Plain language, either written or spoken, is associated with higher-quality communication in healthcare settings, but little research has focused on plain language and clinical trial discussions. The objective of this study was to describe physicians' use of plain language during interactions in which patients were invited to participate in cancer clinical trials. Video-recorded clinical interactions, accompanying transcripts, and self-reported demographic data were taken from a larger study of communication and clinical trials (PACCT). Interactions (n=25) were selected if they included an explicit or pending invitation to participate in a clinical trial. We conducted a qualitative discourse analysis of transcripts. We excerpted all mentions of clinical trials and then inductively coded the excerpts to identify physicians' plain language strategies. The analysis revealed five plain language strategies used by physicians. First, physicians used lexical simplification to replace medical terminology with simpler alternatives, such as replacing "combination study" with "add a second pill." Second, they used patient-centered definitions to differentiate medical terminology from similar concepts, such as clarifying the differences between remissions and cures. Third, they used metaphors to connect medical terminology with familiar concepts, such as "testosterone is the baseball and the receptor is the glove." Fourth, they used second-person narration to describe patients' potential experiences, such as "your brain's okay but your body doesn't want to get off the couch." Finally, they used constructed dialogues, in which they spoke from patients' perspectives, to illustrate potential experiences or choices during a trial. For example, voluntary participation was explained through a hypothetical scenario where the patient might say, "This doesn't make sense. I'm not ready." This study identified plain language strategies that may help patients understand information about cancer clinical trials. These strategies hold promise as part of a shared decision-making process in the context of cancer clinical trials.

OBJECTIVE:This study described physicians' use of plain language during patient-physician cancer clinical trial discussions.METHODS:Video-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial. We used descriptive, qualitative discourse analysis, a method that identifies language patterns at or above the sentence level. We first excerpted discussions of clinical trials, then identified instances of plain language within those discussions. Finally, we inductively coded those instances to describe physicians' plain language practices.RESULTS:The analysis identified four plain language practices. Lexical simplification replaced medical terminology with simpler words. Patient-centered definition named, categorized, and explained complex medical terminology. Metaphor explained medical terminology by comparing it with known concepts. Finally, experience-focused description replaced medical terminology with descriptions of patients' potential physical experiences.CONCLUSION:These plain language practices hold promise as part of effective information exchange in discussions of cancer clinical trials. Testing is needed to identify patient preferences and the extent to which these practices address patient health literacy needs.PRACTICE IMPLICATIONS:Pending further testing, these plain language practices may be integrated into physician clinical trial and other communication training.

The use of reflective essays has become a key artifact of outcome-based writing assessment in the field of writing studies (White, 2005). However, scoring reflective essays may be influenced by textual features irrelevant to most outcomes and assessment rubrics. Two problematic features are teacher-pleasing, which Yancey (1996) called the “schmooze factor,” and student-fashioning, which Miura (2018) related to identity formation. In this article, we present two mixed methods studies to examine the effects of these particular textual features on the direct assessment of first-year writing (FYW) reflective essays. In the first pilot study, we identified four textual features relevant to teacher-pleasing and student-fashioning. In the second quasi-experimental study, we created a sample of FYW essays with and without these features. Two assessment teams then scored the essays in order to determine whether these features had statistically significant effects on assessment scores. The empirical results of these linked studies indicate these features did not have significant effects in a direct assessment of FYW reflective essays. However, in the discussion and conclusion, we argue our mixed methods approach offers a feasible and efficient set of research methods to examine specific textual features in the direct assessments of student writing.

OBJECTIVES:Question Prompt Lists (QPL) increase patient active participation in oncology interactions, but questions remain regarding how QPLs influence patient-oncologist information exchange. We examined how a QPL influenced information exchange during oncology interactions with African-American patients. METHODS:Data were self-reports and video recordings from a parent study testing the effects of a QPL in the outpatient clinics of two urban cancer hospitals. In this secondary analysis, we investigated which QPL questions patients identified as ones they wanted to ask their oncologists, how frequently patients/companions used patient active participation statements to seek information related to each QPL question, whether oncologists provided QPL-related information unprompted or prompted by patients/companions, and how frequently patients' QPL-related information needs were addressed or unaddressed. RESULTS:The QPL influenced information exchange by increasing patients' and companions' (if present) prompting for QPL-related information from their oncologists. Patients/companions most often prompted for QPL-related information about side effects and patient experience. CONCLUSION:This study builds on prior research on QPL interventions by expanding the object of study to information exchange and by analyzing patients' information needs. PRACTICE IMPLICATIONS:This research demonstrates that a QPL supports patient/companion participation in oncology consultations by making information exchange more interactive.

