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PubMed2006

The influence of individual characteristics and contraceptive beliefs on parent-teen sexual communications: a structural model.

PURPOSE: To explore relationships between parent and teen demographic characteristics, parent beliefs about the effectiveness, safety and usability of condoms and oral contraceptives, and parent-teen sexual communication. METHODS: One thousand parents of 13-17-year-olds were surveyed. Structural equation modeling was used to test direct and indirect relationships between parent and teen characteristics, parent effectiveness beliefs, and amount of parent-teen communication about the negative consequences of sex and where to obtain birth control. RESULTS: Parent effectiveness beliefs were directly related to parent-teen communication levels. Minority, religious, politically conservative, and low income parents reported lower effectiveness beliefs than other parent groups. Low income, minority parents reported more discussion with their teens about the negative consequences of sex and where to obtain birth control than high income, White parents. Politically conservative, religious parents reported more discussion with their teen about the negative consequences of sex than their liberal and nonreligious counterparts. In general, nonreligious parents reported more discussion about where to obtain birth control than religious parents. Parents were less likely to talk with males, younger teens, and teens not believed to be romantically involved. Parent and teen gender interacted to predict the amount of parent-teen communication. CONCLUSIONS: Parent beliefs about condom and oral contraceptive efficacy, safety and usability related directly to amount of parent-teen sexual communication. Parent beliefs and communication levels varied across a number of demographic groups. Educating parent groups may result in more frequent and accurate sexual communications with their teenage children.

Adolescent↗

PubMedDate not supplied

Communication effectiveness of individuals with amyotrophic lateral sclerosis.

UNLABELLED: The purpose of this study was to examine the relationships among speech intelligibility and communication effectiveness as rated by speakers and their listeners. Participants completed procedures to measure (a) speech intelligibility, (b) self-perceptions of communication effectiveness, and (c) listener (spouse or family member) perceptions of communication effectiveness for speakers with amyotrophic lateral sclerosis (ALS). The results of this study revealed that perceptions of communication effectiveness for speakers with ALS were quite similar for the speakers and their frequent listeners across 10 different social situations. ALS speakers and their listeners reported a range of communication effectiveness depending upon the adversity of specific social situations. LEARNING OUTCOMES: (1) As a result of this activity, the participant will be able to identify social contexts that are identified by persons with ALS as difficult for effective communication. (2) As a result of this activity, the participant will be able to describe ALS symptomatology using the International Classification of Functioning, Disability, and Health. (3) As a result of this activity, the participant will be able to administer the CETI-M as a measure of communication effectiveness for persons with ALS. (4) As a result of this activity, the participant will gain information that will assist them in counseling persons with ALS and their families.

Adult↗

PubMed2006

Satisfaction with communicative participation as defined by adults with multiple sclerosis: a qualitative study.

PURPOSE: This study examined satisfaction with communicative participation as reported by adults with multiple sclerosis (MS). METHOD: Eight community-dwelling adults with MS participated in semi-structured interviews. They were asked to discuss their satisfaction with their communication in a variety of situations. Interviews were analyzed using a constant comparative method of qualitative description. RESULTS: Themes derived included: Comfort, consisting of Ease and Confidence; Success of the Outcome, including Function is Achieved and A Connection is Made; and Personal Meaning of Participation, including Personal Preferences, Comparison with the Past, and Thinking about One's Own Communication. CONCLUSIONS: Participants described multiple facets of satisfaction with communicative participation. Some of the dimensions were similar to those in existing assessment instruments such as levels of ease or difficulty with performance. Participants did not talk about frequency of activities as a key part of their satisfaction. Implications for identifying intervention targets and treatment outcome measurements are provided. LEARNING OUTCOMES: The reader should be able to: 1) define communicative participation and identify key elements of this construct; 2) identify the issues that were most relevant to satisfaction with communicative participation with participants with MS; and 3) identify reasons for greater emphasis on the subjective viewpoint of people with communication disorders in measurement of treatment outcomes.

Adult↗

PubMed2004

ATP-induced inhibition of gap junctional communication is enhanced by interleukin-1 beta treatment in cultured astrocytes.

