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Biomedical subjects

Terrance L Albrecht

Publications and source records attributed to Terrance L Albrecht.

10 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

Transdisciplinary studies of surgical oncology trial accrual: A National Institutes of Health/National Cancer Institute Roadmap-affiliated project update.

BACKGROUND: A key objective of the National Institutes of Health Roadmap Initiative during the past 2 years has been to address scientific problems and issues through innovative research collaborations that cut across disciplines, traditions, and agendas. METHODS: Recognizing an opportunity to focus on the growing problem of low accrual to cancer surgical trials, the authors organized a multidisciplinary network of 21 clinical researchers and social/behavioral scientists to meet, review the issues, and organize working groups to study the problem. The authors, as representatives of the Karmanos Cancer Institute (Detroit, MI) and the American College of Surgeons Oncology Group, were awarded a Roadmap-affiliated grant from the National Cancer Institute under the "Meetings and Networks for Methodological Development in Interdisciplinary Research" funding mechanism. RESULTS: The overarching objective that guided the methodological developments of this network was to apply state-of-the-science methodologies and analytical strategies to examine the biobehavioral and interpersonal factors that facilitate or impede patients' treatment decision-making. CONCLUSIONS: In this brief report, the authors describe the objectives of their multidisciplinary network and their progress to date.

Advisory Committees↗
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

Communication and informed consent.

PURPOSE OF REVIEW: To examine recent cancer research literature on the extent to which effective communication with adult and pediatric patients and their surrogates occurs during the informed consent process. RECENT FINDINGS: The limited recent empirical evidence found reveals several gaps in knowledge about the quality and process of communication and informed consent. Although commentary and recommendations about the process are available, little is known regarding the actual ways in which treatment and clinical trial information is explained by oncologists (and/or other healthcare providers) to patients and/or their authorized representatives. The few studies reported show wide differences in the ways the process is conducted in differing oncology settings (i.e., academic compared with community clinics), with different types of patients (i.e., adults and children), and in different cultural contexts. SUMMARY: Despite the identified shortcomings in the ways the communication process is transacted and the relative paucity of empirical studies, nearly all investigators and authors agree that personal interaction between healthcare providers and patients (or surrogates) is critical to maintaining the integrity and ethical standards necessary to achieve informed consent.

Clinical Trials as Topic↗
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↗
PubMed2004

Real-time patient satisfaction survey and improvement process.

The purpose of this article is to describe how one multidisciplinary hospital responded to patient-satisfaction issues and improved communication throughout its organization by implementing a real-time assessment of patient and staff satisfaction for a faster and better-focused improvement process. The survey process is based on eliciting information from several different sources in a manner that allows corrective action plans to be made and implemented within 4 to 8 weeks of patient encounters. Organized groups can then review feedback from the implemented action plans within 9 to 16 weeks of patient encounters. This 4-month process is repeated on a quarterly basis, as lessons learned from the previous cycle are fed into the upcoming survey process for continuous patient-satisfaction improvement. Employees, faculty, and administrators have accepted the Real-Time Patient Satisfaction Survey and Improvement Process as a routine activity within the normal operating structure at the Moffitt Cancer Center. This activity of problem identification-action-feedback has been well integrated in the system and will continue to rotate throughout all patient care clinical services at the Moffitt Cancer Center. The program has become a method for goal-setting and establishing management accountability. As an adaptation of continuous quality improvement, The Real-Time Patient Satisfaction Survey and Improvement Process at the Moffitt Cancer Center is applicable for use in other hospitals and cancer centers in the United States. The general design, materials, and analysis plan can be directed toward the needs of the specific institution (and are available for distribution by contacting the authors).

Cancer Care Facilities↗
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↗
PubMedDate not supplied

Current and evolving strategies for colorectal cancer screening.

BACKGROUND: Colorectal cancer is a major cause of cancer mortality and morbidity. Screening can potentially prevent most colorectal cancers by detection and removal of precursor adenomas. METHODS: The literature and clinical practice guidelines are reviewed, with an emphasis on advances of the last 10 years and evolving screening methods. RESULTS: Colonoscopy has come to be used for screening in persons at average risk for colorectal cancer because of the comparative ineffectiveness of other methods, although these methods continue to be recommended. Virtual colonoscopy and fecal DNA testing are emerging technologies with promise to be more effective than fecal occult blood testing or sigmoidoscopy in selecting those persons who should undergo colonoscopy. Next to age, family history is the most common risk factor for colorectal cancer and one that warrants more aggressive screening and, in some instances, genetic counseling and testing. Hereditary nonpolyposis colorectal cancer accounts for as many as 1 in 20 colorectal cancers, but to take advantage of recent advances in genetic testing for this disorder, a high level of clinical suspicion must be maintained. CONCLUSIONS: If we are to reduce mortality and morbidity from colorectal cancer, practicing clinicians need to be aware of current and evolving strategies for colorectal screening, and assertively recommend the appropriate strategy to their patients.

Colonography, Computed Tomographic↗