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Background: Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. Objective: To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. Design: We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Setting/Subjects: Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Measurements: Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. Results: The intervention did not significantly improve caregivers' scores on the PG-13 (p = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores (p = 0.018). Cohen's d (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (−0.19 to 0.63) to 0.39 (−0.07 to 0.86) although none was statistically significant. Conclusion: Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills.Objective: To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework.Methods: Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups. Each group received the intervention consisting of four 1-hour training sessions to teach the 5As for PA counselling. Patient-clinician visits (n = 325) were audio recorded at baseline, immediately post-intervention, and at 6 months. Outcomes were the frequency and quality of PA discussions using the 5As, assessed by blinded coders.Results: Patients' mean age was 44 years; 75% were African American. PA was discussed in 37% (n = 119) of visits overall and did not change from baseline to follow-up. When PA discussions occurred, the frequency of 5As increased from baseline to follow-up for Advise (51-54%), Agree (11-26%), and Assist (11-17%); however, none of the 5As had a statistically significant increase. For Agree, exploration of patient willingness to engage in PA increased from 23% at baseline to 50% at follow-up.Conclusion: A clinician-directed intervention to improve PA counselling increased the frequency of Advise, Agree and Assist, and the quality of Ask and Agree statements, though the absolute numbers were small and only Agree reached statistical significance. Future research is needed to understand the factors that affect the optimal uptake and approach to 5As counselling. [ABSTRACT FROM AUTHOR]

The article focuses on a study which investigated if an intensive educational program in mindfulness, communication and self-awareness is linked with improvement in the well-being, psychological distress and the capacity to relate to patients of primary care physicians. The study included 70 primary care physicians in Rochester, New York who were enrolled in continuing medical education (CME) course in 2007-2008. It found that physicians who enrolled in the CME course showed improvements in mindfulness, burnout and depersonalization. Study authors concluded that mindful communication program is associated with improvements in well-being and attitudes associated with patient-centered care.

Background: Depression treatment is often initially sought from primary care physicians.Objective: To explore the influence of physician personality on depression assessments.Design: Secondary analysis of data collected in a randomized controlled trial.Setting: Offices of primary care physicians in Rochester, NY.Participants: Forty-six physicians; six female actors.Intervention: Eighty-six unannounced standardized patient (SPs) visits; physicians saw one SP with major depression and one with adjustment disorder.Measurements: SPs listened to audiotapes and completed a form on doctoring behaviors and symptom inquiry immediately following the visit. For the assessment of diagnostic documentation, SPs' medical records were reviewed. Physician personality was assessed via items from the NEO-PI-R.Results: Physicians who are more dutiful and more vulnerable were more likely to document a diagnosis of depression; those who are more dutiful also asked fewer questions concerning mood symptoms.Limitation: Roles portrayed by the SPs may not reflect the experience of a typical primary care patient. Most of the PCPs were white men. The sample of PCPs was limited to a single geographic location. Effect sizes were modest.Conclusions: The clinical, educational, and translational, implications of research showing that physician personality traits could affect practice behaviors warrant consideration. Current models of treatment for depression in primary care could be engineered to accommodate the variability in physician personality. Given that there is no single "correct" way to ask about mood disorders or suicide, clinicians are encouraged to adopt an approach that fits their personal style and preferences. [ABSTRACT FROM AUTHOR]

Context Peer assessment has been increasingly recommended as a way to evaluate the professional competencies of medical trainees. Prior studies have only assessed single groups measured at a single timepoint. Thus, neither the longitudinal stability of such ratings nor differences between groups using the same peer-assessment instrument have been reported previously. Methods Participants were all members of 2 consecutive classes of medical students ( n = 77 and n = 85) at the University of Rochester School of Medicine and Dentistry who completed Years 2 and 3 of medical school consecutively. All participants were evaluated by 6−12 classmates near the end of both Years 2 and 3. Main outcome measures were mean numerical ratings on peer-assessed scales of professional work habits (WH) and interpersonal attributes (IA). Results Both scales had high internal consistencies in both years (Cronbach's α 0.84–0.94). The IA and WH scales were moderately correlated with one another ( r = 0.36 in Year 2, r = 0.28 in Year 3). Year 2 scores were predictive of Year 3 scores for both scales (WH: r = 0.64; IA; r = 0.62). Generalisability and decision analyses revealed that 1 class was consistently more discriminating with the WH scale, while the other was more discriminating with of the IA scale. Depending on the class, year and scale, the number of raters needed to achieve a reasonable reliability ranged between 7 and 28. Conclusions Although Year 3 peer ratings were consistently higher than Year 2 peer ratings for both WH and IA, individual scores were highly correlated across the 2 years, despite the fact that different individuals were chosen as peer raters. Abilities appear to be stable between Years 2 and 3 of medical school. Groups may differ in their ability to discriminate different kinds of skills. Generalisability analysis can be used to discover these patterns within groups. [ABSTRACT FROM AUTHOR]

Objective: To evaluate feasibility and to validate a rating scale for two educational programs that use standardized patient-instructors (SPIs) in the office setting to improve physicians' HIV risk communication skills.Design: Pilot randomized trial of announced and unannounced SPIs.Participants/settings: Twenty four primary care physicians in the Rochester, NY, area.Measurements: The Rochester HIV Interview Rating Scale (RHIRS), HIV test ordering, physician satisfaction questionnaire.Results: Physicians found the intervention useful, and predicted a positive effect on their future HIV-related communication. HIV test ordering and RHIRS scores increased similarly in both intervention groups. Announced SPI visits were more convenient and preferred by physicians. Cost for each SPI visit was $75.Conclusions: A brief office-based intervention using SPIs was feasible, well-accepted, convenient, and inexpensive. Announced SPIs were preferred to unannounced SPIs. Pilot results suggesting improvement in HIV-related communication should be confirmed in a larger randomized trial. [ABSTRACT FROM AUTHOR]

Gender and personality may individually impact end-of-life care. Men often receive more aggressive treatments than women near death, and personality – particularly openness – may be associated with increased care utilization when it diverges from traditional treatment norms. However, research has not examined the interaction of these variables in a dyadic context. This study examined the dyadic effects of patient gender and caregiver personality on end-of-life care. Using data from the VOICE randomized clinical trial, the present sample consisted of patient-caregiver dyads receiving outpatient care for advanced cancer in Sacramento and Western New York. Analyses assessed whether caregiver personality was associated with gender-based differences in patient chemotherapy or emergency department/inpatient visits in the 30 days before death. Logistic regression examined the interaction between caregivers' Big Five personality dimensions and patient gender while accounting for patient and caregiver demographic and health characteristics. Of a total of 134 patient-caregiver dyads, 19.4% (n = 26) of patients received chemotherapy and 47.8% (n = 64) had an emergency department/inpatient visit in the 30 days before death. Results demonstrated a significant interaction between caregiver openness and patient gender on receipt of chemotherapy (odds ratio = 0.07, p = 0.006). When caregivers were less open, men were more likely to receive chemotherapy near death, whereas when caregivers were more open, women were more likely to receive chemotherapy near death. Results suggest caregiver personality characteristics, particularly openness, might disrupt gender-based treatment norms at end-of-life. Findings demonstrate that patient and caregiver factors can interact to explain patient healthcare utilization. [ABSTRACT FROM AUTHOR]

Context: Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes.Objectives: We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death.Methods: We conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety.Results: We included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (β = -2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (β = -5.87; SE = 2.56; P = 0.02).Conclusion: A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment. [ABSTRACT FROM AUTHOR]