Nucleotides are signaling molecules involved in variety of interactions between neurons, between glial cells as well as between neurons and glial cells. In addition, ATP and other nucleotides are massively released following brain insults, including inflammation, and may thereby be involved in mechanisms of cerebral injury. Recent concepts have shown that in astrocytes intercellular communication through gap junctions may play an important role in neuroprotection. Therefore, we have studied the effects of nucleotides on gap junction communication in astrocytes. Based on measurement of intercellular dye coupling and recording of junctional currents, the present study shows that ATP (10-100 microM) induces a rapid and a concentration-dependent inhibition of gap junction communication in cultured cortical astrocytes from newborn mice. Effects of agonists and antagonists of purinergic receptors indicate that the inhibition of gap junctional communication by ATP mainly involves the stimulation of metabotropic purinergic 1 (P2Y(1)) receptors. Pretreatment with the pro-inflammatory cytokine interleukin-1beta (10 ng/ml, 24 h), which has no effect by itself on gap junctional communication, increases the inhibitory effect of ATP and astrocytes become sensitive to uridine 5'-triphosphate (UTP). As indicated by the enhanced expression of P2Y(2) receptor mRNA, P2Y(2) receptors are responsible for the increased responses evoked by ATP and UTP in interleukin-1beta-treated cells. In addition, the effect of endothelin-1, a well-known inhibitor of gap junctional communication in astrocytes was also exacerbated following interleukin-1beta treatment. We conclude that ATP decreases intercellular communication through gap junctions in astrocytes and that the increased sensitivity of gap junction channels to nucleotides and endothelin-1 is a characteristic feature of astrocytes exposed to pro-inflammatory treatments.

Adenosine Diphosphate↗

PubMed2005

Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study.

OBJECTIVE: This article describes the approach taken over the past 16 years by one large healthcare organization, Kaiser Permanente (KP), to enhance the clinical communication and relationship skills of their clinicians. METHODS: The centerpiece of KP's approach has been the creation and dissemination of a unifying clinician-patient communication (CPC) framework for teaching and research called the Four Habits Model. RESULTS: The Model has served as the foundation for a diverse array of KP programs. Sustained improvement in patient satisfaction scores has been demonstrated. Clinician-patient communication training has become a well-established component of professional development in KP. DISCUSSION: Enhancing clinicians' communication with patients is a complex task requiring planning and organizational commitment. Factors that have contributed to the success and lessons learned from incorporating clinician communication skills across the organization are described. CONCLUSION: The KP experience attests to the feasibility of bringing the vital skills of effective communication to large numbers of busy clinicians. PRACTICE IMPLICATIONS: Healthcare practices wishing to enhance clinician-patient communication skills should consider using a consistent teaching model, ensuring strong sponsorship from leaders, and emphasizing clinician satisfaction in the design of programs.

California↗

PubMed2005

'She gave it her best shot right away': patient experiences of biomedical and patient-centered communication.

OBJECTIVE: Medical educators and researchers recommend a patient-centered interviewing style, but little empirical data exists regarding what aspects of physician communication patients like and why. We investigated patient responses to videotaped doctor-patient vignettes to ascertain what they liked about patient-centered and biomedical communication. METHODS: We conducted semi-structured interviews with 230 adult medicine patients who viewed videotapes depicting both patient-centered and biomedical physician communication styles. We used a mixed methods approach to derive a "ground-up" framework of patient communication preferences. RESULTS: Respondents who preferred different communication styles articulated different sets of values, important physician behaviors, and physician-patient role expectations. Participants who preferred the patient-centered physician (69%) liked that she worked with and respected patients and explored what the patient wanted. Participants who preferred the biomedical physician (31%) liked that she prevented harm, demonstrated medical authority, and delivered information clearly. CONCLUSIONS: Patients like (and dislike) patient-centered communication for thoughtful, considered reasons that appear grounded in their values and expectations about physicians, patients, and the clinical encounter. PRACTICE IMPLICATIONS: Better understanding the diversity of patient communication preferences may lead to more effective and individualized care.

Adult↗

PubMed2005

Core assumptions and research opportunities in clinical communication.

