BACKGROUND/RATIONALE:
Patient-physician communication is vital to all aspects of clinical care. Specifically, misunderstandings in patient-physician communication can be catastrophic. In 2005, the Joint Commission on Accreditation of Healthcare (JCAHO) identified communication problems as the number one cause of all medical errors in the United States health care system. Poor communication creates tremendous costs - emotionally, psychologically, and financially. Good communication is associated with effective pain control, improved patient emotional and psychological well-being, increased patient adherence to treatment recommendations, and enhanced patient satisfaction.

Effective communication impacts many of the VA priority areas, such as obesity, palliative care, and cancer. The need to improve physician-patient communication is essential for providing effective veteran health care. Yet, before one can improve communication, and design interventions to assist in improving communication, better measures of communication are needed. The aim of this CDA was to measure patient-centered communication and its effects on patients

OBJECTIVE(S):
My proposed CDA-2 training program was designed to develop the methodology skills I needed to design reliable, valid measures that focus on specific communication skills relating to veteran care. My work is particularly invested in developing innovative, measurable communication methodologies that can be used to assess the quality of provider-patient communication and its relationship to veteran health related quality of life. Although most CDA applications are disease-focused, my CDA application focused on developing innovative methodologies to analyze communication. Effective communication is a skill that transcends specific illnesses and contexts. Health communication is inherent within all stages of a person's development, from birth to death, and occurs in a variety of settings such as the home, clinic, hospital, and workplace and among a variety of stakeholders including patients, providers, family members, friends, insurers, and employers. Developing assessment tools that are applicable to a number of settings and for a number of illnesses will help in designing communication interventions that can teach specific tools and techniques for providers in multiple settings and with a variety of individuals.

METHODS:
My CDA encompassed both qualitative and quantitative methods. Qualitatively using thematic analysis to identify communication themes and then quantiatively using those theme to measure the quality of the communicaiton

FINDINGS/RESULTS:
Not yet available.

