Saussurean communication can evolve if individuals interact multiple times with the same communication partner and are given the ability to respond differentially based on past interaction. In the fourth simulation, spatially organized populations are used, and it is shown that this allows Saussurean communication to evolve through kin selection.

Algorithms↗
PubMedDate not supplied

Captured by details: sense-making, language and communication in autism.

UNLABELLED: The communication of people with autism spectrum disorder (ASD) is characterized by a qualitative impairment in verbal and non-verbal communication. In past decades a growing body of descriptive studies has appeared on language and communication problems in ASD. Reviews suggest that the development of formal and semantic aspects is relatively spared, whereas pragmatic skills are considered to be specifically impaired. This unique profile was interpreted mainly within the framework of the theory of mind hypothesis, which links the social-communicative problems of people with autism to an incapacity to attribute mental states to themselves and others. This approach has proven useful, but has also left many questions unanswered. In more recent publications, limited intentionality and symbol formation have been identified as core problems in ASD. Problems in symbol formation in particular might be better understood from the viewpoint of the central coherence hypothesis, which conceptualizes ASD as a weaker drive for the integration of information. Possible links between cognitive findings and communication evoke new perspectives with respect to the complex of communication problems in ASD. LEARNING OUTCOMES: The reader of this manuscript will be able to (1) describe the communication deficit in ASD; (2) discuss the central coherence account of ASD in relation to problems in sense-making; and (3) explain how these difficulties might lead to problems in communication in autism.

Autistic Disorder↗
PubMed2006

The influence of communication goals and physical demands on different dimensions of pain behavior.

The purpose of the present research was to examine the influence of communication goals and physical demands on the expression of communicative (e.g., facial grimaces) and protective (e.g., guarding) pain behaviors. Participants with musculoskeletal conditions (N=50) were asked to lift a series of weights under two communication goal conditions. In one condition, participants were asked to estimate the weight of the object they lifted. In a second condition, participants were asked to rate their pain while lifting the same objects. The display of communicative pain behaviors varied as a function of the communication goal manipulation; participants displayed more communicative pain behavior when asked to rate their pain while lifting objects than when they estimated the weight of the object. Protective pain behaviors varied with the physical demands of the task, but not as a function of the communication goals manipulation. Pain ratings and self-reported disability were significantly correlated with protective pain behaviors but not with communicative pain behaviors. The results of this study support the functional distinctiveness of different forms of pain behavior. Findings are discussed in terms of evolutionary and learning theory models of pain behavior. Clinical implications of the findings are addressed.

Adult↗