OBJECTIVE: Contemporary clinical communication teaching and research reflect the axiomatic importance of building a clinical relationship and of empowering patients as partners. The apparent moral unassailability of these principles has inhibited their scientific scrutiny. By questioning this current hegemony in communication teaching and research, our objective is to identify research opportunities that remain to be fully exploited. METHOD: We identify assumptions in current communication literature and evaluate them from the perspective of relevant empirical and theoretical literature. FINDINGS: The view that the clinical relationship is an objective thing which needs to be 'built' can lead researchers to neglect factors within patients that influence their subjective sense of the relationship. The model of partnership is hard to reconcile with patients' vulnerability and associated dependency needs. The widespread use of the term 'communication skills' emphasises processes at a skill level at the expense of those at levels of cognition, emotion, and value. CONCLUSION: Research is needed into: the extent to which patients' sense of relationship arises from factors outside the relationship; the implications of their vulnerability and dependency for clinical relationships; and the processes at the level of cognition, emotion and value, as well as skill, that are entailed in clinical communication and in communication teaching. RESEARCH AND PRACTICE IMPLICATIONS: Pursuing the research opportunities that we have identified will enhance the theoretical validity and practical relevance of clinical communication research and teaching.

Communication↗

PubMed2005

Enhancing parent-provider communication in ambulatory pediatric practice.

OBJECTIVE: To address the need for interventions to enhance parent-provider communication, the present study evaluated the effectiveness of a brief intervention to enhance interpersonal communication skills by pediatric and internal medicine/pediatric residents with parents of children seen in ambulatory practice. METHODS: In a within-subjects, repeated measures research design, residents (N=28) participated in a 1-112h intervention designed to increase the use of effective communication skills with their patients' families (N=92). Three pediatric visits (one prior to and two following the intervention) were audio-taped and coded using Roter's Interaction Analysis System. Parents' perceptions of residents' communication skills and satisfaction with care were gathered. RESULTS: Residents used more effective interpersonal communication skills following the intervention (p<.05). Parent satisfaction with care also increased (p<.01) with parents reporting greater satisfaction with distress relief (p=.01) and communication following the intervention (p=.05). However, parents' perceptions of resident communication did not change over time. CONCLUSION: These findings suggest that a relatively brief intervention shows promise in improving the quality of care provided within a pediatric ambulatory care setting. PRACTICE IMPLICATIONS: Training residents to increase their use of praise, empathy, and collaboration with families can be done within a brief intervention and may be associated with increased parental satisfaction with care.

Adult↗

PubMed2026

Evaluating a culturally adapted question prompt list to improve end-of-life communication among indonesian migrant caregivers: A randomized controlled trial with qualitative insights.

OBJECTIVE: Indonesian caregivers serve as essential providers of end-of-life (EOL) care in Taiwan. But often face communication challenges due to language, cultural, and hierarchical barriers. This study evaluated the effectiveness of a culturally adapted Question Prompt List (QPL). METHODS: This study employed a two-arm randomized controlled trial design supplemented with qualitative interviews. The study was conducted in a hospice ward and home care setting within a medical center in Taiwan. A total of sixty Indonesian caregivers were recruited and randomly assigned to either the intervention group (n = 30) or the control group (n = 30). The intervention group received routine end-of-life (EOL) education along with a culturally adapted Question Prompt List (QPL), which consisted of 37 items covering domains including the dying process, emotional support, communication, symptom management, and care decision-making. The control group received routine EOL education. Outcome measures included caregiving preparedness, communication self-efficacy, satisfaction, and question-asking behavior. In addition, semi-structured interviews were conducted with eight participants, and the data were analyzed using thematic content analysis. RESULTS: Analysis of covariance revealed no statistically significant between-group differences in caregiving preparedness (F = 1.58, p = .215 [-0.41, 0.44]) or communication selfefficacy (F = 0.83, p = .366 [-0.44, 0.79]). However, communication satisfaction was significantly higher in the intervention group (F = 4.19, p < .05 [0.04, 0.44]). The number of questions asked was also significantly higher in the intervention group (t = -4.35, p < .001 [-5.41, -1.98]). Thematic analysis of qualitative data identified 4 themes and 14 subthemes, illustrating how the QPL reduced anxiety, clarified care needs, and improved confidence. CONCLUSIONS: A culturally adapted QPL can enhance communication engagement and satisfaction among migrant caregivers. PRACTICE IMPLICATIONS: Integrating culturally tailored QPLs into caregiver education and palliative care practice may promote more inclusive and effective communication.