Abstract:Phase 1 cancer clinical trial consultations are fraught with ethical and rhetorical issues. Phase 1 trials are designed to test the toxicity, and not the efficacy, of therapeutic agents. Fewer than 5% of patients benefit from their participation in a Phase 1 trial, and over 75% of experimental drugs do not become approved cancer medicines. Bioethicists have long debated the ethics of recruitment consultations for Phase 1 trials solely in terms of the need for patients to make a rational decision based upon enough information to avoid what are called therapeutic misconceptions and/or unrealistic optimism as motivations to participate in Phase 1 trials. We argue here, however, that the ethical challenges in Phase 1 consultations go beyond providing information about the (unknown) risks and (unanticipated) benefits of a Phase 1 clinical trial. In this article, we present a rhetorically oriented case study of a Phase 1 consultation, followed by a rhetorically informed critique of the rationality of bioethics. We use Lauren Berlant’s (2011) concept of “cruel optimism” to develop a more complete account of the rhetorical and ethical nexus of patient motivations in Phase 1 consultations by creating a discursive space to explore the concerns, hopes, and motivations of cancer patients considering participation in the earliest phase of clinical research in cancer medicine. The goal of our study is to propose a framework aimed at achieving Lisa Keränen’s (2007) concept of relational integrity applied to Phase 1 consultations.

Using concepts and methods from technical and professional communication and linguistics, the authors conducted an observational study of the voice of community members (CMs) in the deliberation of a behavioral institutional review board (IRB). In the discourse of deliberation, they found that CMs had an effective voice in constructing the compliance of individual research protocols under IRB review. But they also found that CMs had an ineffective voice in representing their African-American community, particularly in their efforts to advocate for more consideration of minority research sites and subjects and a fuller consideration of minority community attitudes.

Abstract Background: Few patients, especially racial/ethnic minorities, enroll in clinical trials (CTs) in the United States, in part due to factors related to patient-physician interactions. We describe a theory-based patient intervention to improve communication and enrollment of Black and White men in prostate cancer CTs. We also report on preliminary baseline data comparing Black and White participants' demographic and social characteristics and their willingness to discuss a CT with a physician. Method: A team of communication scientists, psychologists, and clinicians collaborated to create a theory-based, patient-focused intervention. Theories included the common ingroup identity model, which suggests people from different social groups can better achieve goals when they see themselves as members of the same team, and patient-centered communication, which suggests that patient active participation improves clinical communication. The intervention is in the form of a booklet given to patients prior to meeting with their oncologist. The booklet includes a) encouragement to view the patient and physician as a team and participate actively in clinical interactions, and b) 33 questions about participating in a CT. Preliminary data from one data collection site (Detroit, Michigan) include 72 Black (n=40) and White (n=32) men with prostate cancer who completed baseline measures assessing age; education; income; breadwinner status; marital status; health literacy; perceived economic burden (e.g., how difficult is it for you to live on your total household income right now?); general trust in physicians; group-based medical mistrust (including three subscales--suspicion, perceived racial health care disparities, and perceived health care provider support); and willingness to discuss a CT with a physician. Chi-square and independent samples t-tests were conducted to determine racial differences. Results: Black patients were younger (p=.04), had less education (p=.006) and lower annual incomes (p<.001) than White patients, but were equally likely to be the breadwinner. Blacks were more likely to be single than Whites (p<.001). Blacks reported significantly higher economic burden (p=.02), greater group-based medical mistrust (p=.001), greater suspicion of health care (p=.003), greater perceived racial disparities in health care (p=.001), and less perceived support from health care providers (p=.002). Blacks and Whites did not differ in health literacy or general trust in physicians. Regarding willingness to discuss CTs with their physician, high means for both Blacks and Whites (4.2 and 4.7, respectively, on a 5-point scale) indicated that both groups were very willing to discuss a CT with their physician, but Whites were significantly more willing (p=.03). Discussion: Black and White patients differed in many demographic and social characteristics. Both groups indicated they were very willing to discuss a CT with their physician, although Whites were significantly more willing. This finding suggests the intervention may be especially beneficial for Black patients, who are disproportionately under-represented in CTs. Next steps involve analysis of the effect of the intervention and addition of a physician-focused intervention. Citation Format: Lauren M. Hamel, Louis A. Penner, Elisabeth Heath, Dina Lansey, Michael Carducci, Terrance L. Albrecht, Ellen Barton, Mark Manning, Tanina Foster, Mark Wojda, Susan Eggly. Partnering around cancer clinical trials: Preliminary report of an intervention to improve patient-physician communication and clinical trial enrollment of Black and White men with prostate cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B09.