IMPACT:
If we are to improve communication in the VA, we need tools that can reliably measure these changes in the quality of care. The development of evaluation tools for communication is essential for determining which communication behaviors are related to the improvement of patient health related quality of life (HRQoL). By determining the behaviors that are related to patient HRQoL, researchers can design and test effective communication interventions. Currently, we are lagging behind in our ability to assess these interventions and need to develop methods qualitatively and quantitatively that can assess the actual communication change as a result of these interventions. The need to focus on specific communication behaviors that relate to specific health related quality of life outcomes are essential for determining the impact of these interventions on veteran care.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Anderson WG, Alexander SC, Rodriguez KL, Jeffreys AS, Olsen MK, Pollak KI, Tulsky JA, Arnold RM. "What concerns me is..." Expression of emotion by advanced cancer patients during outpatient visits. Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2008 Jul 1; 16(7):803-11. [view]
2. Casarett D, Pickard A, Fishman JM, Alexander SC, Arnold RM, Pollak KI, Tulsky JA. Can metaphors and analogies improve communication with seriously ill patients? Journal of palliative medicine. 2010 Mar 1; 13(3):255-60. [view]
3. Mohan D, Alexander SC, Garrigues SK, Arnold RM, Barnato AE. Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer. Journal of palliative medicine. 2010 Aug 1; 13(8):949-56. [view]
4. Morgan PA, de Oliveira JS, Alexander SC, Pollak KI, Jeffreys AS, Olsen MK, Arnold RM, Abernethy AP, Rodriguez KL, Tulsky JA. Comparing oncologist, nurse, and physician assistant attitudes toward discussions of negative emotions with patients. The journal of physician assistant education : the official journal of the Physician Assistant Education Association. 2012 Sep 19; 21(3):13-7. [view]
5. Zafar SY, Alexander SC, Weinfurt KP, Schulman KA, Abernethy AP. Decision making and quality of life in the treatment of cancer: a review. Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2009 Feb 1; 17(2):117-27. [view]
6. Pollak KI, Arnold R, Alexander SC, Jeffreys AS, Olsen MK, Abernethy AP, Rodriguez KL, Tulsky JA. Do patient attributes predict oncologist empathic responses and patient perceptions of empathy? Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2010 Nov 1; 18(11):1405-11. [view]
7. Steinhauser KE, Alexander SC, Byock IR, George LK, Olsen MK, Tulsky JA. Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. Journal of palliative medicine. 2008 Nov 1; 11(9):1234-40. [view]
8. Alexander SC, Cox ME, Boling Turer CL, Lyna P, Østbye T, Tulsky JA, Dolor RJ, Pollak KI. Do the five A's work when physicians counsel about weight loss? Family medicine. 2011 Mar 1; 43(3):179-84. [view]
9. Rodriguez KL, Bayliss NK, Alexander SC, Jeffreys AS, Olsen MK, Pollak KI, Garrigues SK, Tulsky JA, Arnold RM. Effect of patient and patient-oncologist relationship characteristics on communication about health-related quality of life. Psycho-oncology. 2011 Sep 1; 20(9):935-42. [view]
10. Cox ME, Yancy WS, Coffman CJ, Ostbye T, Tulsky JA, Alexander SC, Brouwer RJ, Dolor RJ, Pollak KI. Effects of counseling techniques on patients' weight-related attitudes and behaviors in a primary care clinic. Patient education and counseling. 2011 Dec 1; 85(3):363-8. [view]
11. Pollak KI, Østbye T, Alexander SC, Gradison M, Bastian LA, Brouwer RJ, Lyna P. Empathy goes a long way in weight loss discussions. The Journal of family practice. 2007 Dec 1; 56(12):1031-6. [view]
12. Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, Pollak KI. Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Annals of internal medicine. 2011 Nov 1; 155(9):593-601. [view]
