Genetic counselors routinely provide service in many environments, including counseling‐type and medical‐type rooms; in this study, counseling environments are characterized by office décor that facilitates discussion around a seated table, while medical environments include an exam table and separate seating. Outside of the genetic counseling context, manipulation of the environment can influence client comfort in disclosing personal information, well‐being, and overall satisfaction with clinician communication. However, there is little known about how clients experience genetic counseling in one environment versus the other and how that might influence their evaluation of genetic counselor communication. To explore the extent to which the physical environment influences client perceptions, we video recorded two simulated sessions addressing the same genetic counseling topic with two contrasting styles of communication (more and less patient‐centered) in front of a greenscreen background. Videos were digitally placed in counseling and medical environments such that the same verbal and nonverbal communication was presented in the two environments, creating a total of four videos (e.g., a 2 × 2 experimental design). Participants ( N = 861) were randomly assigned to observe one of the four videos and respond as if they were the client in the video (e.g., as analog clients). Overall, participants rated the less patient‐centered communication more favorably ( p < 0.05 across variables), contrary to our expectations. Structural equation modeling revealed that perceptions of nonverbal communication mediated the relationship between communication style and perceptions of the counselor's encouragement of participation in the session and the therapeutic bond. Results offer insight into how the physical environment might influence communication in genetic counseling, illustrating new avenues for improving client‐counselor communication in this context.

OBJECTIVE:To examine the relationships between genetic counseling students' use of screensharing and nonverbal communication with verbal communication and standardized patient satisfaction during simulated telehealth visits. METHODS:From 2021-2022, 59 genetic counseling students from the U.S. and Canada conducted video-recorded standardized patient sessions via Zoom. Session recordings were coded using the Roter Interaction Analysis System (RIAS) and the standardized patients completed post-session satisfaction questionnaires. All instances and the total duration of screensharing during each session were recorded by watching the video recordings in full. Nonverbal communication behaviors (nodding, smiling, hand gesturing, eye gaze, forward lean, distance from the camera, and camera angle) were coded from systematic "thin slice" samples of between 15 and 30 s segments from throughout each session. Multiple linear regression models assessed relationships between the students' nonverbal behaviors, use of screensharing, verbal communication, and standardized patients' satisfaction with session communication. RESULTS:Increased screensharing was associated with decreased use of facilitating statements (p < 0.05), decreased patient-centeredness (p < 0.01), and increased verbal dominance (p < 0.05). Nodding was negatively correlated with verbal dominance (p < 0.05). Forward lean was positively correlated with standardized patient satisfaction with session communication (p < 0.05). CONCLUSION:Screensharing, nodding, and forward lean may affect patient-provider communication via telehealth in ways that are analogous to in-person clinical interactions. PRACTICE IMPLICATIONS:The possible negative consequences of screensharing suggest a need for additional research to inform best practices for providing patient-centered care in the telehealth setting.

ObjectiveThe study objective is to evaluate an adaptation of the LEAPS skill framework for cancer care partners (CPs) focusing on autonomy enhancing skills and assessed by strong behavioral intention (SBI) to use these skillsMethodCancer CPs were recruited through public platforms to view and rate 4 LEAPS cancer-specific narratives and 52 skill demonstration videos, indicate SBI to use demonstrated skills and provide information on skill-related measures.ResultsHalf of CPs expressed SBI to use an average of 6.5 of 13 LEAPS skills which did not vary by LEAPS communication domains or examples used to demonstrate skills. Significant predictors of SBI include positive ratings of program narratives and past use of LEAPS-related behaviors in the communication domain of shared decision making (SDM).ConclusionCPs indicated SBIs to use multiple autonomy enhancing skills and positively rated program videos after exposure to the brief LEAPS training program.Practice implicationsThe brevity of the LEAPS training videos make it possible for users to view an individual cancer-specific narrative and 13 skill demonstrations in roughly 6 min. This ultra-brief training can benefit care partners and the patients they accompany by increasing the likelihood that autonomy enhancing skills are used during accompanied visits.

