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PubMed1996

Communication disturbances in schizophrenia and mania.

BACKGROUND: A "natural language" measure was developed for classifying type and severity of communication disturbance in the speech of psychotic patients by assessing their linguistic reference performance. METHODS: This measure was applied to speech samples of schizophrenic, manic, and nonpsychiatric subjects, and the groups were compared on levels and types of communication failures. RESULTS: The speech of the schizophrenic and manic subjects contained much higher frequencies of each of six types of communication failures than did the speech of the control subjects. Proportions of the different types of unclarity differed among the diagnostic groups. CONCLUSIONS: This method provides a measure of overall severity of communication disturbance, discriminates the speech of schizophrenic and manic subjects from that of nonpsychiatric subjects, and reflects some differences in distribution of types of communication failure in schizophrenic vs manic patients. The measure may be helpful in elucidating cognitive weaknesses underlying psychotic communication failures.

Adult↗
PubMed2004

Communicating evidence for participatory decision making.

CONTEXT: Informed patients are more likely to actively participate in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment; however, currently there are no evidence-based guidelines for discussing clinical evidence with patients in the process of making medical decisions. OBJECTIVE: To identify ways to communicate evidence that improve patient understanding, involvement in decisions, and outcomes. DATA SOURCES AND STUDY SELECTION: Systematic review of MEDLINE for the period 1966-2003 and review of reference lists of retrieved articles to identify original research dealing with communication between clinicians and patients and directly addressing methods of presenting clinical evidence to patients. DATA EXTRACTION: Two investigators and a research assistant screened 367 abstracts and 2 investigators reviewed 51 full-text articles, yielding 8 potentially relevant articles. DATA SYNTHESIS: Methods for communicating clinical evidence to patients include nonquantitative general terms, numerical translation of clinical evidence, graphical representations, and decision aids. Focus-group data suggest presenting options and/or equipoise before asking patients about preferred decision-making roles or formats for presenting details. Relative risk reductions may be misleading; absolute risk is preferred. Order of information presented and time-frame of outcomes can bias patient understanding. Limited evidence supports use of human stick figure graphics or faces for single probabilities and vertical bar graphs for comparative information. Less-educated and older patients preferred proportions to percentages and did not appreciate confidence intervals. Studies of decision aids rarely addressed patient-physician communication directly. No studies addressed clinical outcomes of discussions of clinical evidence. CONCLUSIONS: There is a paucity of evidence to guide how physicians can most effectively share clinical evidence with patients facing decisions; however, basing our recommendations largely on related studies and expert opinion, we describe means of accomplishing 5 communication tasks to address in framing and communicating clinical evidence: understanding the patient's (and family members') experience and expectations; building partnership; providing evidence, including a balanced discussion of uncertainties; presenting recommendations informed by clinical judgment and patient preferences; and checking for understanding and agreement.

Communication↗
PubMed1996

Gap-junctional communication in normal and neoplastic prostate epithelial cells and its regulation by cAMP.

Gap-junctional communication and expression of gap junction-forming proteins were investigated in normal human prostate epithelial cells and in several malignant prostate cell lines. In comparison with normal cells, gap-junctional communication in malignant cells, as assayed by the transfer of 443-Da fluorescent tracer Lucifer yellow, was either reduced or not detected. Malignant cells expressed mRNA transcripts for connexin (Cx) 43, whereas normal cells expressed mRNA transcripts for Cx32 and Cx40. In both normal and malignant cells, gap-junctional communication was enhanced twofold to fivefold by treatment with forskolin, an agent known to increase intracellular levels of cAMP. Immunocytochemical staining with a Cx43-specific antibody revealed that in malignant cells this enhancement correlated with the number of gap junctions and occurred without any qualitative or quantitative alteration in Cx43 mRNA or protein. Moreover, western blot analyses showed that both control and forskolin-treated malignant cells expressed only one form of Cx43. Our data suggest that gap-junctional communication in both normal and malignant prostate cells may be regulated by hormones that work via a cAMP-dependent signal transduction pathway. Thus, both normal and malignant cells offer a new experimental model system in which interactions between a hormonal form of cellular communication and intercellular communication mediated via gap junctions can be studied.

