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Few studies have defined the association of physician-patient communication with physical activity levels in patients with peripheral arterial disease. We hypothesized that a face-to-face intervention versus video watching would improve physical activity levels in patients with peripheral arterial disease. The authors conducted a randomized trial involving 2 interventions. The face-to-face intervention included a brief dialogue with patients to understand their perceptions of peripheral arterial disease and importance of walking. The comparison group watched a video that included an overview of peripheral arterial disease. The primary outcome was changed from baseline to follow-up in levels of physical activity. Fifty-one patients with peripheral arterial disease were randomized. There were no statistically significant differences between the 2 groups in reported activity level or walking ability at 12 weeks. For within group changes, the patients in the video-watching group improved their walking speed (8.5%; SD = 4.1; P = .05). Patients with peripheral arterial disease may benefit from the use of an educational video to increase the use of unsupervised physical activity. Further research is needed to identify interventions that can increase the use of unsupervised physical activity in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Previous studies have demonstrated the effects of the September 11th 2001 terrorist attacks on anxiety and anxiety-related conditions in Americans. However, data regarding associations between the attacks and patients' health perceptions are lacking. The objective of this study was to explore associations between the personal impact of the September 11th attacks and patients' perceptions of health and illness. METHOD: We performed a cross-sectional survey of 303 adult African-American, Caucasian, and Hispanic patients at primary care clinics in Houston, Texas. Data were collected between October 15, 2001 and March 1, 2002. We developed items to measure the impact of the September 11th attacks and patients' quality of life. Previously validated scales were used to measure health status, health locus of control, preferences regarding the patient-physician relationship, and patients' explanatory models of illness. RESULTS: Twenty-two percent of patients reported no impact from the attacks, 41% reported mildly negative impact, 22% reported moderately negative impact, and 15% reported extremely negative impact in their lives. In multivariate analysis, demographic characteristics were not associated with impact from the attacks. However, patients who perceived a more external locus of control with respect to health and patients who reported greater meaning of illness in their lives also reported more negative impact from the September 11th attacks. CONCLUSIONS: The September 11th terrorist attacks had at least a somewhat negative impact for a majority of patients far from the site of the nearest attack, and regardless of their demographic backgrounds. The amount of negative impact that patients perceived as a result of the terrorist attacks correlates with certain illness perceptions, including an external health locus of control and a perception of greater meaning of illness in one's life. Such correlations may indicate an effect of terrorism on patients' illness behaviors. Further research is needed to better understand effects of the threat of terrorism on the general health and illness behaviors of patients. [ABSTRACT FROM AUTHOR]

Patient refusal of physicians' recommendations may partially account for variations in lung cancer treatment affecting survival. Reasons for refusal have not been well researched, and patients who refuse are often labeled derogatorily as irrational or enigmatically non-compliant. This study explored why patients refused recommendations for further diagnosis or treatment of lung cancer.We conducted in-depth interviews with nine patients, identified and recruited over a 2-year period, with documented refusal of doctors' recommendations. Recruiting was hampered by deaths, logistics, and refusal to participate. Questions focused on participants' understanding of disease, medical recommendations, and perceptions of decision-making. Transcripts were analyzed using a grounded theory approach. Participants emphasized self-efficacy, minimizing threat, fatalism or faith, and distrust of medical authority; explanations were often multi-dimensional. Comments included complaints about communication with physicians, health system discontinuities, and impact of social support.Explanations of participants' decisions reflected several ways of coping with an undesirable situation, including strategies for reducing, sustaining, and increasing uncertainty. Problematic Integration Theory helps to explain patients' difficulties in managing uncertainty when assessments of disease outcomes and treatment recommendations diverge. Implications for clinical communication include increasing trust while delivering bad news, understanding the source of resistance to recommendations, and discussing palliative care. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Using participant-observation and discourse analysis, this study explores the communication occurring on the Breast Cancer List, an on-line discussion group which continues to grow in membership and activity. Issues discussed include the evolution of the List, who participates, what topics are discussed. Three major dimensions are identified: exchange of information, social support, and personal empowerment. Social support via computer is compared with face-to-face groups. Empowerment centers on enhanced decision-making and preparation for new illness-related experiences. The influence of gender is considered in terms of communicative style and limitations of access. It is concluded that the List fulfills the functions of a community, with future concerns about information control and the potential to enhance patient-provider understanding. [ABSTRACT FROM AUTHOR]