The therapeutic relationship is a key component of successful genetic counseling. In psychotherapy, a strong therapeutic relationship can improve patient health outcomes and a poor relationship can worsen psychological functioning. Investigation of the therapeutic relationship in genetic counseling has shown evidence for a similar pattern. Reliable measurement of the therapeutic relationship is necessary for consistency across studies in the genetic counseling context. One measure that has been adapted for use in genetic counseling is the Working Alliance Inventory (WAI). However, there have been no studies of the factor structure or item-level method bias analyses for the genetic counseling-adapted version of the WAI. The goal of this study was to test the factor structure of the WAI observer version (WAI-O) bond subscale and assess method bias in a genetic counseling context. We hypothesized that differences in factor structures would exist for items that were positively (n = 9) versus negatively (n = 3) worded (reverse coded). Secondary data analysis was performed on two data sets that utilized the WAI-O in genetic counseling contexts. Data set 1 used simulated genetic counseling sessions that were judged by analog clients recruited through crowdsourcing platforms (N = 861). Data set 2 was conducted with genetic counseling clients, and sessions were evaluated by a research team (N = 120). Principal axis factor analysis with oblique oblimin rotation supported a two-factor solution for the WAI-O bond subscale across data sets. Items factored based on wording, with the positively worded items loading together and the negatively worded items loading on the second factor. Confirmatory factor analyses supported the removal of all negatively worded items from the instrument across data sets. Results suggest that the negatively worded items on the WAI-O may be capturing a construct inconsistent with the positively worded items and support rewording and/or excluding them from use for a more reliable measure of the therapeutic bond.

ObjectiveTo assess the Behavioral Intention Predictive Framework's utility in explaining variation in cancer patients' strong behavioral intention (SBI) to use LEAPS (Listen, Educate, Assess, Partner, Support) communication skills after viewing training videos.MethodsNinety-eight patients were enrolled through anonymized online platforms to view LEAPS training videos, complete background and communication questionnaires and report their SBI to use LEAPS skills.ResultsOn average, patients indicated SBI to use 6 of 13 skills and 46% of patients expressed SBI across individual skills. The framework explained 27.7% of the adjusted variance in SBI with significant predictors of frequent past use of LEAPS-related shared decision-making behaviors, poor emotional health, being rarely accompanied to visits and positive ratings of narrative videos. Finally, 21.7% of the adjusted variance in problem communication was explained by infrequent use of LEAPS-related information behaviors, patient accompaniment of another adult and positive narrative scores.ConclusionPatients SBI to use multiple LEAPS skills and past problem communication were explained by framework predictors.InnovationDespite theoretical and empirical evidence that behavioral intention significantly predicts behavior, it has not been studied in patient communication research. Application of the novel framework to LEAPS training videos contributes an innovative address of this research gap.

Clinician racial bias has been associated with less patient-centered communication, but little is known about how it affects trainees' communication. We investigated genetic counseling students' communication during sessions with Black or White standardized patients (SPs) and the extent to which communication was associated with SP race or student scores on the Race Implicit Association Test (IAT). Sixty students conducted a baseline SP session and up to two follow-up sessions. Students were randomly assigned to a different White or Black SP and one of three clinical scenarios for each session. Fifty-six students completed the IAT. Session recordings were coded using the Roter Interaction Analysis System. Linear regression models assessed the effects of IAT score and SP race on a variety of patient-centered communication indicators. Random intercept models assessed the within-student effects of SP race on communication outcomes during the baseline session and in follow-up sessions (n = 138). Students were predominantly White (71%). Forty students (71%) had IAT scores indicating some degree of pro-White implicit preference. Baseline sessions with White relative to Black SPs had higher patient-centeredness scores. Within-participant analyses indicate that students used a higher proportion of back-channels (a facilitative behavior that cues interest and encouragement) and conducted longer sessions with White relative to Black SPs. Students' stronger pro-White IAT scores were associated with using fewer other facilitative statements during sessions with White relative to Black SPs. Different patterns of communication associated with SP race and student IAT scores were found for students than those found in prior studies with experienced clinicians.

The purpose of this investigation was to examine communication skill use and related characteristics, as well as factors associated with problematic communication during conferences, in parents and teachers of children on the autism spectrum (AS). Participants were 36 parent-teacher dyads who completed questionnaires on communication, defined within the Listen, Educate, Assess, Partners, Support (LEAPS) Model, as well as measures on problem-solving and relationship quality. Parents reported more frequent use of LEAPS-defined skills than teachers, as well as a more positive view of problem-solving and relationship quality. Both parents and teachers reported similar levels of problematic communication. Problematic communication was inversely associated with problem-solving and relationship quality for parents. For teachers, problematic communication was inversely related to skill use and relationship quality. Communication during parent-teacher conferences may be improved through LEAPS-based communication training for both teachers and parents. This training may diminish problematic communication and align cross-setting intervention practices, and subsequently optimize outcomes for children on the AS.

