Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers

Background Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver’s psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving. Purpose To examine the influence of psychosocial contextual variables on caregiver ambulatory BP. Methods Participants were 81 spouse–caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time. Results Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant. Conclusions Caregivers’ psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.

An Initial Investigation of Suicide Attempt Disclosures Among US Veterans

Background: Patient disclosure of prior suicidal behaviors is critical for effectively managing suicide risk; however, many attempts go undisclosed. Aims: The current study explored how responses following a suicide attempt disclosure may relate to help-seeking outcomes. Method: Participants included 37 veterans with a previous suicide attempt receiving inpatient psychiatric treatment. Veterans reported on their most and least helpful experiences disclosing their suicide attempt to others. Results: Veterans disclosed their suicide attempt to approximately eight individuals. Mental health professionals were the most cited recipient of their most helpful disclosure; romantic partners were the most common recipient of their least helpful disclosures. Positive reactions within the context of the least helpful disclosure experience were positively associated with a sense of connection with the disclosure recipient. Positive reactions within the most helpful disclosure experience were positively associated with the likelihood of future disclosure. No reactions were associated with having sought professional care or likelihood of seeking professional care. Limitations: The results are considered preliminary due to the small sample size. Conclusion: Findings suggest that while positive reactions may influence suicide attempt disclosure experiences broadly, additional research is needed to clarify factors that drive the decision to disclose a suicide attempt to a professional.

Experience of communication among cervical cancer patients in Kenya

Communication influences patient disclosure, treatment adherence, and outcome, adaptation to illness, and bereavement. Different cancer patients and caregivers communicate their various experiences in unique ways. These distinctive experiences are necessary to be told, because it empowers both the teller and everyone who hears and shares that experience. However, there is little research documenting the experiences of cervical cancer patients and caregivers in Kenya and the rest of Africa. This study therefore sought to assess the communication experience among cervical cancer patients and their caregivers. This study was a qualitative study employing the phenomenological method to obtain data from cervical patients and caregivers. It was carried out in Uasin Gishu County, Kenya, where a range of in-depth interviews were held with eight patients and eight caregivers purposively sampled. Data from the interviews were analysed thematically and presented in narrative form using paraphrases and quotations. Ethical issues such as informed consent, confidentiality and official authorisation were observed at all levels. To enrich this study, hermeneutic theory, which explains more about the individual's experience, was used. The findings of the study indicated that communication is therapeutic, although most of the patients and the caregivers were reluctant to talk about their illness. The findings of this study will be of interest to scholars, policy-makers and caregivers of terminally ill patients.

Evaluation of a Revised Home Medication Experience Questionnaire (HOME-Qv2)

The Home Medication Experience Questionnaire (HOME-Qv2) was developed to identify patient medication experience issues for pharmacist intervention. The study objectives were to (1) evaluate patient responses to the HOME-Qv2 medication experience questionnaire and (2) describe recommendations made by pharmacists in response to the identified medication experience issues and adoption of recommendations. The study sample was comprised of older adults, 55 years and above, who have one or more chronic illnesses for which they routinely take 4+ prescription medications. The HOME-Qv2 was administered to patients and a pharmacist made recommendations based on the responses. At 3 months, the research team followed up with participants via telephone, during which the HOME-Qv2 was again administered and participants shared their adoption of recommendations. Twenty-four patients completed the questionnaire, and twenty-one were available for follow-up. At 3 months, there was a significant decrease in patient self-reported HOME-Qv2 medication experience issues. There were 31 interventions/recommendations provided by the pharmacists, and 64.5% reported adopted. The HOME-Qv2 appears to facilitate patient disclosure of medication experience issues and informed targeted pharmacist recommendations.

Fake brain helping human brain

Mental health disorders affect 30% of the world’s population and rates of diagnosiscontinue to increase. This huge global burden on the individual and societal levels requiresenhancement of current diagnosis and treatment. Artificial intelligence (AI) offers novelapproaches to diagnosis in mental healthcare. Personal digital devices that have becomeomnipresent in the developed world can be used as sensors for continuous monitoring ofindividual’s behaviour. Analysis of behavioural markers such as sleep, social media use andcommunication patterns through the use of sensors creates a patient’s digital phenotype.Continuous monitoring offers an insight into patients’ regular behaviour that is different from theself-reported, momentary snapshot used in conventional diagnostic practices. Virtual humans offeran alternative way to collect information, allowing for increased patient disclosure. Currentapplications of AI facilitate access to mental healthcare by monitoring patient functioning in reallife and immediately connecting patients to appropriate resources. Despite many benefits of AI inmental healthcare, further translation of this innovation from research to clinical practice requiresdiligent policy making to address privacy and confidentiality concerns.

How Primary Care Physicians Elicit Sensitive Health Information From Patients: Describing Access to Psychosocial Information

Multiple communication models describe factors that influence disclosure of sensitive health information. However, these models do not address the receiver’s perspective of health-related information, nor do they address how the receiver promotes disclosure. In the primary care chronic disease visit, the patient (sender) must disclose sensitive health-related psychosocial information to the primary care physician (PCP) (receiver) for the PCP to understand potential barriers to care (e.g., financial strain) and make treatment decisions (e.g., referral to social work). A vital gap exists in understanding how PCPs perceive that patients disclose. We conducted individual, semi-structured interviews ( n = 17) to understand PCPs’ perceptions of patient disclosure of sensitive, psychosocial information in the clinical visit. PCPs facilitate patient disclosure by (a) building and maintaining rapport and (b) nurturing the patient–provider relationship. This article describes PCPs’ perceptions of how they access psychosocial information which is vital to inform clinical decisions that facilitate personalized care.

Meeting Patients Where They Are

In this chapter the author describes the challenges of engaging and communicating with patients and how technology can improve communication, elicit honest patient disclosure, and create more productive conversation and help patients engage and partner in their care. The author will also discuss how research with multimedia programs reveals it can help reduce anxiety, improve knowledge, help low health literacy audiences, and contribute to improved outcomes. This chapter will also examine how multimedia decision aid programs can help patients understand their options and complex risk information, while helping them consider their values and preferences so they can truly engage in shared decision making.

Meeting Patients Where They Are

In this chapter the author describes the challenges of engaging and communicating with patients and how technology can improve communication, elicit honest patient disclosure, and create more productive conversation and help patients engage and partner in their care. The author will also discuss how research with multimedia programs reveals it can help reduce anxiety, improve knowledge, help low health literacy audiences, and contribute to improved outcomes. This chapter will also examine how multimedia decision aid programs can help patients understand their options and complex risk information, while helping them consider their values and preferences so they can truly engage in shared decision making.