Author(s): Pruchnic, Jeff; Susak, Chris; Grogan, Jared; Primeau, Sarah; Torok, Joe; Trimble, Thomas; Foster, Tanina; Barton, Ellen | Abstract: The development of present-day assessment culture in higher education has led to a disciplinary turn away from statistical definitions of reliability and validity in favor of methods argued to have more potential for positive curricular change. Such interest in redefining reliability and validity also may be inspired by the unsustainable demands that large-scale quantitative assessment would place on composition programs. In response to this dilemma, we tested a mixed-methods approach to writing assessment that combined large-scale quantitative assessment using thin-slice methods with targeted, smaller-scale qualitative assessment of selected student writing using rich features analysis. We suggest that such an approach will allow composition programs to (a) directly assess a representative sample of student writing with excellent reliability, (b) significantly reduce total assessment time, and (c) preserve the autonomy and contextualized quality of assessment sought in current definitions of validity.

Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients’ decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial.

Abstract Background: Decades of research have demonstrated the salutary effects of higher perceived social support on thoughts and feelings about one's health. Separate work has shown that Black patients with higher race-based medical suspicion have more negative perceptions of their healthcare. Prior studies have not systematically investigated the extent to which perceived social support is related to medical suspicion in Black cancer populations. Purpose: We specifically explored whether larger social network size and higher social support satisfaction moderated negative perceptions and feelings typically experienced by Black patients scoring high on suspicion. Methods: 114 Black cancer patients reported their social support and suspicion at a baseline session. One week later, they interacted with their oncologist about initial treatment options during a clinic visit. Following the interaction, patients reported their uncertainty regarding the recommended treatment, perceived difficulty completing treatment, and distress. Results: Moderation results showed that larger social network size was related to less uncertainty and less perceived difficulty completing treatment for Black patients low in suspicion. However, larger social network size failed to reduce uncertainty and perceived difficulty and exacerbated distress for Black patients high in suspicion. Social support satisfaction moderated only the relation between medical suspicion and perceived difficulty. Conclusions: Social support is associated with distinct cancer treatment perceptions for Black cancer patients as a function of patients' suspicion, which may be explained by entrenchment in a social network that reinforces negative personal biases. Citation Format: Sarah C. E. Stanton, Louis A. Penner, Susan Eggly, Felicity W. K. Harper, Lauren M. Hamel, Tanina Foster, Michael S. Simon, Ellen Barton, Robert A. Chapman, Terrance L. Albrecht. Perceived Social Support Moderates the Associations between Race-Based Medical Suspicion and Perceptions of Cancer Treatment. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A84.

143 Background: Few patients, especially racial/ethnic minorities, enroll in clinical trials (CT), in part due to patient-oncologist communication. Question prompt lists (QPLs) improve communication, but have not been tested in CT discussions in a diverse patient population. We describe the development and acceptability of a theory-based QPL to improve communication and enrollment of White and Black men in prostate cancer CTs. Methods: Two existing QPLs were adapted by a team of communication scientists, psychologists, clinicians and patients. Guiding theories were the common ingroup identity model, which suggests people from different social groups can better achieve goals when they are on the same team, and patient-centered communication, which suggests that patient active participation improves clinical communication. The revised QPL included text to encourage patients to see themselves and their oncologist as a team, and 33 questions about CTs to encourage patients to participate actively in clinical interactions that include a CT discussion. To test acceptability, we recruited 15 Black or White men currently enrolled in a prostate cancer CT at an urban comprehensive cancer center. We asked patients to provide feedback on the QPL, to endorse which questions were most important, and for suggested improvements. Results: Patients participated anonymously. All patients said the QPL would be useful. Four patients reported liking the graphics/layout. Six patients reported liking the team text, but one commented that it was unnecessary. Three patients liked that the QPL included many questions, several of which they had not thought to ask when they discussed a CT with their oncologist. Ten patients endorsed the questions they thought were important to ask (M = 24 questions, SD = 9). The most frequently endorsed questions were what is already known about this treatment and how serious are the side effects? Conclusions: Patients found the QPL to be acceptable and useful. The QPL was revised according to patient feedback. We are testing the revised QPL's influence on patient-oncologist communication about CTs, patient understanding of CTs offered, and patient decisions to enroll in a CT.

