More Than Just Talk: The Importance of Effective Patient-Provider Communications

Mobile-Based Patient-Provider Communication in Cancer Survivors: Role of Health Literacy and Patient Activation

Authors:

Anubhuti Poudyal, Texas A&M University (Presenter)

Y. Alicia Hong, Texas A&M University
Shaohai Jiang, National University of Singapore

Public Health Statement: Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based communication with their healthcare providers. The relationship of mobile-based patient-provider communication (PPC) and patients’ health outcomes remains unclear. How health literacy and patient activation interact with such relationship is unexplored.

Purpose: Data on mobile-based patient-provider communication (MBPPC) in cancer survivors are limited. In this study, we examined the relationship of MBPPC and emotional health outcomes and the effects health literacy and patient activation on this relationship.

Methods/Approach: We drew data from National Cancer Institute’s Health Information Technology Survey (HINTS) 4 Cycle 3, 459 cancer survivors were include in the analysis. First, structural equation modeling was performed to test the pathway linking MBPPC to emotional health, mediated by health literacy. Second, hierarchical regression was conducted to examine the moderation effect of patient activation. Last, a normal theory based approach was adopted to examine the moderated mediation model.

Results: MBPPC (e.g., patients’ use of email, text message, mobile app, and social media to exchange health information with providers) had no direct effect on cancer survivors’ emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health, and further increased the indirect effect of MBPPC communication on emotional health, suggesting a moderated mediation model.

Conclusions/Implications: MBPPC alone does not directly result in improvement in emotional health, health literacy is the key to realize its health benefits. When patients are equipped with the ability to obtain, interpret, and understand basic health information and service, they can utilize MBPPC to maximize health benefits. In addition, considering that patient activation could significantly strengthen the effects of MBPPC, effective programs are needed to activate patients in the course of cancer care. As mHealth movement continues, more research in is needed on mobile-based PPC and its impact on cancer survivors’ health outcomes.

Interdisciplinary Cancer Provider-reported Challenges to Culturally Sensitive Communication and Care

Authors:

Aubrey Villalobos (Presenter)
The George Washington University

Patrice Fleming, The George Washington University
Serena Phillips, The George Washington University
Mandi Pratt-Chapman, The George Washington University

Public Health Statement: To promote high quality care for the increasingly diverse population of cancer patients in the U.S., it is important to understand the nature of the cross-cultural communication challenges that providers experience.

Purpose: To characterize the communication challenges that cancer care professionals face when interacting with patients from backgrounds different from their own.

Methods/Approach: An online survey was administered to a sample of n=406 cancer care providers using an observational cross-sectional study design. The survey contained items about demographic characteristics and two open-ended questions. Analysis included quantitative tabulation of participant characteristics and qualitative coding of open-response survey questions.

Results: Physicians (n=200), nurses (n=170) and other professionals (n=36) were included in the sample. The majority identified as female (52.7%), white (71.9%) and heterosexual (95.8%) and most frequently had a hematology/oncology specialty (60.6%). Overall, providers most frequently reported the following challenges: language barriers, treatment refusal or lack of adherence to care, alternative medical beliefs and managing family dynamics. Providers most frequently cited use of interpreter services, enlisting help from colleagues with concordant languages or backgrounds, trainings for providers, and negotiating care plans acceptable to patient religious beliefs as strategies that they have used or would like to use.

Conclusions/Implications: Doctors, nurses, and other professionals working with cancer patients are concerned about their ability to communicate effectively and make appropriate care recommendations when cultural and/or communication challenges arise. Providers have some strategies for overcoming, but training could help bridge the gap.

Personalized Medicine for Prevention: Can Risk-Stratified Screening Decrease Colorectal Cancer Mortality at an Acceptable Cost?

Authors:

Sujha Subramanian (Presenter)
RTI International

Georgiy Bobashev, RTI International
Robert Morris, RTI International
Sonja Hoover, RTI International

Public Health Statement: This study provides guidance for evaluating risk-stratified cancer screening.

Purpose: Tailored health care interventions are expected to transform clinical practice. The objective of this study was to develop an innovative model to assess the effectiveness, cost, and harms of risk-stratified colorectal cancer screening.

Methods/Approach: We updated a previously validated microsimulation model consisting of three interlinked components: risk assessment, natural history, and screening/treatment modules. We used data from representative national surveys and the literature to create a synthetic population that mimics the family history and genetic profile of the US population. We applied risk stratification based on published risk assessment tools to triage individuals into five risk categories: high, increased, medium, decreased, and low.

Results: On average, the incremental cost of risk-stratified screening for colorectal cancer compared to the current approach at 60% and 80% compliance rates are $18,342 and $23,961 per life year gained. The harms in terms of false positives and perforations are consistently lower for personalized scenarios across all compliance rates. False positives are reduced by more than 47.0% and perforations by at least 9.9%. There is considerable uncertainty in the life years gained but the reduction in harms remains stable under all scenarios.

Conclusions/Implications: A key finding is that risk-stratified screening can reduce harms at all levels of compliance. Therefore, selection of screening scenarios should include comprehensive comparisons of mortality, harms from screening, and cost.