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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): We propose a pilot study to closely analyze communication patterns between patients and doctors during oncology medical interviews. While increasing priority is being given to "patient-centered" cancer care, a fundamental understanding of patients as active collaborators during oncology interviews is in its infancy. Limited rigorous, descriptive, and qualitative attention has been given to identifying unique communication patterns between cancer patients and their doctors during what are often delicate and highly charged, yet routine interviews in oncology clinics. Recent surveys suggest that more than 1/3 Americans consider cancer to be their most fearful health concern, and half of those people believe cancer is difficult or impossible to prevent. Yet little is known about: a) patient-initiated actions (PIA's) designed to express fears, uncertainties, and hopes about cancer diagnosis and treatment; and b) doctor- responsive actions (DRA's) designed to attend and/or disattend to patients' issues. Void of this basic empirical foundation, attention cannot be adequately given to long-term interventions designed to enhance communication skills comprising trusting and stable relationships in oncology clinics. The identification and verification of fundamental interactional patterns, between cancer patients and their providers, is thus a pre-requisite for redesigning existing attempts to increase communication satisfaction, healing outcomes, and quality of life. A collaboration has been formed between health communication researchers, oncologists, and an NCI designated Comprehensive Cancer Center to perform this study. Systematic examinations of videorecordings and transcriptions of 15 oncologists and 150 patients during naturally occurring oncology visitations will occur. Attention will be given to the interactional organization of verbal, nonverbal, and nonvocal orientations during oncology interviews. Age, gender, and ethnicity will be collected in the Pre- Visit Questionnaire. The same variables from participating physicians (including their specialization) will be extracted from institutional records. Anchored in our conceptual framework, Post-Visit Questionnaires will focus on patients' fears, uncertainties, hopes, and communication satisfaction. Implications are drawn for subsequent R01 funding, extending this pilot investigation to more diverse patient oncologist interactions and cancer centers. Grounded and innovative educational interventions can emerge from basic research findings, including Video Review Techniques (VRT's) and workshops shaped by digitized video excerpts from oncology interviews. Research findings and data can eventually be integrated into a DVD navigational system designed to facilitate ongoing communication training for oncologists, cancer patients, and their family members/significant others.