Objective: We conducted an exploratory mixed methods study to describe the ambivalence African-American adolescents and their caregivers expressed during motivational interviewing sessions targeting weight loss.Methods: We extracted ambivalence statements from 37 previously coded counseling sessions. We used directed content analysis to categorize ambivalence related to the target behaviors of nutrition, activity, or weight. We compared adolescent-caregiver dyads' ambivalence using the paired sample t-test and Wilcoxon signed-rank test. We then used conventional content analysis to compare the specific content of adolescents' and caregivers' ambivalence statements.Results: Adolescents and caregivers expressed the same number of ambivalence statements overall, related to activity and weight, but caregivers expressed more statements about nutrition. Content analysis revealed convergences and divergences in caregivers' and adolescents' ambivalence about weight loss.Conclusion: Understanding divergences in adolescent-caregiver ambivalence about the specific behaviors to target may partially explain the limited success of family-based weight loss interventions targeting African American families and provides a unique opportunity for providers to enhance family communication, foster teamwork, and build self-efficacy to promote behavior change.Practice implications: Clinicians working in family contexts should explore how adolescents and caregivers converge and diverge in their ambivalence in order to recommend weight loss strategies that best meet families' needs. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Objective:We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss.Methods:We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements.Results:Counselors' questions to elicit motivational statements and emphasis on autonomy increased the likelihood of both caregiver change talk and commitment language statements. Counselors' reflections of change talk predicted further change talk, and reflections of commitment language predicted more commitment language.Conclusions:When working to increase motivation among caregivers of adolescents with overweight or obesity, providers should strive to reflect motivational statements, ask questions to elicit motivational statements, and emphasize caregivers' autonomy.

Clinical trials are the gold standard in medical research evaluating new treatments in cancer care; however, in the United States, too few patients enroll in trials, especially patients from minority groups. Offering patients the option of a clinical trial is an ethically-charged communicative event for oncologists. One particularly vexed ethical issue is the use of persuasion in trial offers. Based on a corpus of 22 oncology encounters with Caucasian-American (n = 11) and African-American (n = 11) patients, this discourse analysis describes oncologists' use of two persuasive strategies related to the linguistic structure of trial offers: topic placement and topic framing. Findings are presented in total and by patient race, and discussed in terms of whether these strategies may constitute ethical or unethical persuasion, particularly with respect to the ethical issue of undue influence and the social issue of underrepresentation of minorities in cancer clinical trials.

BACKGROUND:African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients.OBJECTIVE:To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African American and White patients.METHODS:From an archive of video-recorded oncology visits, we selected all visits with African American patients that included a trial offer (n = 11) and a matched sample of visits with demographically/medically comparable White patients (n = 11). Using mixed qualitative-quantitative methods, we assessed differences by patient race in (i) word count of entire visits and (ii) frequency of mentions and word count of discussions of clinical trials and key elements of consent.RESULTS:Visits with African American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation.DISCUSSION AND CONCLUSIONS:African American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients. Possible explanations include a less active communication style of African Americans in medical visits, oncologists' concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African American patients, particularly purpose and risks.

Objective: The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment). Methods: Thirty-seven black adolescents with obesity received a single motivational interviewing session targeting weight-related behaviors. The video-recorded transcribed sessions were coded using the Minority Youth Sequential Coding for Observing Process Exchanges generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. Results: Asking open-ended questions to elicit adolescent CT and emphasizing adolescents' autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. Conclusions: This study provides clinicians with insight into the most effective way to communicate with black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need, and commitment to weight loss recommendations are more likely to increase motivational statements, whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision making, emphasizing their autonomy may be particularly effective in evoking motivational statements.