Calcium-Binding Proteins↗
PubMed1984

A non-supervised training program for Carkhuff's discrimination and communication skills and its effects upon the reactions of others during brief interactions.

Used Carkhuff's Indices of Communication and Discrimination along with other measures to assess the level of communication and discrimination skills at various stages of communication training. Ss were 14 male and 9 female students in a psychology of adjustment class. Results indicated that: (a) treatment and control groups did not differ in communication skills before they went through training; (b) the treatment group offered higher levels of communication skill after it had completed training than did the control group before it began training; (c) the control group offered levels of communication skill equal to those of the treatment group once the control group also had completed training. A similar pattern was found for discrimination skill. The effects of training cannot be dismissed as paper-and-pencil artifacts because others who were ignorant of the growth conditions concept reacted differently in brief unstructured interactions to those who had completed training.

Adult↗
PubMed2003

Communication skills training for health care professionals working with cancer patients, their families and/or carers.

BACKGROUND: Research suggests communication skills do not reliably improve with experience and considerable effort is dedicated to courses improving communication skills for health professionals. The evaluation of such courses is of importance to enable evidence-based teaching and practice. OBJECTIVES: To assess whether communication skills training is effective in changing behaviour of health professionals in cancer care with regard to communication/interaction with patients. SEARCH STRATEGY: We searched CENTRAL (Cochrane Library Issue 3 2001), MEDLINE (1966 to November 2001), EMBASE (1980 to November 2001), PsycInfo (1887 to November 2001), CINAHL (1982 to November 2001), AMED (1985 - October 2001), Dissertation Abstracts International (1861 to March 2002) and EBM Reviews (1991 to March/April 2001). Reference lists of relevant articles were searched. SELECTION CRITERIA: Randomized controlled trials or controlled before and after studies of communication skills training in cancer health professionals, measuring changes in behaviour/skills using objective and validated scales. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Although 2822 references were considered, only two trials involving 232 health professionals were included. One provided an intensive three-day course then assessed oncology doctors interacting with a total of 640 patients; the other provided a modular course then used role plays with oncology nurses for skill assessment. In one trial, course attendees used more focused questions (34% increase, probability < 0.005), focused and open questions (27% increase, p = 0.005), expressions of empathy (69% increase, p < 0.005) and appropriate responses to cues (38% increase, p < 0.05) at follow up than non-attendees. No significant differences were found between attendees and non-attendees in use of leading questions. From baseline to follow up in the same study, attendees had significantly different changes in rates of leading questions (relative risk 0.72, p < 0.05), focused questions (Relative Risk 1.25, p < 0.005), open questions (RR 1.17, p < 0.05) and empathy (RR 1.50, p = 0.005). The only significant difference in observed communication skills in the second trial was that the trained group were more in control of the follow-up interview than the untrained group (p < 0.05). Both studies investigated differences in summarising, interrupting and checking but found none. REVIEWER'S CONCLUSIONS: The training programmes assessed by these trials appear to be effective in improving cancer care professionals communication skills. It is not known whether the training would be effective if taught by other educators, nor has any trial compared the efficacy of both programmes.

Caregivers↗
PubMed1985

Person-to-person communication in an applied research/service delivery setting.

Data from a national survey (n = 1666) of researchers, practitioners, and policymakers in the field of rural mental health services were used to conduct a sociometric analysis of person-to-person communication in the field. This article describes the structure of the person-to-person communication network in terms of its connectedness, centrality, homogeneity, and differentiation. Despite the diversity of survey respondents, and apparently meager interorganizational communication, communication in he field is similar, in many respects, to that observed in "invisible colleges." While the probability of two randomly chosen individuals being in contact is low (0.0008), over 70% were connected indirectly. The person-to-person communication network is also highly centralized and exhibits higher than expected communication among respondents in the same professional role, type of work organization, and geographical region. It does not appear to be highly differentiated with respect to topic, since the majority of information providers are contacted with respect to a number of topics.

