Dataset Information

Understanding clinical communication about mood disturbance symptoms among breast cancer patients: A mixed methods analysis.

ABSTRACT:

Objectives

We aimed to characterize the relationships between breast cancer patient mood symptom severity and demographic/medical factors with clinical communication about mood, and to explore mood discussion content.

Methods

134 breast cancer patients (mean age=58.3; 14% minority; 13% metastatic) had oncology clinic visits audio-recorded, transcribed, and coded for mood communication. Patient Care Monitor assessed mood symptoms (anxiety/depression presence/severity). Logistic regressions measured associations between mood, demographic/medical factors, and communication. Thematic analysis characterized discussion topics.

Results

Over half of patients (55%; n = 73) reported mood symptoms. Worse mood symptoms were associated with younger age and current treatment (p's < 0.05). 19% of clinic visits (n = 26/134) contained mood discussions. Discussions were more common for younger women and those with non-metastatic disease (p's < 0.05). Odds of discussing mood increased with symptom severity (OR=4.52, p = 0.018). Cancer-related anxiety and medication management were among the most common topics discussed.

Conclusions

Communication about mood occurred infrequently, with women currently undergoing treatment, with metastatic disease, or with mild mood symptoms at potentially increased risk for inadequate discussion. Both patient-focused and provider-focused interventions to improve clinical communication about mood symptoms could be beneficial.

Practice implications

Clinicians hold a key role in supporting cancer patients' well-being by using and encouraging effective communication about patients' mood.

SUBMITTER: Zimmaro LA

PROVIDER: S-EPMC9203906 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Publications

Understanding clinical communication about mood disturbance symptoms among breast cancer patients: A mixed methods analysis.

Zimmaro Lauren A LA Sorice Kristen A KA Handorf Elizabeth A EA Daly Mary B MB Reese Jennifer B JB

Patient education and counseling 20220210 7

<h4>Objectives</h4>We aimed to characterize the relationships between breast cancer patient mood symptom severity and demographic/medical factors with clinical communication about mood, and to explore mood discussion content.<h4>Methods</h4>134 breast cancer patients (mean age=58.3; 14% minority; 13% metastatic) had oncology clinic visits audio-recorded, transcribed, and coded for mood communication. Patient Care Monitor assessed mood symptoms (anxiety/depression presence/severity). Logistic reg ...[more]

PMID: 35184908

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Project description:ImportanceWithdrawal-of-life-sustaining treatments (WOLST) rates vary widely among critically ill neurologic patients (CINPs) and cannot be solely attributed to patient and family characteristics. Research in general critical care has shown that clinicians prognosticate to families with high variability. Little is known about how clinicians disclose prognosis to families of CINPs, and whether any associations exist with WOLST.ObjectivesPrimary: to demonstrate feasibility of audio-recording clinician-family meetings for CINPs at multiple centers and characterize how clinicians communicate prognosis during these meetings. Secondary: to explore associations of 1) clinician, family, or patient characteristics with clinicians' prognostication approaches and 2) prognostication approach and WOLST.Design setting and participantsForty-three audio-recorded clinician-family meetings during which prognosis was discussed from seven U.S. centers for 39 CINPs with 88 family members and 27 clinicians.Main outcomes and measuresTwo investigators qualitatively coded transcripts using inductive methods (inter-rater reliability > 80%) to characterize how clinicians prognosticate. We then applied univariate and multivariable multinomial and binomial logistic regression.ResultsClinicians used four distinct prognostication approaches: Authoritative (21%; recommending treatments without discussing values and preferences); Informational (23%; disclosing just the prognosis without further discussions); advisory (42%; disclosing prognosis followed by discussion of values and preferences); and responsive (14%; eliciting values and preferences, then disclosing prognosis). Before adjustment, prognostication approach was associated with center (p < 0.001), clinician specialty (neurointensivists vs non-neurointensivists; p = 0.001), patient age (p = 0.08), diagnosis (p = 0.059), and meeting length (p = 0.03). After adjustment, only clinician specialty independently predicted prognostication approach (p = 0.027). WOLST decisions occurred in 41% of patients and were most common under the advisory approach (56%). WOLST was more likely in older patients (p = 0.059) and with more experienced clinicians (p = 0.07). Prognostication approach was not independently associated with WOLST (p = 0.198).Conclusions and relevanceIt is feasible to audio-record sensitive clinician-family meetings about CINPs in multiple ICUs. We found that clinicians prognosticate with high variability. Our data suggest that larger studies are warranted in CINPs to examine the role of clinicians' variable prognostication in WOLST decisions.

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Dataset Information

Understanding clinical communication about mood disturbance symptoms among breast cancer patients: A mixed methods analysis.

Objectives

Methods

Results

Conclusions

Practice implications

Publications

Understanding clinical communication about mood disturbance symptoms among breast cancer patients: A mixed methods analysis.

Similar Datasets

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