Technology provides opportunities to enhance communication skills training for genetic counseling graduate students. We assessed the acceptability of an online communication training program. Graduate student volunteers completed five online training modules on basic communication skills with opportunities to practice the skills within three simulated/standardized patient (SP) sessions. Participants completed online questionnaires reporting on acceptability, perceived usefulness, and realism of the modules and SP sessions. They also reported on the ease of transferring skills from the modules to clinical practice. Out of the 60 students who completed the baseline session, 35 (58%) completed all five training modules. Out of these 35 students, most found the modules to be useful (94%) and agreed that they were relevant to clinical practice (97%). At least 88% of participants found the genetic counselors, patient, and case scenarios to be realistic. Twenty-eight students had participated in clinical rotations since completing the intervention. Of these, 17 (61%) reported that it was at least slightly easy to use the skills in actual clinical cases. Most students also reported being able to transfer the skills they had learned into clinical practice. While the training was well-received, the relatively low completion rate of 58% raises concern that the intervention may need formal integration into the program curriculum to succeed due to the time and effort demands on students.

Communication is essential to effective genetic counseling, but few studies have systematically evaluated methods of assessing communication skills among genetic counseling trainees. The study's objective is to compare the strength of associations between standardized patient (SP) satisfaction with simulated genetic counseling sessions and student skill use during the sessions, as reported by SPs and students. We hypothesized that (1) Both SP- and student-reported skill use will be significantly associated with SP satisfaction ratings during the baseline simulation and (2): SP ratings of student skill use will show a stronger relationship to SP satisfaction than student self-rating of skill use. Sixty genetic counseling students and recent graduates (referred to as "students") from accredited U.S. and Canadian programs participated in the study and completed a baseline virtual-simulated genetic counseling session. Both students and SPs completed post-session questionnaires about communication skill use (a 22-item checklist) and SPs completed a satisfaction questionnaire based on the session (a 14-item Likert scale). Multilevel regression models assessed associations between SP satisfaction during the baseline session and SP- or student-reported skill use. SP satisfaction was significantly associated with skill use reported by both SPs and students, but the model based on SP report explained a higher proportion of the variance in SP satisfaction than student-reported skill use (SP model fixed effects R-2 = 27%, adjusted R-2 = 21%; vs. student model R-2 = 7%, adjusted R-2 = -2%). For both the SP and student models, use of more skills from the LISTEN domain (which focused on eliciting the patient's perspective) was associated with higher SP satisfaction, while other skill category domains were not. These findings support the SP satisfaction measure as sensitive to variation in student performance of key communication skills, especially those eliciting the patient's perspective. Moreover, SP assessment of session satisfaction can be a useful assessment of student communication performance and a meaningful proxy for actual patient satisfaction.

Communication is essential to effective genetic counseling, but few studies have rigorously evaluated Methods of teaching or assessing genetic counseling communication. We aimed to: 1) Compare the strength of associations between standardized client (SC)- and student-reported skill use and SC satisfaction with simulated genetic counseling sessions, and 2) Determine if brief, online communication skills training modules improved SC-reported skill use. We recruited genetic counseling students and recent graduates from accredited programs across the U.S. and Canada. Participants completed a baseline virtual simulated genetic counseling session and a follow-up session about five weeks later. Participants and SCs completed post-session surveys about communication skill use (a 22-item checklist) and session satisfaction (a 12-item Likert scale). Random intercept models assessed associations between SC satisfaction and either SC- or participant-reported skill use in the baseline session. Participants had been randomized to complete a series of modules either before (“immediate group”) or after (“delayed group”) the follow-up session. The online modules covered 22 communication skills that included effective elicitation of concerns, information exchange, shared decision-making, facilitation of adherence, and interpersonal rapport. Two-sample t-tests assessed differences in SC-reported skill use between the groups at follow-up. Sixty participants completed the baseline session, and 23 participants completed the follow-up session. At baseline, both SC- and participant-rated skill use were significantly associated with higher SC-rated satisfaction, but the model with SC-reported skill use explained a higher proportion of the variance in SC satisfaction scores (R2=76% versus R2=55%). At follow-up, SCs reported that immediate group participants used an average of two more skills than the delayed group (p=0.097). The communication skills modules increased students’ use of the target skills. Both SC- and student-reported skill use was positively associated with SC-reported satisfaction. These modules may complement existing teaching Methods: for genetic counseling students and other learners.