13. Alexander SC, Pollak KI, Morgan PA, Strand J, Abernethy AP, Jeffreys AS, Arnold RM, Olsen M, Rodriguez KL, Garrigues SK, Manusov JR, Tulsky JA. How do non-physician clinicians respond to advanced cancer patients' negative expressions of emotions? Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2011 Jan 1; 19(1):155-9. [view]
14. Rodriguez KL, Bayliss N, Alexander SC, Jeffreys AS, Olsen MK, Pollak KI, Kennifer SL, Tulsky JA, Arnold RM. How oncologists and their patients with advanced cancer communicate about health-related quality of life. Psycho-oncology. 2010 May 1; 19(5):490-9. [view]
15. Back AL, Michaelsen K, Alexander S, Hopley E, Edwards K, Arnold RM. How oncology fellows discuss transitions in goals of care: a snapshot of approaches used prior to training. Journal of palliative medicine. 2010 Apr 1; 13(4):395-400. [view]
16. Alexander SC, Sullivan AM, Back AL, Tulsky JA, Goldman RE, Block SD, Stewart SK, Wilson-Genderson M, Lee SJ. Information giving and receiving in hematological malignancy consultations. Psycho-oncology. 2012 Mar 1; 21(3):297-306. [view]
17. Kennifer SL, Alexander SC, Pollak KI, Jeffreys AS, Olsen MK, Rodriguez KL, Arnold RM, Tulsky JA. Negative emotions in cancer care: do oncologists' responses depend on severity and type of emotion? Patient education and counseling. 2009 Jul 1; 76(1):51-6. [view]
18. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Sugg Skinner C, Rodriguez KL, Tulsky JA. Oncologist communication about emotion during visits with patients with advanced cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007 Dec 20; 25(36):5748-52. [view]
19. Pollak KI, Alexander SC, Grambow SC, Tulsky JA. Oncologist patient-centered communication with patients with advanced cancer: exploring whether race or socioeconomic status matter. Palliative Medicine. 2010 Jan 1; 24(1):96-8. [view]
20. Robinson TM, Alexander SC, Hays M, Jeffreys AS, Olsen MK, Rodriguez KL, Pollak KI, Abernethy AP, Arnold R, Tulsky JA. Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis. Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2008 Sep 1; 16(9):1049-57. [view]
21. Goldman RE, Sullivan A, Back AL, Alexander SC, Matsuyama RK, Lee SJ. Patients' reflections on communication in the second-opinion hematology-oncology consultation. Patient education and counseling. 2009 Jul 1; 76(1):44-50. [view]
22. Pollak KI, Alexander SC, Coffman CJ, Tulsky JA, Lyna P, Dolor RJ, James IE, Brouwer RJ, Manusov JR, Østbye T. Physician communication techniques and weight loss in adults: Project CHAT. American journal of preventive medicine. 2010 Oct 1; 39(4):321-8. [view]
23. Pollak KI, Alexander SC, Tulsky JA, Lyna P, Coffman CJ, Dolor RJ, Gulbrandsen P, Ostbye T. Physician empathy and listening: associations with patient satisfaction and autonomy. Journal of the American Board of Family Medicine : JABFM. 2011 Nov 1; 24(6):665-72. [view]
24. Pollak KI, Coffman CJ, Alexander SC, Manusov JR, Ostbye T, Tulsky JA, Lyna P, Esoimeme I, Brouwer RJ, Dolor RJ. Predictors of weight loss communication in primary care encounters. Patient education and counseling. 2011 Dec 1; 85(3):e175-82. [view]
25. Pollak KI, Alexander SC, Østbye T, Lyna P, Tulsky JA, Dolor RJ, Coffman C, Namenek Brouwer RJ, Esoimeme I, Manusov JR, Bravender T. Primary care physicians' discussions of weight-related topics with overweight and obese adolescents: results from the Teen CHAT Pilot study. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2009 Aug 1; 45(2):205-7. [view]
26. Steinhauser KE, Alexander SC, Byock IR, George LK, Tulsky JA. Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliative & supportive care. 2009 Dec 1; 7(4):393-404. [view]
27. Gulbrandsen P, Østbye T, Lyna P, Dolor RJ, Tulsky JA, Alexander SC, Pollak KI. The influence of physician communication style on overweight patients' perceptions of length of encounter and physician being rushed. Family medicine. 2012 Mar 1; 44(3):183-8. [view]
28. Dolor RJ, Østbye T, Lyna P, Coffman CJ, Alexander SC, Tulsky JA, Brouwer RJ, Esoimeme I, Pollak KI. What are physicians' and patients' beliefs about diet, weight, exercise, and smoking cessation counseling? Preventive medicine. 2010 Nov 1; 51(5):440-2. [view]