Analysis of Variance↗
PubMed2005

Factors that influence physicians' detection of distress in patients with cancer: can a communication skills training program improve physicians' detection?

BACKGROUND: No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians' ability to detect distress in patients with cancer. METHODS: First, the authors used a randomized design to assess the impact, on physicians' ability to detect patients' distress, of a 1-hour theoretical information course followed by 2 communication skills training programs: a 2.5-day basic training program and the same training program consolidated by 6 3-hour consolidation workshops. Then, contextual, patient, and communication variables or factors associated with physicians' detection of patients' distress were investigated. After they attended the basic communication skills training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Interviews with a cancer patient were recorded before training, after consolidation workshops for the group that attended consolidation workshops, and approximately 5 months after basic training for the group that attended basic training without the consolidation workshops. Patient distress was recorded with the Hospital Anxiety and Depression Scale before the interviews. Physicians rated their patients' distress on a visual analog scale after the interviews. Physicians' ability to detect patients' distress was measured through computing differences between physicians' ratings of patients' distress and patients' self-reported distress. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: Fifty-eight physicians were evaluable. Repeated-measures analysis of variance showed no statistically significant changes over time and between groups in physicians' ability to assess patient distress. Mixed-effects modeling showed that physicians' detection of patients' distress was associated negatively with patients' educational level (P = 0.042) and with patients' self-reported distress (P < 0.000). Mixed-effects modeling also showed that physicians' detection of patient distress was associated positively with physicians breaking bad news (P = 0.022) and using assessment skills (P = 0.015) and supportive skills (P = 0.045). CONCLUSIONS: Contrary to what was expected, no change was observed in physicians' ability to detect distress in patients with cancer after a communication skills training programs, regardless of whether physicians attended the basic training program or the basic training program followed by the consolidation workshops. The results indicated a need for further improvements in physicians' detection skills through specific training modules, including theoretical information about factors that interfere with physicians' detection and through role-playing exercises that focus on assessment and supportive skills that facilitate detection.

Communication↗
PubMed2001

Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet.

The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia. 30 informal carers were allocated to the workshop sessions and 15 to the booklet. Outcome measures included awareness of communication strategies; perceived frequency of communication breakdown at home, and the associated level of distress; general stress; and consumer satisfaction. At six week follow-up, the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group. Both groups reported some reduction in the frequency of communication problems at home, and a reduction in the associated level of distress. The frequency of other problem behaviours remained stable. Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner.

Activities of Daily Living↗
PubMed1984

Inhibition of cell communication between Balb/c 3T3 cells by tumor promoters and protection by cAMP.

The effect of phorbol ester tumor promoters on the communication between individual cells in confluent culture was studied using a fluorescent dye transfer method. Cell-cell communication between mouse Balb/c 3T3 cells and between Chinese hamster V79 cells was inhibited almost completely by tumor-promoting phorbol esters, but not by nonpromoting derivatives; the effect was reversed upon removal of the promoter. Intercellular communication between Balb/c 3T3 cells, but not Chinese hamster V79 cells, was increased significantly in the presence of dbcAMP and caffeine, and these compounds counteracted the effects of tumor promoters. Inhibition of cell communication by phorbol esters appears to be receptor-mediated, since specific binding of 3H-phorbol-12,13-dibutyrate to Balb/c 3T3 cells was inhibited only by compounds that also inhibit intercellular dye transfer. A study with cycloheximide suggests that the reversible inhibition of intercellular communication by phorbol esters may not need de novo protein synthesis, while upregulation of communication by cAMP requires protein synthesis.

Animals↗
PubMedDate not supplied

Improving communication of drug risks to prevent patient injury: proceedings of a workshop.