Family caregivers often accompany older patients to medical visits. To optimize care, it is important to understand communication during these triadic visits. In this study we examine the presence of a caregiver on the amount of biomedical and psychosocial-emotional talk during primary care visits. We leveraged a dataset of audiotaped primary care visits with 189 older ethnically Chinese and Latinx patients. We classified each visit according to a family caregiver's presence ('accompanied') or absence ('unaccompanied'). We used the Roter Interaction Analysis System to analyze the audiotapes, identifying and comparing frequency of biomedical and psychosocial-emotional communication elements between accompanied and unaccompanied visits. For accompanied visits, we first excluded and then included caregiver talk. Of the 189 visits, 60 (32%) were accompanied. Patients who were accompanied were on average older (77.5 vs. 67.2; p<.001), and more often had limited English proficiency (87% vs 62%; p<.001). Half (n=96) of all visits were fully, and 15 partially, language concordant in Chinese, English or Spanish; 66 visits had a professional interpreter present. For 11 (18%) accompanied visits, caregivers acted as interpreters. Doctors did not vary the frequency of biomedical or psychosocial-emotional talk between accompanied and unaccompanied visits. Patients in accompanied visits had less of every talk element compared with patients in unaccompanied visits, including medical information, medical questions, psychosocial and lifestyle information, psychosocial questions, and emotional talk (all p<.02). When adding caregiver talk, there was no longer a difference between accompanied and unaccompanied visits for any element except medical questions which was higher for accompanied visits (p=.02). Having a caregiver present did not change physician communication behavior. Caregivers were active participants for both biomedical and psychosocial-emotional communication. It remains unclear the best ways to elicit patients' communication preferences and to balance communication with patients and their caregivers during visits.

INTRODUCTION:Poor client-provider communication is a critical barrier to long-term retention in care among people living with HIV. However, standardized assessments of this key metric are limited in Africa. We used the Roter Interaction Analysis System (RIAS) to quantitatively characterize patterns of person-centred communication (PCC) behaviours in Zambia.METHODS:We enrolled pairs of people living with HIV making routine HIV follow-up visit and their providers at 24 Ministry of Health-facilities supported by the Centre for Infectious Disease Research in Zambia in Lusaka province between August 2019 and November 2021. Client-provider encounters were audio-recorded and coded using RIAS by trained research staff. We performed latent class analysis to identify interactions with distinctive patterns of provider PCC behaviours (i.e. rapport building, person-centred counselling, PCC micropractices [e.g. brief empathy statements], assessing barriers to care, shared decision-making and leveraging discretionary power) and compared their distribution across client, provider, interaction and facility characteristics.RESULTS:We enrolled 478 people living with HIV and 139 providers (14% nurses, 73.6% clinical officers, 12.3% were medical officers). We identified four distinct profiles: (1) "Medically Oriented Interaction, Minimal PCC Behaviours" (47.6% of interactions) was characterized by medical discussion, minimal psychosocial/non-medical talk and low use of PCC behaviours; (2) "Balanced Medical/Non-medical Interaction, Low PCC Behaviours" (21.0%) was characterized by medical and non-medical discussion but limited use of other PCC behaviours; (3) "Medically Oriented Interaction, Good PCC Behaviours" (23.9%) was characterized by medically oriented discussion, more information-giving and increased use of PCC behaviours; and (4) "Highly person-centred Interaction" (7.5%) was characterized by both balanced medical/non-medical focus and the highest use of PCC behaviours. Nurse interactions were more likely to be characterized by more PCC behaviours (i.e. Class 3 or 4) (44.8%), followed by medical officers (33.9%) and clinical officers (27.3%) (p = 0.031). Longer interactions were also more likely to integrate more PCC behaviours (p < 0.001).CONCLUSIONS:PCC behaviours are relatively uncommon in HIV care in Zambia, and often limited to brief rapport-building statements and PCC micropractices. Strengthening PCC, such as shared decision-making and leveraging discretionary power to better accommodate client needs and preferences, may be an important strategy for improving the quality in HIV treatment programmes.

