Background:

Constructive interactions with healthcare providers are not only crucial for achieving quality care delivery, but they also contribute to improved outcomes for cancer patients. This study examines the relationship between personal health literacy and perceived patient-centered communication quality (PPCQ).

Methods:

A cross-sectional analysis examined the relationship between health literacy constructs and PPCQ (a composite score of seven items), using the Health Information National Trends Survey (HINTS) 5, Cycle 4 (2020). Descriptive statistics detailed how health literacy and PPCQ vary among different racial/ethnic groups. A multiple regression determined which health literacy construct (finding, understanding, or using information to inform health-related decisions/actions) is the strongest predictor of PPCQ. Control variables included sociodemographics, health insurance coverage, and health status.

Results:

The sample included 579 adult respondents with a history of cancer who had seen a healthcare provider within the past 12 months (weighted n = 21,036,645). The majority of the sample identified as Non-Hispanic White, female, in good health, and insured, with a mean age of 67. Asian/Native Hawaiian/other Pacific Islander individuals had the lowest means for the health literacy constructs: find and understand. Each health literacy construct was positively associated with PPCQ (p<0.0001). The strongest predictor of PPCQ was understanding health information to inform health-related decisions and actions (p<0.0001).

Conclusion:

Implementing standardized practices is necessary to ensure that providers communicate effectively and patients have an active role in the relationship. Policies should reflect a commitment towards improving personal and organizational health literacy.

Background: An effective vaccine against human papillomavirus (HPV-Vx) exists but is vastly underutilized. Although routinely recommended at ages 11-12, HPV-Vx is approved at 9-10 years.

Objective: To describe provider and staff experiences with feasibility and acceptability of initiating HPV-Vx at 9-10 years.

Design/Methods: As part of an ongoing randomized trial comparing initiation of HPV-Vx at age 9-10 (intervention) versus 11-12 (control) across 17 practices in CO (9 intervention) and 16 practices in CA (8 intervention), we administered a survey to intervention group providers and conducted semi-structured interviews with intervention group providers and staff ≤3 months after launch.

Results: 66 (92%) CO providers and 39 (87%) CA providers completed the surveys; 18 providers and 17 staff completed interviews. Of survey respondents, 59 (90%) in CO and 30 (77%) in CA were routinely recommending HPV-Vx at ages 9-10. Among these, most respondents reported either no change or improvement in factors such as parental concerns (83% CO, 84% CA) and discussion times (78% CO, 73% CA). Interviewees reported many parents were receptive to early vaccination, with pushback often stemming from child expectations for a vaccine-free visit rather than vaccine concerns. Interviewees also reported shorter HPV-Vx conversations at age 9-10 because sexual activity was not discussed. Additionally, early initiation allowed for fewer simultaneous vaccinations at age 11, which was sometimes preferred.

Conclusions: These findings show recommending HPV-Vx at ages 9-10 was feasible for clinicians and generally acceptable to parents. Trial results will determine if early initiation of HPV-Vx increases vaccination completion rates.

Background: Open communication between patients and providers is important for diabetes management and overall health maintenance. This qualitative study explored patients’ experiences and perceptions regarding communication and diabetes-specific self-advocacy during clinical encounters among participants of a community-based lifestyle intervention.

Methods: Semi-structured interviews (n=45) and 6 focus groups (n=25) were conducted with participants of a 12-week, health coach-led Diabetes and Hypertension Self-Management Program (DHSMP), implemented in churches in West Virginia. Three independent coders used thematic analysis to identify themes/subthemes related to the study’s purpose.

Results: Several themes emerged from the data. Participants generally perceived the ability to self-advocate as important and noted that it fosters partnership with their providers, brings attention to patient concerns, especially related to medication, and aids patient-provider discussion regarding self-care topics rather than just “the numbers” (HbA1c). A primary patient-related theme affecting communication was empowerment through education. Program participation improved knowledge about their diabetes, which translated to more questions/discussion with providers. Some participants also mentioned that support received from their health coaches/peers empowered them to be more confident communicating with their healthcare team. Main provider-related themes included providers being attentive and nonjudgmental, being open to discussing research or new treatments that patients are interested in and being accessible outside of appointments via phone or patient portal messaging if needed.

Conclusion: Study findings offer unique patient perspectives for self-advocacy as being important for disease management. In addition, intervention delivery by trained health coaches was well received and empowered patients to improve communication and diabetes-specific self-advocacy during clinical encounters.