Objective: Facilitating lifestyle change and improved self-management are important aspects of diabetes treatment. Previous research shows motivational, patient-centred approaches are more effective at this than traditional, didactic approaches. This study explores the degree to which doctors with no previous training in motivational techniques employ these methods to affect behaviour change in routine consultations. Methods: A cross-sectional design was employed. Forty-four routine consultations with nine physicians were tape-recorded, of which nineteen focussed on behaviour change; patient questionnaires assessed patient demographics, intention to self-manage and satisfaction with consultation. Physician behaviour was coded for use of motivational, behaviour change techniques, patient-centeredness and other verbal communication variables; patient communication was also assessed. Results: Lifestyle issues were raised in 43% of consultations but few motivational strategies were employed; 10% of physicians' communication was patient-centred. An association was found between physicians' use of patient-centred strategies and patients expressing views (r = .44, p < .05). Higher patient satisfaction with the consultation was related to physician partnership-building (r = .37, p < or = .05) and patients asking questions (r = -.31, p < or = .05). Familiarity between doctor and patient was associated with more physician recommendations and directives (r = .35, p < or = .05) and information giving (r= .30, p < or = .05), and more assertive responses by the patient (r = .31, p < or = .05). Conclusion: Effective communication strategies related to behaviour change were not used routinely in diabetes consultations in the clinic studied. More patient-centred approaches were associated with higher indicators of patient satisfaction. Practice Implications: Physicians require training and support in employing behaviour change techniques if these are to be integrated into routine care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the meaning of active participation from the patient's perspective. METHODS: We used a narrative framework to analyze transcripts generated from 16 qualitative open-ended, semi-structured interviews with primary care patients in Houston, Texas. RESULTS: Patients' illness narratives reflected several themes related to patient participation. These included patients' perspectives of illness (i.e., how central the illness is in the patient's overall life story and how changeable the patient believes their illness to be) and aspects of actions pursued in the context of patients' illness narratives (i.e., the degree of illness-related activity that a patient engages in and the role of partnership with the patient's physician in health decision making and illness management). The relationships among these themes explained a limited number of distinct illness-management strategies pursued by patients. CONCLUSION: Our findings revealed a level of complexity to patients' healthcare participation that has not been previously described. Patients' illness-management strategies were explained by four thematic story elements in dynamic interplay with unique variations for each individual. Further research is needed to explore how these story elements influence communication between patients and physicians. PRACTICE IMPLICATIONS: By understanding the nature of and relationships between the thematic elements in patients' illness narratives, practitioners will be able to better inform their negotiations with patients regarding participation in healthcare. [ABSTRACT FROM AUTHOR]

In the context of hospital intensive care units, lives often hang in tenuous balance among potential healing, continuing survival, and death. Caretakers and loved ones, both family and friends, who are present to accompany and lend support to the stricken individuals are witnesses to suffering that embodies pain, discomfort, and prolonged uncertainty. My experiences throughout a concentrated period of being present in three, overlapping situations of people in the liminal space of the ICU are described. This essay explores the process of witnessing such suffering as both moral and communicative, sensory and emotive, privileged and responsibility-laden. Interpersonal, public, and intrapersonal aspects of witnessing are considered.