Some 40% of older patients are routinely accompanied to their medical visits by care partners. When actively engaged in visit communication, or their engagement is heightened by pre-visit prompts, patients benefit by more patient-centered visits and higher visit satisfaction. Over 60% of patients with cancer are routinely accompanied to their medical visits by a care partner but relatively little is known about their visit communication, receptivity to skill training or if training might lead to greater active engagement in visit communication. The study objective is to explore these questions by having cancer care partners (CCPs) evaluate a brief CCP-focused intervention and explore their future intention to use skills. CCPs are defined here as unpaid adults who routinely accompany patients with breast, colon, prostate or lung cancer to their medical visits. We recruited CCPs through CloudResearch Prime Panels and enrolled 91 criteria-qualified participants. The CCPs were asked to evaluate four 2-minute cancer-specific narratives presented by a simulated video care-partner (SVCP) on four measures of authenticity and to rate a set of 13 SVCP demonstrated skills on clarity and their intention to use skills. CPs averaged 43 years old, were 64% female and mostly family members (88%). The majority of CCPs (68%) rated the narratives as completely authentic and skill clarity highly (4.2 on a 5-pt scale). They also expressed a strong intention to use 6.2 skills and a moderate intention to use 3.8 skills at an upcoming visit. CCPs positively evaluated the skills intervention and expressed strong to moderate intention to use demonstrated skills. This level of intention is associated with small to medium behavior change suggesting that a brief skills-focused training may heighten CCPs active engagement in visit communication and benefit patient outcomes in ways suggested by studies of older primary care patients.

Objective: To examine the efficacy of a brief, online intervention designed to enhance genetic counseling students' patient-centered communication.Methods: Genetic counseling students and recent graduates were randomized to two groups following a baseline standardized patient (SP) session: (1) immediate intervention exposure, which consisted of five modules that taught patient-centered communication skills followed by a second SP session, or (2) delayed intervention exposure following completion of the second session. Sessions were coded using the Roter Interaction Analysis System. Short-term efficacy was assessed by comparing communication during the second session between the delayed and immediate intervention exposure groups. Longer-term efficacy was assessed by comparing communication during a third session approximately five weeks later.Results: During the second session, students in the immediate intervention exposure group (n = 18) used more emotionally responsive statements and were more likely to use teach-back than those in the delayed intervention exposure group (n = 23). Students' emotionally responsive statements decreased among the immediate intervention exposure group during the third session.Conclusion: Exposure to the intervention was associated with multiple, positive changes to students' patientcentered communication behavior.Practice implications: These time- and resource-efficient modules may be beneficial as an introduction to communication skills training or a supplement to existing training.

Contracting is a skill used by genetic counselors (GCs) to establish a shared vision for the session. Ensuring that patients and GCs are aligned on expectations for the encounter allows GCs to meet patient needs and support patient autonomy. Although contracting is described in the practice-based competencies (PBCs), the process has not been systematically observed in practice. We sought to further elucidate the skills used for contracting within genetic counseling sessions through directed content analysis of transcripts from 148 simulated prenatal and cancer genetic counseling sessions. An a priori codebook and rating scale were developed based on four contracting sample skills described in the PBCs: (a) describing the genetic counseling process, (b) eliciting client concerns, (c) applying client concerns to a session agenda, (d) modifying the agenda in response to emerging concerns. The rating scale described the quality of each skill on a 4-point scale of "absent," "minimal," "adequate," and "excellent." The codebook and rating scale were pilot tested with 40% of transcripts (n = 60). Three authors independently coded and rated the final 60% of transcripts (n = 88), resolving discrepancies via a consensus process. We found that the four PBC skills were present in most sessions (88%-98%), and on average, GCs received "adequate" scores on all four skills. We also identified three additional components of contracting not described in the PBCs: assessing whether client concerns were met, inviting to interrupt, and providing opportunity for partner concerns. This study represents the first attempt to evaluate GC performance of a PBC during a genetic counseling session. Our findings demonstrate that the PBC sample contracting skills reflect practice and suggest that they can be used in assessment of the genetic counseling contracting process. This type of analysis could be adapted in the future to provide support for other standards of practice in the genetic counseling field.