PURPOSE: The Centers for Education & Research on Therapeutics (CERTs) is conducting a series of workshops on managing the risks of therapeutics, with the ultimate goal to develop an agenda for research and education about risk and its management. This paper presents the results of the first workshop in the series, a 2-day meeting focused on communication of drug risks to healthcare professionals and patients. METHODS: The 50 workshop participants represented the medical-products industry, academia, consumer groups, regulatory bodies and the media. Together, they sought to identify and understand barriers to successful risk communication, to identify tools or methods that could improve risk communication, and to develop research and education agendas that would lead to better risk communication in the future. RESULTS: Limitations of current methods of risk communication were identified, and research and education agendas were proposed to clarify and resolve these issues. CONCLUSION: Common themes for potential solutions include enhanced education of healthcare providers, increased motivation of patients and families, use of creative communication technologies, and better organization of and access to medical records and information.

Communication↗
PubMedDate not supplied

Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives.

The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease.

Adult↗
PubMedDate not supplied

Long term benefits of communication skills training for cancer doctors.

OBJECTIVE: To assess satisfaction and learning accomplishments after communication skills training courses for cancer doctors in the Nordic countries. METHOD: 155 physicians from the five Nordic countries participated in a communication skills training course. Questionnaires were completed at baseline, at course completion and at follow-up after 2 to 6 years. RESULTS: 94% of the physicians indicated satisfaction with the course. Physicians who had participated in the whole course (as opposed to those who had participated only in parts of the course) and physicians from Denmark and Sweden were most satisfied with the course. Whereas physicians at baseline most frequently reported a need to learn specific aspects of communication, often with emphasis on psychiatric problems, at follow-up they most typically reported that they had learnt basic communication skills (i.e. to listen and to pose open-ended questions). The majority of the physicians reported at follow-up that they applied the learnt skills to patient-related work, in relation to colleagues and on a personal level. CONCLUSION: Communication skills courses for senior clinicians with no previous formal training in this field should emphasise basic communication skills as well as the handling of difficult situations in doctor-patient interaction.

Adult↗
PubMed2005

Good communication with patients receiving bad news about cancer in Japan.

PURPOSE: Despite a recent increase in the attention given to improving communication when disclosing bad news to cancer patients, understanding of good patient-physician communication is still lacking in Japan. The aim of the present study is to describe attributes of good communication with patients receiving bad news about cancer in Japan. METHODS: Forty-nine participants, including 42 cancer patients and seven oncologists, were requested to undergo an in-depth interview, and the data obtained were qualitatively analyzed. RESULTS: Seventy-one attributes of good communication with patients receiving bad news about cancer were obtained from 619 opinions, and classified into four domains. (1) SETTING: a private room and sufficient time. (2) Information given: impact on daily activities and alternative therapy. (3) Method of disclosure: facilitation of patient understanding. (4) Emotional support: encouragement and allowing expression of emotions. CONCLUSIONS: The four domains of good patient-physician communication in Japan are apparently similar to those in Western countries. The domain involving information given and method of disclosure in previous Western studies was further divided into two domains in the present study. Japanese physicians should perhaps pay careful attention to these issues when disclosing bad news about cancer. There are some cultural differences related to the details of communication attributes (e.g. using euphemisms and showing consideration for the patient's family).

Adult↗
PubMed1995

Hepatocyte growth factor inhibits intercellular communication via gap junctions in rat hepatocytes.

We demonstrated that HGF reduces gap junctional intercellular communication of rat hepatocyte doublets and increases cell spreading. Intercellular communication via gap junctions was markedly reduced in hepatocyte doublets with HGF (20 ng/ml) 3-12 hr after inoculation. Immunocytochemistry revealed spotty localization of connexin 32 on the plasma membrane of 3-hr cultured control hepatocyte doublets, whereas HGF-treated doublets showed significantly less connexin 32 staining. Genistein maintained intercellular communication in the presence of HGF, indicating that HGF reduces intercellular communication by down regulation of connexin 32 through the c-met/HGF receptor-tyrosine-kinase-mediated pathway. Furthermore, TGF-beta 1 maintained intercellular communication in the presence of HGF. Regulation of intercellular communication in hepatocytes by HGF and TGF-beta 1 might play an important role during liver regeneration.