An increasing number of health seekers in the United States are looking outside conventional medicine to address their health needs. It is estimated that in the United States, 38% of adults use complementary and alternative medicine (CAM). Extant research characterizes CAM users as a unified homogeneous group, with little understanding of the differences among them in terms of attitudes toward body, wellness, disease, and pivotal aspects of their personal histories. In this article, we seek to better understand the nuances of who uses CAM and why, using the following questions: How do people communicate their life stories that explain their decision to use CAM? How do the life stories enable us to understand the similarities and differences among CAM users? Based on analysis of the narratives of 18 individuals, three clusters or types of CAM users emerged: natives, immigrants, and tourists. In an effort to push our analysis further, we theorized three dimensions that help to explain CAM users' objectives, motives, and resultant sense of empowerment. Together, these dimensions comprise The Pathfinder Model of CAM Usage. The Pathfinder Model can be useful to clarify self-understanding among CAM users themselves, as well as for conventional and alternative practitioners, as they establish a working relationship and communicate with their patients during medical encounters. Understanding the path of the health seeker can help influence the quality of the relationship and the communicative strategies providers use to educate and influence., (© The Author(s) 2015.)

A shift has occurred in the provision of health care to include a focus not just on biology and disease but also on the whole person, preventative care, and an array of healing modalities based on systems of beliefs and values not typically included within biomedical practice. This approach to health care, termed integrative medicine (IM), blends biomedicine with a broader understanding of patients and their illnesses, including elements of mind, body, and spirit that may be contributing to an ailment. While the use of integrative medicine has increased and centers for integrative medicine have proliferated within conventional health care organizations, distinct tensions arise from this amalgamation. The tensions between IM and biomedical clinicians often center on their differing training and philosophies, as well as on a larger system of health care that privileges biomedicine. As a result, this research is designed to explore the challenges IM clinicians face in collaborating with conventional practitioners to provide patient care. Analysis of interviews with 14 clinicians at one center for integrative medicine revealed four specific challenges they face in their attempt to co-practice IM with conventional medicine. The four challenges include (a) challenges to collaboration, (b) challenges to legitimacy, (c) challenges to consistency, and (d) challenges to unification. Future research should investigate the ways in which these challenges can be addressed so that collaboration throughout the system is facilitated. The professional training of clinicians, the structuring and institutionalization of integrative medicine, and enhanced systems for communicating patient information all play a significant role in this transformation.

Objectives: This study examines three integrative health centers to understand their (1) historical development, organizational goals, and modalities, (2) the processes and challenges of integrating complementary and allopathic medicine, while encouraging staff collaboration, and (3) how each center becomes institutionalized within their community., Methods: We focus on three organizational case studies that reflect varying forms of integrative health care practices in three U.S. cities. Participant-observation and in-depth interviews with center directors were analyzed qualitatively., Results: Important patterns found within the three cases are (1) the critical role of visionary biomedical practitioners who bridge complementary and allopathic practices, (2) communicating integration internally through team interaction, and (3) communicating integration externally through spatial location, naming, and community outreach., Conclusion: IM centers continue to blaze new trails toward mainstream access and acceptance by gathering evidence for IM, encouraging team collaboration within organizational contexts, constructing organizational identity, and negotiating insurance reimbursements., Practice Implications: IM is not the enactment of specific modalities, but rather a philosophy of healing. Though scheduling conflicts, skepticism, and insurance coverage may be obstacles toward IM, collaboration among specialists and with patients should be the ultimate goal., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

This article indicates the need for health communication scholars to attend to the growing national problem of rural food insecurity. A review of the health communication literature reveals that food insecurity and rural health overall are research issues that have been overlooked. Using the Culture-Centered Approach ( Dutta, 2008 ), while simultaneously searching for community assets as well as problems, we explore aspects of rural residents' food environments, culture, and institutional structures that empower and constrain their communities. Twelve focus groups (n = 86), segmented by race/ethnicity, were conducted in rural central Texas. Results were analyzed using grounded theory methodology. Our findings outline problems and personal obstacles described by participants, as well as creative solutions and coping mechanisms illustrative of individual agency and social capital inherent in their rural culture. We conclude by providing suggestions for future research that will aid health communication scholars to further the conversation on rural food insecurity.