Conference Presentations

1. Alexander SC, Pollak KI, Arnold RM, Sochacki M M, Carpenter L, Tulsky JA. Assessing communication skills during oncology visits. Paper presented at: Communication in Healthcare International Annual Conference; 2007 Oct 1; Charleston, SC. [view]
2. Pollak KI, Coffman CJ, Alexander SC, Tulsky JA, Dolor RJ. Can physicians predict which overweight and obese patients will improve nutrition, physical activity and weight? Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 28; Washington, DC. [view]
3. Alexander SC, Sullivan A, Back AL, Goldman R, Block S, Stewart S, Lee S. Communication in hematological malignancy consultations. Paper presented at: American Academy on Communication in Healthcare Research and Teaching Annual Forum; 2010 Oct 16; Scottsdale, AZ. [view]
4. Lee SJ, Sullivan A, Alexander SC. Content of hematological malignancies consultations: Good and bad news from the Hema-Com Study. Poster session presented at: American Society of Hematology Annual Meeting; 2009 Dec 1; New Orleans, LA. [view]
5. Alexander SC, Tulksy JA, Byock I, George L, Steinhauser KE. Development of a semi-structured interview to assist life completion tasks for patients approaching the end-of-life. Paper presented at: Communication in Healthcare International Annual Conference; 2007 Oct 1; Charleston, SC. [view]
6. Alexander SC, Lyna P, Østbye T, Tulsky JA, Dolor RJ, Coffman CJ, Pollak KI. Do primary care physicians provide weight-related advice in the recommended manner? Poster session presented at: International Conference on Communication in Healthcare; 2011 Oct 16; Chicago, IL. [view]
7. Alexander SC, Tulsky JA, Coffman CJ, Dolor RJ. Do the 5 A's work for weight-loss counseling? Paper presented at: International Conference on Communication in Healthcare; 2009 Oct 1; Miami, FL. [view]
8. Davis JK, Kodish E, Alexander SC, Yamokoski A. Doctor-family informed consent communication for pediatric phase 1 cancer trials. International Conference on Communication in Healthcare, Research and Teaching Forum. Paper presented at: International Conference on Communication in Healthcare; 2011 Oct 16; Chicago, IL. [view]
9. Kennifer SL, Alexander SC. How do hospital-based physicians ascertain intubation preferences in patients with impending respiratory arrest? Poster session presented at: International Conference on Communication in Healthcare; 2009 Oct 1; Miami, FL. [view]
10. Alexander SC. How do non-clinicians respond to advance cancer patients' negative expressions of emotions. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD. [view]
11. Alexander SC, Morgan P, Strand J, Pollak KI, Abernathy A, Jeffreys AL, Olsen MK, Arnold RM, Rodriguez KL, Garrigues SK, Manusov JR, Tulsky JA. How do non-physician clinicians respond to cancer patient's expressed emotions? Paper presented at: American Academy on Communication in Healthcare Research and Teaching Annual Forum; 2010 Oct 16; Scottsdale, AZ. [view]
12. Steinhauser KE, Alexander SC, Byock I, Tulsky JA. OUTLOOK: An intervention to improve quality of life for patients at end-of-life. Paper presented at: Communication in Healthcare International Annual Conference; 2007 Oct 1; Charleston, SC. [view]
13. Pollak KI, Coffman CJ, Tulsky JA, Gulbrandsen P, Lyna P, Brouwer RJ, Dolor RJ, Alexander SC, Ostbe T. Physician Use of MI techniques and patient satisfaction and autonomy support. Paper presented at: American Academy on Communication in Healthcare Research and Teaching Annual Forum; 2010 Oct 16; Scottsdale, AZ. [view]
14. Pollak KI, Alexander SC, Tulsky JA, Østbye T, Lyna P, Coffman C, Bravender T. Physician use of MI techniques and weight change among overweight adolescents: Results from TeenCHAT. Paper presented at: International Conference on Communication in Healthcare; 2011 Oct 16; Chicago, IL. [view]
15. Gramling R, Norton S, Ladwig S, Metzger M, DeLuca J, Epstein R, Quill T, Alexander SC. Prognosis communication in palliative care: A direct observation study. The Science of Compassion: Future Directions in End-of-Life and Palliative Care Research. Poster session presented at: National Institute of Nursing Research National Summit; 2011 Aug 22; Bethesda, MD. [view]
16. Loberiza F, Sullivan A, Alexander SC. Psychological correlates of having advance care planning in patients with hematological malignancies. Poster session presented at: American Society of Hematology Annual Meeting; 2009 Dec 1; New Orleans, LA. [view]
17. Pollak, Alexander, Ostbye, Lyne, Tulsky, Dolor, Coffman. Teen Chat: How do primary care physicians talk to adolescents about obesity? Paper presented at: North American Primary Care Research Group Annual Meeting; 2008 Apr 27; Rio Grande, PR. [view]
18. Tulsky JA, Alexander SC, Farrell D, Pollak KI. Web-based communication training using tailored feedback on audio-recorded conversations. Paper presented at: International Conference on Communication in Healthcare; 2011 Oct 16; Chicago, IL. [view]
19. Pollak KI, Alexander SC, Coffman CJ, Tulsky JA, Dolor RJ. Weight's up Doc? Physicians use of Motivational Interviewing techniques predict weight loss among overweight and obese adults in primary care. Paper presented at: Obesity Society Annual Scientific Meeting; 2009 Oct 4; Phoenix, AZ. [view]
20. Pollak KI, Manusov JR, Alexander SC, Tulsky JA, Coffman CJ. Who's talking about weight? Predictors of weight-related communication in primary care visits with overweight and obese adults. Paper presented at: International Conference on Communication in Healthcare; 2009 Oct 1; Miami, FL. [view]

DRA: Health Systems
DRE: Prevention, Prognosis
Keywords: none
MeSH Terms: none