Biomedical subjects

Louis A Penner

Publications and source records attributed to Louis A Penner.

7 recordsLinked to original sources

PubMed2006

Information seeking during "bad news" oncology interactions: Question asking by patients and their companions.

Previous research has investigated patient question asking in clinical settings as a strategy of information seeking and as an indicator of the level of active patient participation in the interaction. This study investigates questions asked by patients and their companions during stressful encounters in the oncology setting in the USA. We transcribed all questions patients and companions asked the oncologist during 28 outpatient interactions in which "bad news" was discussed (n = 705) and analyzed them for frequency and topic. Additionally, we analyzed the extent to which personal and demographic characteristics and independently obtained ratings of the oncologist-patient/companion relationships were related to question asking. Findings demonstrated that at least one companion was present in 24 (86%) of the 28 interactions and companions asked significantly more questions than patients. The most frequently occurring topics for both patients and companions were treatment, diagnostic testing, diagnosis, and prognosis. In general, personal and demographic characteristics were unrelated to question asking, but older patients asked fewer questions, while more educated patients asked more questions. With regard to ratings of the quality of the dyadic relationships, results showed that "trust" between the physician and companions was positively correlated and "conversational dominance by physician" was negatively correlated with the frequency of companion questions. Additionally, positive ratings of the relationship between physicians and companions were correlated with fewer patient questions. This study demonstrates that companions are active participants in stressful oncology interactions. Future research and physician training in communication would benefit from expanding the focus beyond the patient-physician dyad to the roles and influence of multiple participants in medical interactions.

Aged↗

PubMed2006

Parent communication and child pain and distress during painful pediatric cancer treatments.

Children with cancer often consider treatment procedures to be more traumatic and painful than cancer itself. Previous research indicates that parents' behavior before and during painful medical procedures influences children's distress level. Understanding parents' naturally occurring communication patterns is essential to identifying families in need of an intervention to enhance coping and emotional well-being. Using the concept of definition of the situation from a symbolic interactionism theoretical framework, this study developed a typology of parent communication patterns and tested relationships between those patterns and children's responses to potentially painful treatment procedures. Analyses are based on video-recorded observations of 31 children and their primary parents (individuals functioning in a parenting role and serving as the primary familial caregivers during the observed procedure) in the USA during clinic visits for potentially painful pediatric oncology treatments. Four communication patterns emerged: normalizing, invalidating, supportive, and distancing. The most common communication patterns differed by clinic visit phase: normalizing during pre-procedure, supportive during procedure, and both distancing and supportive during post-procedure. Parents' communication also varied by procedure type. Supportive communication was most common during lumbar punctures; normalizing and distancing communication were most common during port starts. Six children (19.4%) experienced invalidation during at least one clinic visit phase. Analyses indicated that invalidated children experienced significantly more pain and distress than children whose parents used other communication patterns. This typology provides a theoretical approach to understanding previous research and offers a framework for the continuing investigation of the influence of parents' communication during potentially painful pediatric oncology procedures.

Adult↗

PubMed2005

Impact of brachytherapy on regional, racial, marital status, and age-related patterns of definitive treatment for clinically localized prostate carcinoma.

BACKGROUND: The impact of the increased use of permanent prostate brachytherapy compared with other treatment modalities (such as radical prostatectomy and external-beam radiation therapy [EBRT]) for the treatment of clinically localized prostate carcinoma, and the previously reported regional, racial, and age-related variations in prostate carcinoma treatment, have not been well characterized to date. Therefore, the authors evaluated the impact of permanent prostate brachytherapy on the relative rates of the use of specific prostate carcinoma treatment modalities over time. METHODS: Surveillance, Epidemiology, and End Results (SEER) cancer registry data from 1995 to 2000 were analyzed in a longitudinal, observational study utilizing bivariate and multivariate techniques. RESULTS: Differential changes in the use of specific definitive treatment modalities were noted by region, age group, racial/ethnic group, and marital status. Increasing use of permanent prostate brachytherapy, with and without concomitant EBRT, was proportional to the decreasing use of radical prostatectomy alone and EBRT alone over time. CONCLUSIONS: The current study revealed that permanent prostate brachytherapy appears to be replacing other treatment modalities in increasing numbers of clinically localized prostate carcinoma cases. Persistent regional, racial/ethnic, marital status, and age-related differences in the use of permanent prostate brachytherapy merit further investigation.

Adult↗

PubMed2005

Prosocial behavior: multilevel perspectives.

Current research on prosocial behavior covers a broad and diverse range of phenomena. We argue that this large research literature can be best organized and understood from a multilevel perspective. We identify three levels of analysis of prosocial behavior: (a) the "meso" level--the study of helper-recipient dyads in the context of a specific situation; (b) the micro level--the study of the origins of prosocial tendencies and the sources of variation in these tendencies; and (c) the macro level--the study of prosocial actions that occur within the context of groups and large organizations. We present research at each level and discuss similarities and differences across levels. Finally, we consider ways in which theory and research at these three levels of analysis might be combined in future intra- and interdisciplinary research on prosocial behavior.

Altruism↗

PubMed2005

A portable, unobtrusive device for videorecording clinical interactions.

Recording and analyzing real-time interactions in clinical settings is important for basic and applied research in psychology and other disciplines. Investigators frequently have used simple audiotaping procedures to record these encounters (e.g., Roter, Geller, Bernhardt, Larson, & Doksum, 1999), but videorecording is increasingly viewed as more reliable and valid, because it captures the full range of complex and interdependent verbal and nonverbal behaviors that occur in an interaction. This article describes a system designed to videotape clinical interactions in a manner that can be moved in and out of different clinical rooms to preserve flexibility in its use. Data are presented to demonstrate that the system is unobtrusive during the interaction, yet fully compatible with institutional review board guidelines to protect human participants' privacy and freedom to control the recording process.

Equipment Design↗

PubMed2003

Communication and consumer decision making about cancer clinical trials.

Communication between patients and physicians likely mediates traditional patient and physician predispositions in determining patient outcomes, including perceptions and decision making. However, the extent to which a mediating effect occurs is unclear. The purpose of this essay is to outline the need for conceptualizing more holistic models of consumer-provider interaction that demonstrate the role of the therapeutic relationship in treatment outcomes. We focus on an important communicative context for exploring this question: the situation where patients, with the help of oncologists, are faced with making treatment choices, particularly whether to enroll in a clinical trial in response to their life-threatening cancer diagnosis. We explore the question from the perspectives of the medical provider, the patient, and the accompanying family member, in order to better frame the complex interactional dynamics occurring during the interaction.

Clinical Trials as Topic↗

PubMed2003

Understanding patient decisions about clinical trials and the associated communication process: a preliminary report.

BACKGROUND: Although patient participation in clinical trials is vital to cancer research, the rate of enrollment in such trials is not adequate for advancing scientific knowledge. Relatively little is known about why patients enroll in such trials. This affects the training and education programs designed to increase such participation. METHODS: A model of the accrual process, which focuses on communication among the physician, patient, and family members is described. Then a system for observing and recording these interactions is presented. RESULTS, CONCLUSION: Data are presented that suggest using the system to test the conceptual model can improve our understanding of patient decisions about clinical trials and hold out the potential for improving provider training.

Clinical Trials as Topic↗