Conceptualizing Health Communication and its Impact on Patient Outcomes in Oncology Outpatient Settings: A Mixed-Methods Study.

OBJECTIVES: Informed by the dual process theory of supportive message, the aim of this study is to systematically describe symptom communication, including its relationship with patient outcomes. DATA SOURCES: This is a mixed-methods study with an exploratory design. By examining symptom communication that occurred in oncology and hospice outpatient clinics, the qualitative phase employed conversation analysis to validate a typology of interaction patterns. The subsequent quantitative phase examined the relationship between interaction patterns and patient outcomes. CONCLUSION: A total of 52 cancer patients' outpatient communications with their health care providers were included in the analysis. Ten unique interaction patterns were identified and defined. Among the 10 interaction patterns, some patterns are significantly associated with critical patient outcomes, including satisfaction, health communication self-efficacy, and symptom agreement between patients and their health care providers. This study represents one of the few mixed-methods studies to examine the patterns of real outpatient symptom communications and link them to concrete patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Our results present various interaction patterns that are commonly used in medical encounters and suggest that using some patterns affects critical patient outcomes.

Communication in Oncology Outpatient Clinic Settings: Congruence of Quality of Life Assessment between Patient-Physician and Patient-Caregiver Dyads.

Objectives: The aims of this study were to investigate the congruence of HRQOL reports between patient-physician and patient-caregiver dyads and to determine the association of variables, if any, with the congruence between dyads. Methods: This correlational study with a cross-sectional design first approached physicians who provided care for patients with advanced cancer at the participating institution. Then, participating physicians' patients and their caregivers were recruited. All participants were required to independently fill out an HRQOL questionnaire during their outpatient visits. Descriptive statistics, weighted kappa, Wilcoxon signed-rank test, and linear regression were employed for data analysis. Results: A total of 52 patient-physician and 27 patient-caregiver dyads were examined. Patients suffered from considerable problems in all three HRQOL domains: symptom, functioning, and overall HRQOL. The patients' level of agreement was moderate with the caregivers and fair with the physicians. A significant relationship was found between several patient-related variables and disagreement. Conclusion: These patients with advanced cancer experienced a compromised HRQOL, warranting immediate attention. When there are barriers to obtaining a patient's self-report, clinicians may consider caregivers as a reasonable source. Patients with special characteristics need additional attention because their problems may be at a greater risk of being overlooked.

Neuro-Cognitive Differences in Semantic Processing Between Native Speakers and Proficient Learners of Mandarin Chinese.

The present study aimed to investigate the neural mechanism underlying semantic processing in Mandarin Chinese adult learners, focusing on the learners who were Indo-European language speakers with advanced levels of proficiency in Mandarin Chinese. We used functional magnetic resonance imaging technique and a semantic judgment task to test 24 Mandarin Chinese adult learners (L2 group) and 26 Mandarin Chinese adult native speakers (L1 group) as a control group. In the task, participants were asked to indicate whether two-character pairs were related in meaning. Compared to the L1 group, the L2 group had greater activation in the bilateral occipital regions, including the fusiform gyrus and middle occipital gyrus, as well as the right superior parietal lobule. On the other hand, less activation in the bilateral temporal regions was found in the L2 group relative to the L1 group. Correlation analysis further revealed that, within the L2 group, increased activation in the left middle temporal gyrus/superior temporal gyrus (M/STG, BA 21) was correlated with higher accuracy in the semantic judgment task as well as better scores in the two vocabulary tests, the Assessment of Chinese character list for grade 3 to grade 9 (A39) and the Peabody Picture Vocabulary Test-Revised. In addition, functional connectivity analysis showed that connectivity strength between the left fusiform gyrus and left ventral inferior frontal gyrus (IFG, BA 47) was modulated by the accuracy in the semantic judgment task in the L1 group. By contrast, this modulation effect was weaker in the L2 group. Taken together, our study suggests that Mandarin Chinese adult learners rely on greater recruitment of the bilateral occipital regions to process orthographic information to access the meaning of Chinese characters. Also, our correlation results provide convergent evidence that the left M/STG (BA 21) plays a crucial role in the storage of semantic knowledge for readers to access to conceptual information. Moreover, the connectivity results indicate that the left ventral pathway (left fusiform gyrus-left ventral IFG) is associated with orthographic-semantic processing in Mandarin Chinese. However, this semantic-related ventral pathway might require more time and language experience to be developed, especially for the late adult learners of Mandarin Chinese.