Analysis of Variance↗
PubMed2000

Students' perceptions of parent-adolescent closeness and communication about sexuality: relations with sexual knowledge, attitudes, and behaviors.

The main goal of this study was to explore how parent-adolescent closeness and communication about sexuality were associated with three aspects of adolescent sexuality (sexual knowledge, attitudes and behaviors). Participants were 157 boys and girls in grades 9 to 12 from two suburban high schools in the Midwest. Canonical correlation analyses revealed two significant combinations of variables. First, younger age and less maternal and paternal communication were related to less sexual behavior and less sexual knowledge. Second, being younger and female and receiving less maternal communication was related to less sexual knowledge and more conservative attitudes. Contrary to expectation, higher levels of parental closeness in conjunction with parental communication did not have a significant influence on these adolescents' sexuality. Given the importance of both age and parental communication in predicting adolescent's sexuality in this study, implications concerning the timing of communication become evident.

Adolescent↗
PubMed1994

Communicating a drug alert. A case study on acitretin in The Netherlands.

In October 1990, a recall procedure was initiated for the teratogenic drug acitretin, and the recommended post-therapy contraception period after acitretin therapy was extended from 2 months to 2 years due to the possibility of its conversion to the lipophilic compound etretinate. The aim of the present study was to evaluate the communication procedures and their effects as a drug alert from the health authorities, the pharmaceutical company and professional associations of health professionals to the population at risk. A model was used to evaluate communication between three hierarchical levels. Data were obtained via semi-structured interviews and structured questionnaires. Communication procedures were evaluated according to channel characteristics and by analysis of their contents. The effect was measured as whether the drug dispensers identified acitretin users, contacted physicians, and whether physicians communicated in person with the population at risk. The penetration of direct mail from the health authorities and from the pharmaceutical company ranged from 97-98% and 65-94% at Level 2 (health professionals). The population at risk was informed via personal communication with health professionals, and/or the mass media. Of the women at risk, 19% were contacted by a dermatologist, 30% by their GP, and 39% by the pharmacist. 35% was never informed by any health professional. The Dutch health care system is adequately equipped for effective communication between health authorities, pharmaceutical industry and health professionals.(ABSTRACT TRUNCATED AT 250 WORDS)

Acitretin↗
PubMed1988

An evaluation of a communications training program within a self-help group for sexually abusive families.

Remediating the dysfunctional communications patterns of sexually abusive families is an important step in treating them. No communications training program for such families has been evaluated, however. This paper describes an evaluation of a communications training program carried out within the context of a self-help group for sexually abusive families. Group members were randomly assigned to receive an eight-week communications training program or to continue participating at self-help meetings. No group differences were apparent on a preintervention communications questionnaire, but the posttraining scores of experimental subjects were higher than controls. Experimental subjects maintained these scores upon follow-up and the scores of controls increased when the program was administered to them by a student therapist. It is suggested that the procedures and findings of this study contribute to the community mental health field by a) underscoring communications concepts that are helpful to abusive families; b) modeling a novel design for evaluating interventions that includes self-help participation as a nonspecific treatment; and c) illustrating the value of collaborative efforts between self-help groups and human services providers when they serve their mutual interests.

Adult↗
PubMed1988

Perceptions of communication, cohesion, and adaptability in families of adolescents with and without learning handicaps.

Adaptability, cohesion, and communication patterns were studied in 30 families of learning-handicapped adolescents and 30 families of nonhandicapped adolescents. Parent and adolescent perspectives on each of these variables were solicited. The results indicated that adolescents in each of these groups had similar perspectives on adaptability, cohesion, and communication. The parents of the learning-handicapped adolescents, however, felt that their families were less cohesive and had lower levels of communication about problems than did their offspring. When levels of communication were related to adaptability and cohesion, it was evident for both groups that the families with high reported cohesiveness had the most positive communication patterns. Additionally, adolescents rated their families higher on communication if they also perceived a greater amount of flexibility in adaptation.

Adaptation, Psychological↗