Humans↗

PubMedDate not supplied

Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

Attitude of Health Personnel↗

PubMed1976

Communication and spatial relationships in a colony of common grackles.

Most communication among common grackles Quiscalus quiscula occurs at distances of less than a few metres in the noisy environment of a breeding colony. This report examines both the adaptations of communication to these conditions and the effects of communication in regulating individual's spatial relationships. For each of six vocalizations and five action patterns studied in one colony, I consider variation in the form of the display, the circumstances associated with its use, and the responses it elicits. Each individual, male or female, has one characteristic, stereotyped song pattern that would facilitate individual recognition between mates. Variation in the components of vocalizations and action patterns is of two kinds: unidimensional, with either covarying or nested components, or multidimensional, with independently varying components, alternatives that have different implications for communication. The wide-spectrum sounds made by common grackles offer advantages in close-range communication in colonies, because the ease of locating such signals would minimize the cocktail-party effect, although they would have disadvantages in long-range communication. Most vocalizations of common grackles lack assocations with specific responses or external contexts, a situation that should often characterize short-range communication between acquainted individuals. The responses to vocalizations vary with context, especially the initial spatial relationships and identities of the interactors.

Animal Communication↗

PubMed2002

The effects of communication modes on performance and discourse organization with an adaptive interface.

This paper reports a study of different communication patterns on performance with a simulated adaptive interface that created the impression of a talking and listening computer which would help participants solve problems with a computer. There were four levels of communication modes which differed in the restrictions placed on human-computer communication. Dependent measures included tasks completed per minute as well as participants' utterances, which were assessed for verbosity, disfluencies, and indices of common ground. The largest performance differences were found between the groups that could communicate freely and those where communication was restricted or denied. As restriction increased, performance decreased. Further, as restriction increased, the computer assumed greater control and verbosity decreased. Performance on the simple tasks declined as communication restriction increased, but no differences were observed for complex tasks. The results are discussed with respect to differences between human-human and human-computer communication as well as research on adaptive environments.

Analysis of Variance↗

PubMed2002

Gap junction-mediated intercellular communication in ischemic preconditioning.

Gap junction-mediated communication can modulate cell death in different tissues. In myocardium, gap junction communication is altered during ischemia, which contributes to the development of arrhythmias, but still allows synchronization of the onset of rigor contracture in the progression of injury. During reperfusion, gap junction communication allows cell-to-cell spread of hypercontracture and cell death. Since the intracellular signal transduction systems involved in modulation of gap junction-mediated communication are activated during ischemic preconditioning, the hypothesis can be raised that gap junctions are end-effectors of preconditioning contributing to its protective effect on cell death. This paper reviews the available information supporting this hypothesis. It has been shown that ischemic preconditioning may influence gap junction-mediated intercellular communication by activation of different kinases, including PKC and MAPK cascades, and by preservation of cGMP among other mechanisms. Connexin phosphorylation by PKC, p38/MAPK, and PKG, tends to reduce intercellular communication. This effect of ischemic preconditioning seems to have no relevant consequences during prolonged ischemia, and does not significantly modify the time course of either electrical uncoupling or the frequency or temporal distribution of ventricular arrhythmias during this period. However, any modification of gap junction communication during initial reperfusion could contribute to the reduced extent of hypercontracture and cell death observed in preconditioned hearts. The potential role of gap junctions as effectors of ischemic preconditioning against lethal injury secondary to ischemia-reperfusion deserves to be investigated in depth.

Animals↗

PubMed2001

Communication between members of the cardiac arrest team--a postal survey.

AIMS: Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. METHOD: A questionnaire on cardiac arrest team composition, leadership, communication and debriefing was distributed nationally to Resuscitation Training Officers (RTOs) and their responses analysed. RESULTS: One hundred and thirty (55%) RTOs replied. Physicians and anaesthetists were the most prominent members of the team. The Medical Senior House Officer is usually nominated as the team leader. Eighty-seven centres (67%) have no communication between team members prior to attending a cardiopulmonary arrest. In 33%, communication occurs but is either informal or fortuitous. The RTOs felt that communication is important to enhance team dynamics and optimise task allocation. Only 7% achieve a formal debrief following a cardiac arrest. CONCLUSION: Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.

