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The ecology of patient and caregiver participation in consultations involving advanced cancer.

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Title: The ecology of patient and caregiver participation in consultations involving advanced cancer.
Authors: Freytag, Jennifer, Street Jr, Richard L., Xing, Guibo, Duberstein, Paul R., Fiscella, Kevin, Tancredi, Daniel J., Fenton, Joshua J., Kravitz, Richard L., Epstein, Ronald M., Street, Richard L Jr (AUTHOR)
Source: Psycho-Oncology. Jun2018, Vol. 27 Issue 6, p1642-1649. 8p. 4 Charts.
Subjects: Cancer case studies, Patients' attitudes, Caregivers, Medical consultation, Patient participation, Tumor treatment, Tumors & psychology, Psychology of caregivers, Communication, Cooperativeness, Medical referrals, Patient education, Physician-patient relations, Secondary analysis
Abstract: Objective: To identify predictors of participation of patients with advanced cancer in clinical encounters with oncologists and to assess the impact of patient and caregiver participation on perceptions of physician support.Methods: This is a secondary data analysis from the Values and Options in Cancer Care study, a cluster randomized clinical trial of a patient-centered communication intervention. Patients and caregivers completed pre-visit and post-visit health and communication measures. Audio recorded patient-caregiver (when present)-physician encounters were coded for active patient/caregiver participation behaviors (eg, question asking, expressing concern) and for physicians' facilitative communication (eg, partnership-building, support). Mixed linear regression models were used to identify patient, physician, and situational factors predicting patient and patient plus caregiver communication behaviors and post-visit outcomes.Results: Physician partnership building predicted greater expressions of concern and more assertive responses from patients and patient-caregiver pairs. Patients' perceptions of greater connectedness with their physician predicted fewer patient expressions of concern. Patient perceptions of physician respect for their autonomy were lower among patients accompanied by caregivers. Caregiver perceptions of physician respect for patient autonomy decreased with increasing patient age and varied by site.Conclusions: In advanced cancer care, patient and caregiver communication is affected by ecological factors within their consultations. Physicians can support greater patient participation in clinical encounters through facilitative communication such as partnership-building and supportive talk. The presence of a caregiver complicates this environment, but partnership building techniques may help promote patient and caregiver participation during these visits. [ABSTRACT FROM AUTHOR]
Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: The ecology of patient and caregiver participation in consultations involving advanced cancer.
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  Data: <searchLink fieldCode="AR" term="%22Freytag%2C+Jennifer%22">Freytag, Jennifer</searchLink><br /><searchLink fieldCode="AR" term="%22Street+Jr%2C+Richard+L%2E%22">Street Jr, Richard L.</searchLink><br /><searchLink fieldCode="AR" term="%22Xing%2C+Guibo%22">Xing, Guibo</searchLink><br /><searchLink fieldCode="AR" term="%22Duberstein%2C+Paul+R%2E%22">Duberstein, Paul R.</searchLink><br /><searchLink fieldCode="AR" term="%22Fiscella%2C+Kevin%22">Fiscella, Kevin</searchLink><br /><searchLink fieldCode="AR" term="%22Tancredi%2C+Daniel+J%2E%22">Tancredi, Daniel J.</searchLink><br /><searchLink fieldCode="AR" term="%22Fenton%2C+Joshua+J%2E%22">Fenton, Joshua J.</searchLink><br /><searchLink fieldCode="AR" term="%22Kravitz%2C+Richard+L%2E%22">Kravitz, Richard L.</searchLink><br /><searchLink fieldCode="AR" term="%22Epstein%2C+Ronald+M%2E%22">Epstein, Ronald M.</searchLink><br /><searchLink fieldCode="AR" term="%22Street%2C+Richard+L+Jr%22">Street, Richard L Jr</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Psycho-Oncology%22">Psycho-Oncology</searchLink>. Jun2018, Vol. 27 Issue 6, p1642-1649. 8p. 4 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Cancer+case+studies%22">Cancer case studies</searchLink><br /><searchLink fieldCode="DE" term="%22Patients'+attitudes%22">Patients' attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Caregivers%22">Caregivers</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+consultation%22">Medical consultation</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+participation%22">Patient participation</searchLink><br /><searchLink fieldCode="DE" term="%22Tumor+treatment%22">Tumor treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Tumors+%26+psychology%22">Tumors & psychology</searchLink><br /><searchLink fieldCode="DE" term="%22Psychology+of+caregivers%22">Psychology of caregivers</searchLink><br /><searchLink fieldCode="DE" term="%22Communication%22">Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Cooperativeness%22">Cooperativeness</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+referrals%22">Medical referrals</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+education%22">Patient education</searchLink><br /><searchLink fieldCode="DE" term="%22Physician-patient+relations%22">Physician-patient relations</searchLink><br /><searchLink fieldCode="DE" term="%22Secondary+analysis%22">Secondary analysis</searchLink>
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  Data: <bold>Objective: </bold>To identify predictors of participation of patients with advanced cancer in clinical encounters with oncologists and to assess the impact of patient and caregiver participation on perceptions of physician support.<bold>Methods: </bold>This is a secondary data analysis from the Values and Options in Cancer Care study, a cluster randomized clinical trial of a patient-centered communication intervention. Patients and caregivers completed pre-visit and post-visit health and communication measures. Audio recorded patient-caregiver (when present)-physician encounters were coded for active patient/caregiver participation behaviors (eg, question asking, expressing concern) and for physicians' facilitative communication (eg, partnership-building, support). Mixed linear regression models were used to identify patient, physician, and situational factors predicting patient and patient plus caregiver communication behaviors and post-visit outcomes.<bold>Results: </bold>Physician partnership building predicted greater expressions of concern and more assertive responses from patients and patient-caregiver pairs. Patients' perceptions of greater connectedness with their physician predicted fewer patient expressions of concern. Patient perceptions of physician respect for their autonomy were lower among patients accompanied by caregivers. Caregiver perceptions of physician respect for patient autonomy decreased with increasing patient age and varied by site.<bold>Conclusions: </bold>In advanced cancer care, patient and caregiver communication is affected by ecological factors within their consultations. Physicians can support greater patient participation in clinical encounters through facilitative communication such as partnership-building and supportive talk. The presence of a caregiver complicates this environment, but partnership building techniques may help promote patient and caregiver participation during these visits. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/pon.4710
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              Text: Jun2018
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