Pre-exposure prophylaxis (PrEP) to prevent HIV infection, has been available to the public for almost 11 years. However, many people, especially cisgender women, are unaware of it. Barriers previously identified regarding this disparity is the lack of patient-provider consultations about HIV prevention and sexual health. The objective of this study was to assess the perspectives of Latina cisgender women in Puerto Rico (PR) discussing sexual health and HIV prevention practices, especially PrEP, with healthcare providers (HCP). A mixed-methods study was employed. An online survey evaluating attitudes towards PrEP was available from February-July 2021 among (n=174) sexually active cisgender adult women in PR. Semi-structured interviews with 15 surveyed participants, collected data about discussing HIV prevention practices and sexual health with their HCP. Descriptive statistics and thematic analysis were completed, respectively. About 79.3%(n=138) reported having a primary doctor, yet only 12.1%(n=21) talked with a healthcare provider about HIV prevention, including PrEP, in the past year. While 70.7%(n=123) did not know about PrEP, 84.5%(n=147) would like to learn more about it. From the interviews, results show the lack of sexual health communication with providers: “I have not talked about HIV with any of my providers”. Others discussed initiating such conversations: “He never talked to me about HIV. I am the one who asked him if he could give me a referral to get tested for HIV.” Our findings suggest that Latina cisgender women in PR have insufficient support from their providers to discuss their sexual health and HIV prevention practices. Sexual health promotion, including HIV prevention, is critical to ending the HIV epidemic.

Background: Post COVID-19 pandemic research shows, when trust is present in the patient provider relationship preventative services are more likely to be used. Screening predictors such as communicating cultural competence and fostering trust remain social challenges for providers. Often social partnerships between patient and provider are difficult to build. The purpose of this study is to describe a video created for breast and cervical cancer screening providers to use therapeutic communication. The aim is to increase cultural competence and trust among women who need screening services.

Methods: A descriptive quantitative study was used to assess breast and cervical cancer screening providers' trust building communication skills. Breast and cervical cancer providers partner with the Pennsylvania Breast and Cervical Cancer Early Detection Program. The program surveyed providers using a voluntary, confidential tool.

Results: Providers reported interest in the training and increased perceived awareness of their ability to foster a culturally competent and honest patient provider relationship. As was hypothesized, all perceptions of therapeutic communication to build social partnerships was positive.

Conclusion: The present study supported the need for cancer screening providers to interact with direct training on therapeutic communication including cultural competency and trust building to become more comfortable creating social partner relationships with patients. The study also reinforces the need for cancer screening providers to be educated in communication and relationship building.

Background: In July 2021, the North Dakota State University Center for Immunization Research and Education (CIRE) received a three-year, multimillion-dollar grant to increase state COVID-19 vaccination rates. The first year saw physician “VaxChamps” present data-focused peer-to-peer education on vaccine safety, efficacy, and necessity to healthcare professionals. As vaccination rates plateaued, VaxChamps’ presentations pivoted to emphasizing communications strategies to strengthen patient-provider relations.

Methods: This presentation draws from an ongoing ethnographically-oriented process evaluation that began in July 2021. Qualitative data include longitudinal semistructured interviews with VaxChamps (n=17); observational fieldnotes from team meetings and peer-to-peer education; document review of presentation materials; and reflective team discussions. Thematic analysis is iteratively informed by immersion in the project and triangulation of data sources.

Results: In interviews and reflective discussions, VaxChamps expressed ambivalence about giving data-focused presentations and spoke of their attempts to couch data in more appealing narrative and emotional contexts. As VaxChamps switched presentation content, they expressed more interest and engagement in the communications material. Additionally, participants reported increased confidence to discuss vaccines with vaccine-hesitant patients. Observational fieldnotes also documented increased interaction among VaxChamps and audience members as the content shifted to a communications focus.

Conclusions: Inundating healthcare professionals – and patients – with information about COVID-19 vaccines has limited effectiveness when encouraging vaccination among vaccine-hesitant patients, as the first year of our project demonstrated. The pivot to emphasizing new forms of communication – with providers as partners rather than as authoritative educators – may help shift clinical encounters to prioritize relationships over information.

Background

Serious illness conversations focusing on a patient's goals, values, and priorities can reduce psychological distress and lead to improved quality of life. Training healthcare professionals (HCPs) in serious illness conversations can help improve competence and conversation quality; however, training is limited in scale and accessibility. Chatbots can be used to train and reinforce communication skills.

