Outcomes of Physicians' Communication Goals During Patient Interactions.

During healthcare visits, physicians may set communication goals such as providing their patient with information about treatment; however, no recommendations exist regarding which goals physicians should prioritize during their often-brief interactions with patients. Two studies examined five communication goals (providing information, reducing distress, increasing patient satisfaction, increasing patient adherence, and encouraging hope) in the context of physician-patient interactions and their relationship with patient and physician outcomes. In Study 1, audio-recordings of physician-patient interactions were coded by research assistants for goal-related content. In Study 2, patients reported their physician's use of each goal during the interaction. In both studies, patients and physicians reported visit outcomes. Within-study meta-analyses suggested that the goal of reducing distress, but not the other goals, was consistently related to improved outcomes in Study 1. All goals were related to improved outcomes in Study 2. We then computed sample-size-weighted meta-analytic effects of each goal on each outcome across both studies. These results suggested that all of the goals had similar-sized positive relationships with patient and physician outcomes across studies. These findings suggest that physicians should generally approach consultations with communication goals in mind, but prioritizing efforts to reduce distress may be particularly beneficial.

Should patients be optimistic about surgery? Resolving a conflicted literature.

Following surgery, some patients suffer distress, disappointment, regret, poor adjustment, and poor quality-of-life. Surgeons may define 'success' based on objective clinical outcomes, but patients' perceptions of surgical success rely primarily on a comparison to their initial expectations. We review the literature on the relationship between patients' surgical expectations and psychosocial outcomes and attempt to resolve a conflict in the literature. Specifically, we propose that conflicting conclusions regarding the merits of optimism primarily stem from differing methodological approaches by researchers in the field. Studies that examine preoperative expectations in isolation typically conclude that optimism is positively associated with beneficial psychosocial outcomes. Studies that compare preoperative expectations to objective surgical outcomes typically conclude that optimism, particularly unrealistic optimism, is associated with detrimental psychosocial outcomes. As a whole, the evidence strongly supports an association between optimistic expectations and positive psychosocial outcomes following surgery if those expectations are based in reality. If preoperative optimism ultimately turns out to be unrealistic, however, it is likely to be a postoperative liability.

Two definitions of waiting well.

Waiting for uncertain news is often distressing, at times even more distressing than facing bad news. The goal of this article was to investigate strategies for "waiting well" during these periods of uncertainty. Specifically, we propose 2 definitions of waiting well. First, people can wait in such a way as to ease their distress during the waiting period. Second, people could wait in such a way as to ease the pain of bad news or enhance the thrill of good news. We conducted a longitudinal study of law graduates (N = 230) awaiting their result on the California bar exam. Participants completed questionnaires prior to the exam, every 2 weeks during the 4-month waiting period, and shortly after learning whether they passed or failed. Cross-lagged models revealed that participants were quite unsuccessful at waiting well by our first definition. That is, their coping strategies were ineffective for reducing distress associated with uncertainty, apparently even backfiring in some cases. However, multiple regression analyses examining relationships between waiting experiences and responses to good and bad news found that many participants were successful at waiting well according to our second definition: Participants who suffered through a waiting period marked by anxiety, rumination, and pessimism responded more productively to bad news and more joyfully to good news, as compared with participants who suffered little during the wait. These findings substantiate the difficulty of enduring a stressful waiting period but suggest that this difficulty may pay off once the news arrives.

Waiting for a baby: Navigating uncertainty in recollections of trying to conceive.

OBJECTIVE: Guided by the uncertainty navigation model, this study examined experiences of uncertainty associated with trying to conceive and identified predictors of this experience using a multi-method approach. METHOD: 429 American adults from Amazon's Mechanical Turk who had a child under age three completed online questionnaires regarding their experiences trying to conceive, including recollections of psychological adjustment, use of coping strategies, and individual and situational variability. Then they provided open-ended reflections of their experience trying to conceive. Participants' descriptions were analyzed for word use using LIWC, a text-analysis software program, to obtain an unobtrusive and pseudo-observational measure of coping resources. RESULTS: Consistent with the uncertainty navigation model, recollections of distress as individuals tried to conceive were associated with lower levels of dispositional optimism; intolerance of uncertainty; fewer social, emotional, and cognitive resources (reflected in word use); placing greater importance on conception; lower risk for infertility; and less searching for meaning in life. CONCLUSIONS: This study revealed many novel insights regarding the experience of trying to conceive, including protective factors and vulnerabilities that may buffer or heighten the distress associated with this experience.

Patients' anxiety and hope: predictors and adherence intentions in an acute care context.