Background: Limiting high-intensity exercise is recommended for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) due to its association with penetrance, arrhythmias, and structural progression. Guidelines recommend shared decision-making (SDM) for exercise level, but there is little evidence regarding its impact. Therefore, we sought to evaluate the extent and implications of SDM for exercise, decisional conflict, and decisional regret in patients with ARVC and at-risk relatives. Methods: Adults diagnosed with ARVC or with positive genetic testing enrolled in the Johns Hopkins ARVC Registry were invited to complete a questionnaire that included exercise history and current exercise, SDM (SDM-Q-9), decisional conflict, and decisional regret. Results: The response rate was 64.8%. Two-thirds of participants (68.0%, n=121) reported clinically significant decisional conflict regarding exercise at diagnosis/genetic testing (DCS [decisional conflict scale]≥25), and half (55.1%, n=98) in the past year. Prevalence of decisional regret was also high with 55.3% (n=99) reporting moderate to severe decisional regret (DRS [decisional regret scale]≥25). The extent of SDM was highly variable ranging from no (0) to perfect (100) SDM (mean, 59.6±25.0). Those diagnosed in adolescence (≤age 21) reported significantly more SDM ( P =0.013). Importantly, SDM was associated with less decisional conflict (ß=−0.66, R 2 =0.567, P <0.01) and decisional regret (ß=−0.37, R 2 =0.180, P <0.001) and no difference in vigorous intensity aerobic exercise in the 6 months after diagnosis/genetic testing or the past year ( P =0.56; P =0.34, respectively). Conclusions: SDM is associated with lower decisional conflict and decisional regret; and no difference in postdiagnosis exercise. Our data thus support SDM as the preferred model for exercise discussions for ARVC.

Sillitoe's metaphor of individual sacrifice, singular focus and hard work applies in equal measure to traditional thinking about how to achieve success in a research career. Planning for the Relationship-Centered Care Initiative began in the spring of 2001 with the two co-principal investigators who conceived of a project that would involve two arms: applying Relationship-Centered Care principles to changing the culture of a large medical school and creating a relationship centered care research network. By design, the research network included individuals with different professional and methodological orientations. Logistic support and day-to-day management of the project fell to the project manager, Dave Mossbarger. While the effects of physical environment have been studied in many settings such as classroom design, instrumentation in aviation, and hospital design for patients with dementia, scant attention has been paid to the effect(s) of physical context on developing and sustaining research and research relationships.

Online methods of teaching and assessing communication skills meet not only the need for remote education during the COVID-19 pandemic but also future demand for flexible training methods. This study aimed to explore the utility of standardized video prompts intended to elicit samples of genetic counselors' (GCs') interpersonal, psychosocial, and counseling skills by describing variation in GCs' socioemotional communication during their responses to a series of videotaped communication challenges. We analyzed the previously recorded communication of 43 GCs responding to a set of videotaped simulated client prompts related to a cancer or prenatal counseling session. We applied the Roter Interaction Analysis System to the prompts and GCs' responses, focusing on the proportion of socioemotional content as an indicator of interpersonal, psychosocial, and counseling skill use. We analyzed the responses of 21 GCs to the cancer prompts and 22 GCs to the prenatal prompts. Two-sample t tests explored differences in the proportion of socioemotional content in GCs' responses to prompts within and across the two scenarios. Overall, socioemotional statements accounted for 31% (SD = 8%) of all GC statements in response to the prenatal prompts and 36% (SD = 9%) of statements in response to the cancer prompts (Bonferroni-adjusted p=.49). The proportion of socioemotional communication in individual prompt responses varied from 4% (SD = 12%) to 76% (SD = 26%) across the cancer prompt series and 10% (SD = 13%) to 76% (SD = 30%) across the prenatal prompt series. Across the two scenarios, two of 10 matched prompts showed significant differences in the proportion of GCs' socioemotional content of the prompt responses (p's < 0.001). These differences appear related to differences in the socioemotional nature of the prompts. These findings inform online methods of communication assessment that are useful during restrictions to in-person learning due to COVID-19, as well as future hybrid training and research efforts.

“Operations Research: Impact of Client Communication Training on Client Participation and Contraceptive Continuation in Indonesia.” This study was funded by the U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) under the terms of Cooperative Agreement Number HRN-A-00-98-00012-00 and Population Council Subagreement number A100.68A. The opinions expressed herein are those of the author and do not necessarily reflect the view of USAID.

PURPOSE:Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals.METHODS:We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes.RESULTS:Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads.CONCLUSION:Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.