Methods

We developed a chatbot prototype that follows the Serious Illness Conversation Guide (SICG) for HCPs to practice skills critical to navigating conversations with patients diagnosed with life-limiting illnesses. SICG content experts adapted a roleplay case scenario involving a reluctant patient with recurrent metastatic cancer. Chatbot users can advance through the scenario, choose a reply, receive feedback, and verbally rehearse and record responses. We held interviews with HCPs (N=7) trained in the SICG to gather feedback on usability, overall impressions, suggestions for improvement, and perceived barriers to implementation.

Results

HCPs reported high usability, with a mean System Usability Score of 72 (SD=10.1). Qualitative feedback was generally positive and HCPs were enthusiastic about the chatbot’s perceived utility as an accessible, asynchronous training tool. Most HCPs agreed that practicing aloud is important and beneficial to HCPs regardless of experience level. Recommendations to enhance chatbot content and user experience were obtained for future work.

Conclusion

We demonstrated usability and acceptability of a chatbot that addresses a gap in patient-provider communications and can potentially improve the quality of patient-centered care. Further work is needed to enhance and test the chatbot among HCPs serving various geographies.

Childhood cancer survivors, who delay initiation of recommended vaccinations during cancer directed therapy, have lower rates of HPV vaccination coverage than their peers in the general population. Survivors are at higher risk for developing HPV-associated cancers in adulthood. The HPV Cancer Prevention and Transition Oncology Programs (TOP) at St. Jude Children’s Research Hospital, engaged in an ongoing quality improvement initiative to increase HPV vaccination rates in survivors of childhood cancer who have recently completed their cancer-directed therapy. The premise was to address gaps in strong presumptive recommendations of HPV vaccination between pediatric oncologists and pediatric care providers.

Patients age ≥ 9 years who are followed by TOP and who are at least one-year post-completion of cancer-directed therapy were identified. HPV vaccination promotion packets were sent to parents/caregivers or patients during the month of their off-therapy anniversary. Concurrently, letters were sent to the patient’s primary care provider encouraging them to make a strong, presumptive recommendation for HPV vaccination at the patient’s next visit.

Three hundred and eighty-five packets and letters were distributed in 2022. In January of 2023, one year following the launch of the QI project, the project team initiated review of patient medical and immunization records to extract dates of HPV vaccine initiation and completion. Letters will be sent to patients who have not initiated or completed the HPV vaccine series The intent is that this new practice positively impacts HPV vaccination uptake in early survivors of childhood cancer, preventing future cancer diagnosis.

The effectiveness of the project is currently being evaluated and will be adapted as needed.

Motivational interviewing (MI) is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. MI is applicable to many healthcare disciplines where boosting patient motivation and evoking statements favoring change, known as change talk, are key to improved health. Clinicians can recognize patients’ thoughts of changing behavior and nurture their commitment towards a particular goal.

Clinicians can practice using MI, specifically related to risk of opioid use disorder (OUD), in a new training developed by the Centers for Disease Control and Prevention (CDC). In this training, clinicians identify core components of clinical MI and how it can be applied to help patients with pain make beneficial changes. Additionally, a MI patient case scenario provides clinicians with opportunities to practice effective communication strategies that can help empower patients to make positive changes, an important step towards improving patient outcomes and reducing the risk of opioid misuse or OUD.

The lessons learned and skills acquired in the training can be applied to the implementation of CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain. Implementation of this guideline can help to ensure persons have equitable access to safe and effective pain management and offers opportunities to improve communication between clinicians and patients to make informed, person-centered decisions related to pain care. Through practice and application of MI, clinicians can improve their relationships with patients and motivate them to make behavioral changes critical to their health.

Background:

Activate Teen (AT) is a starter kit for teens who don’t know how or what to talk about with providers. AT encourages teens to get thinking about their health care appointment prior to the visit. This process ensures teens are getting the most out of that time with their provider. AT is sent when adolescents schedule an appointment; once AT kit is delivered teens “activate” their kit by scanning a QR code secured on the kit; AT teens then discover connections between products and questions they have; and lastly, the appointment guide included in the kit is tailored prior to or during their visit.

Methods:

Researchers utilized a mixed methods approach to follow usage and interest trends among AT users. The first strategy involved tracking the number of times a QR code was used and which of the corresponding resources were most utilized. Second, during mock appointments teens were given the opportunity to exhibit how the AT kit helped them be more autonomous and comfortable within the health care visit process.

Results & Conclusion:

AT helped support teens as they prepared for their healthcare visit with their provider. This process encouraged teens to think about what they wanted to discuss, write down their questions and concerns before getting in front of their provider, as well as establish a strong patient provider relationship. This session will cover qualitative themes and QR code trends among AT users. Ultimately, providing AT motivates teens to get involved in their health while promoting autonomy.