The purpose of this study was to explore how patients use narratives to create coherent understandings of risks associated with complex antithrombotic therapies. We led four focus groups consisting of patients older than 65 years of age who had a diagnosis of cardiovascular disease and were using a prescription for cardioprotective agents, such as aspirin, anticoagulants, and/or antiplatelets. The participants' stories were retrospective accounts about physician and patient interactions and adverse events organized in the plot structure of a trial-and-error story. The trial-and-error narrative structure emphasizes patients' idiosyncrasies and reasons why they expect to experience adverse events from changes in treatment. Any fears that they might have had about these risks were mitigated by physician expertise, patient responsibility, and medical technology. Patients who expressed concern about not having sufficient access to medical expertise (e.g., physicians, laboratory tests) seemed less willing to accept risks. The trial-and-error risk narratives helped patients deal with ambiguity and uncertainty about the outcomes of their therapies, and revealed patients' orientations to the risks they faced.

Objective: A growing body of qualitative and quantitative research suggests that individual patients and physicians often have differing perspectives, or 'explanatory models,' regarding the patient's health condition or illness. Discordance between explanatory models may lead to difficulties in communication and poor disease outcomes. However, due to a lack of tools to systematically measure concordance in patient and physician explanatory models, a large-scale study of explanatory models of illness has not been previously possible. The objective of this project was to develop and pilot-test a survey-based tool (the CONNECT Instrument) that measures salient aspects of explanatory models of illness., Methods: We conducted a multi-method survey development project that included qualitative and quantitative item development, refinement, pilot testing, and psychometric evaluation. We evaluated the instrument in two unique, consecutive cohorts of primary care patients in a variety of private and public settings in Houston, TX. We also used the instrument to examine concordance between patient and physician explanatory models in the second cohort., Results: The final version of the CONNECT Instrument contains nineteen items that focus on six dimensions of explanatory models. Cronbach alphas ranged from 0.65 to 0.89 for the six CONNECT dimensions. The instrument demonstrated evidence of criterion-related validity when individual CONNECT dimension scores were compared with scores from previously published instruments, and demonstrated expected differences between patients 'and physicians' explanatory models of illness., Conclusion: The CONNECT instrument is a tool with good psychometric properties that enables researchers to measure important aspects of patients 'and physicians' explanatory models of illness. Our continuing work will focus on gathering additional validity evidence and evaluating associations between explanatory model concordance and health outcomes., Practice Implications: The CONNECT instrument can be used to improve quality in clinical practice and medical education by measuring an important intermediate outcome in the chain of factors leading to patient trust, satisfaction, and adherence.

In this study, we investigate the use of narrative in online conversations among persons suffering from chronic opiate addiction and evaluate both its positive and negative uses. Illness narratives, as argued by sociologist Arthur Frank and psychiatrist/medical anthropologist Arthur Kleinman, enable patients to give order to life experiences and receive support from others. We wished to explore under what circumstances online support coalesces and breaks apart. The narratives we examined exemplify two topics frequently discussed on the message board: the recovery process and what it means to be 'clean'. To better understand these narratives from a theoretically based approach, we used the work of rhetorical theorist Kenneth Burke. Burke's description of two human motives, suffering and perfection, led us to an understanding of how unification and division happened within the online community. We found that the recovery narrative primarily embodied the author's suffering and, consequently, received support from other members of the message board. The second narrative centered on what it means to be 'clean' through a discussion of the author's desire to court temptation, revealing what Burke calls the rotten nature of perfection. As a result, the author of the narrative provoked disagreements and did not receive support.

Background: Whether doctor-patient communication differs by race was investigated in patients with pulmonary nodules or lung cancer., Methods: Eligible patients (n = 137) had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern Veterans Affairs Medical Center from 2001-2004. Doctor-patient consultations were audiotaped. Audiotapes were transcribed, unitized into utterances, and utterances were coded as doctors' information-giving or patients' and companions' active participation (asking questions, expressing concerns, and making assertions). Data were compared by patient race and doctor-patient racial concordance using t-tests or chi-square tests as appropriate. Mixed linear regression was used to determine the independent predictors of doctor's information-giving after controlling for clustering of patients by doctor., Results: Patient age, gender, marital status, clinical site, and health status were similar by race (P > .20), but black patients were somewhat less likely to have education beyond high school and to bring a companion to the visit (P = .06) than white patients. Black patients and their companions received significantly less information from doctors (49.3 vs. 87.3 mean utterances; P < .001) and produced significantly fewer active participation utterances (21.4 vs. 37.2; P < .001) than white patients. In mixed regression analyses, after adjusting for patients' and companions' participation, clustering by doctor, and other factors, race no longer predicted information-giving (P = .54). Patients in racially discordant interactions received significantly less information and were significantly less active participants (P < .001) when compared with patients in racially concordant interactions, and after controlling for patients' participation and other factors using mixed regression, racial discordance did not predict information-giving., Conclusions: The results indicate a pattern of communication that may perpetuate patient passivity and limited information exchange where black patients and patients in discordant interactions do less to prompt doctors for information and doctors in turn provide less information to these patients., ((c) 2006 American Cancer Society.)