Communication↗

PubMed2004

Pediatrician-parent-child communication: problem-related or not?

Pediatricians are generally confronted with a variety of health problems. Each of these problems may benefit from another pattern of healthcare communication. It is unknown whether the communication process during pediatric visits actually differs by the nature of the child's problem. This study first examined whether three formerly identified communication patterns could be distinguished within real-life pediatric outpatient encounters (N=846). Then, communication patterns during encounters with children with respiratory (n=269) or behavioral problems (n=77) were compared. Videotaped visits were observed using the Roter Interaction Analysis System. Two-level multivariate logistic regression analysis examined what factors contributed to the communication patterns. A biopsychosocial communication pattern was observed in 45%, a psychosocial in 15% and a biomedical pattern in 40% of the visits. Child's age and pediatrician's experience were related to the communication pattern. Different patterns did indeed prevail in respiratory and behavioral problems. As less experienced pediatricians attend to psychosocial issues less, they may have to be specifically encouraged to do so.

Age Factors↗

PubMed2003

Consumer/provider communication research: directions for development.

Communication between health care providers and consumers is a critical part of effective health care delivery. Yet, the strategic use of interpersonal communication in health care delivery is most complex, multifaceted, and often problematic, necessitating careful study of the communication process in health care to increase understanding and help improve health communication practices. The National Cancer Institute (NCI) sponsored an expert symposium on consumer/provider communication research to examine progress and identify gaps in the research literature on doctor/patient communication. This paper and this special issue of Patient Education and Counseling reviews several of the key perspectives and suggestions presented at the symposium for directing future research and applications concerning consumer/provider communication.

Communication↗

PubMed2000

Communicator styles of hospital patients during nurse-patient counseling.

This article describes nurse-patient communication during counseling sessions. It focuses on the patient as a participant in a discussion and aims at a description of patients' communicator styles, which were observed on videotape based on 38 counseling sessions transcribed word by the word. Interviews of the participating nurses and patients were used for partial support of the interpretations. The analytic method chosen was typology, and it has been used for achieving a multifaceted qualitative description of patient communication. The research material yielded seven types of communicator styles: Quietly Assenting, Emotionally Expressive, Storyteller, Stoic Observer, Inquisitive of Detail, Dominant, and Critical Self-observer. The communicator styles were indicative of the multitude of ways in which patients participate in counseling discussions and they make it possible to describe the varying expressions of patient communication. This article presents new background information on patient communication and the outcome may prove to be useful for developing health counseling.

Adolescent↗

PubMed2003

Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus.

The maintenance of intellectual activity is an important area in the "good death" concept. To clarify the communication capacity levels of terminally ill cancer patients in their final week, and to identify factors contributing to the development of communication capacity impairment and agitated delirium, a retrospective study was performed on 284 consecutive hospice inpatients. The data were collected by chart review, and two independent raters measured the degree of communication capacity and agitation in the last week, using multiple items from the Memorial Delirium Assessment Scale, the Communication Capacity Scale, and the Agitation Distress Scale. The percentages of patients who could achieve complex communication were 43%, 28%, and 13% at 5 days, 3 days, and 1 day before death, respectively. Agitated delirium was identified in 20%. Patients receiving opioids at a dose of > or =120 mg oral morphine equivalents/day one week before death were significantly unable to communicate clearly 3 days before death (0.48 [0.28-0.84], P=0.011). Male gender and the presence of icterus were identified as significant contributors to the development of agitated delirium (odds ratios [95% C.I.]=2.6 [1.4-5.0], P<0.01; 2.4 [1.3-4.4], P< 0.01). These findings demonstrate that communication capacity impairment and agitated delirium are frequently observed in terminally ill cancer patients, and are significantly correlated with a higher dose requirement of opioids and the presence of icterus. To explore the best management to maintain the intellectual activity of dying patients, research should focus on a homogeneous sample of patients receiving high-dose opioids and those with hepatic encephalopathy. In the meanwhile, clinicians should educate patients and family members about the nature of the dying process and help facilitate the completion of life purposes requiring complex mental activities before the latest stages of cancer.

Aged↗