CONTEXT: Good patient-provider interactions promote satisfaction with health care, adherence to treatment recommendations and improved health. However, little research has examined patients' emotions and how they relate to patients' experiences with health care and their adherence intentions in acute care settings. OBJECTIVE: This study examined the predictors and consequences of two emotions pertinent to the uncertainty of acute health-care experiences: anxiety and hopefulness. DESIGN: Patients who arrived at a general surgery clinic for an initial consultation were interviewed before and after the consultation. Prior to the consultation with a physician, patients completed baseline measures of their emotional state. Following the consultation, patients completed measures of understanding of the information provided by the surgeon, perceived control over treatment decisions, adherence intentions and emotional state. RESULTS: Understanding and control predicted less anxiety and greater hopefulness, compared to baseline. Only hopefulness predicted adherence intentions. These relationships remained even after controlling for characteristics of the patients and interactions. DISCUSSION: These findings identify aspects of psychosocial care that are critical for promoting positive (and mitigating negative) emotional states in patients. Even in a brief consultation in a clinic setting, physicians may be able to improve patients' emotional state by promoting a sense of control and clarifying information they convey, and patients' positive emotional states may be critical for raising adherence intentions.

Expectations in the context of gallbladder and hernia surgery: a descriptive report.

OBJECTIVE: Patients' expectations predict important health outcomes. The goal of this study is to describe the types of expectations that hernia and gallbladder patients have for the outcomes of their surgery and to identify relationships between these expectations and both patient- and surgeon-reported variables. DESIGN: Patients (N = 143) at an out-patient surgery clinic completed self-report questionnaires before and after a pre-surgical consultation in which they learned they would be scheduled for surgery. After indicating their general expectations for their surgical outcomes (positive or negative), patients reported specific outcome expectations, which were coded into eight categories: functional improvement, symptom relief, quality-of-life improvement, emotional improvement, general health, no effect expected, no response (or unsure) and negative expectations. RESULTS: Functional improvement and symptom relief were the most common types of expectations mentioned by patients. A key finding was a significant difference in the pattern of expectations provided by Hispanic versus non-Hispanic patients, as well as between patients across the range of health literacy. CONCLUSIONS: Patients undergoing hernia and gallbladder surgery have a variety of expectations, and these expectations vary across demographic groups. Patients who are particularly vulnerable to poor physician communication have positive but diffuse expectations.

Mapping individual differences in the experience of a waiting period.

Waiting for uncertain news, such as the outcome of a job interview or medical test, is a ubiquitous and difficult but little studied experience. We conducted a longitudinal examination, guided by the predictions of the uncertainty navigation model (Sweeny & Cavanaugh, 2012), to examine broad trends and individual differences in experiences during a consequential waiting period. Fifty students preparing for the California bar exam completed questionnaires at 6 time points: shortly before and after the exam, at 2 intermediate time points during the 4-month waiting period, and immediately before and after learning whether they passed. We identified key individual differences in the overall experience of a waiting period, such that dispositional optimists reported lower levels of anxiety and rumination on average, and defensive pessimists and people uncomfortable with uncertainty reported higher levels. Longitudinal growth curve modeling analyses suggested that waiting is most difficult at the start and end of a waiting period, although people maintained hope and optimism throughout the wait. These temporal trends were generally robust, although some individual differences emerged. These findings provide the first evidence regarding when and for whom waiting periods are most difficult and thus can serve as the basis for future investigations of waiting experiences.

The relative importance of patients' decisional control preferences and experiences.

OBJECTIVE: Patients' role in treatment decision-making can influence psychosocial and health-related outcomes (i.e. satisfaction, felt respect, adherence). We examined decisional control in a surgical context, identifying correlates of patients' preferences and experiences. DESIGN: 380 patients and 7 surgeons were surveyed during initial surgical consultation visits in a low-income outpatient clinic. MEASURES: Patients reported preferences for (pre-consultation) and experiences of (post-consultation) decisional control, demographics, satisfaction with care, and adherence to treatment recommendations. Surgeons rated patients' health status. RESULTS: Preferences for and experiences of decisional control were unrelated, suggesting significant preference-experience misalignment. However, this misalignment did not appear to be consequential for patient outcomes. Rather, more decisional control, regardless of patients' preferences, predicted greater satisfaction with care and greater self-reported adherence as assessed at a post-surgical appointment. CONCLUSIONS: Decisional control predicts better outcomes for patients, regardless of their preferences for control over treatment decisions. These findings suggest that interventions should aim to increase patients' degree of decisional control when feasible and appropriate.

Predictors of genetic testing decisions: a systematic review and critique of the literature.

Genetic testing is increasingly available in medical settings and direct-to-consumer. However, the large and growing literature on genetic testing decisions is rife with conflicting findings, inconsistent methodology, and uneven attention across test types and across predictors of genetic testing decisions. Existing reviews of the literature draw broad conclusions but sacrifice nuanced analysis that with a closer look reveals far more inconsistency than homogeny across studies. The goals of this paper are to provide a systematic review of the empirical work on predictors of genetic testing decisions, highlight areas of consistency and inconsistency, and suggest productive directions for future research. We included all studies that provided quantitative analysis of subjective (e.g., perceived risk, perceived benefits of testing) and/or objective (e.g., family history, sociodemographic variables) predictors of genetic testing interest, intentions, or uptake, which produced a sample of 115 studies. From this review, we conclude that self-reported and test-related (as opposed to disorder-related or objective) predictors are relatively consistent across studies but that theoretically-driven efforts to examine testing interest across test types are sorely needed.