Purpose: Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment., Patients and Methods: Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale., Results: Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors., Conclusion: Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.

African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.

This study addresses the potential of entertainment television to educate about serious subject matter, such as health content. Through the use of open-ended, in-depth interviews of regular viewers in two metropolitan sites, this study explores audience response to a fictionalized, serialized portrayal of ovarian cancer on thirtysomething. Our questions were directed to the audience's (a) viewing process, including interpersonal contact, identification with characters, and prior experience with cancer, (b) understanding of content, especially illness imagery and coping strategies, and (c) applications to real life, including questions, insights, knowledge, and actions. The details of this exploration indicate the complexity of audience response to this kind of content and suggest guidelines for health communicators as they work with the entertainment industry to embed health-promoting messages in the media.

The patient role as discussed in popular and professional literature is in a transitional period, but actual patient behaviors remain predominantly traditional. This article summarizes advice to the public concerning patient-physician communication from the past 25 years of popular periodicals and recent self-help literature. The few extant programs for improving patient communication skills are identified. Recommendations are made for more extensive patient-focused education and research regarding skills development and behavior change.

A survey of graduates of the Independent-Study Programme (ISP) at the College of Medicine, University of Illinois, was conducted in order to assess the impact of the ISP on their subsequent careers. Responses from ninety-nine of these graduates, when compared with their classmates, lend strong support to the idea that such an independent study programme has long-lasting effects on the participants. The ISP graduates are selecting a medical subspecialty in a much higher percentage than their classmates or the national average. They also are engaging in more research, administration, and teaching. Differences between the ISP and the traditional graduates are explained in terms of unique educational opportunities, contact with teachers and peers, orientation towards independent learning and curricular requirements.

Gynecologic teaching associates teach the communication and psychomotor skills for breast and pelvic examinations in most medical schools in the United States and Canada. Evaluations of these gynecologic teaching associate programs have included faculty impressions of program effectiveness and measurement of student retention of skills but not student evaluations of the effectiveness and value of such programs. At the University of Illinois at Chicago students evaluated their gynecologic teaching associate program. High ratings were given to program organization and content; the knowledge, ability, and professionalism of the teaching associates; and the outcomes of the sessions with respect to the learning skills needed to perform the examinations. Students emphasized the importance of the ability of the teaching associates to provide immediate informative feedback and to reduce anxiety during the teaching sessions. Students tended to view their ability to perform breast examination to be greater than for the pelvic examinations but felt they learned more about both in the sessions. This information supports the value of the gynecologic teaching associate model in medical education.

The Gynecological Teaching Associate (GTA) instructional method is recognized as excellent by the Association of Professors of Gynecology and Obstetrics Undergraduate Education Committee for the instruction of medical students and doctors in the skills required for performance of women's reproductive health evaluation (obstetric-gynaecological history, breast and pelvic examinations, and PAP smear). The method is used in over 90% of American and Canadian medical schools and thus represents a major allocation of educational resources. This success is to a large extent dependent on the quality of training programmes for the GTAs. This paper provides a description of the training programme for GTAs at the University of Illinois at Chicago which has operated successfully for the last 3 years, resulting in a group of 18 GTAs who train approximately 450 medical students and residents each year. It is hoped that this information will help medical educators and planners to develop and/or maintain their GTA programmes (or equivalent in other countries) in the fiscally difficult times facing institutions of higher learning.