Patient Education and Counseling 94 (2014) 141–142
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Editorial
Talking about transplantation issues—Does it need to be difficult?
In this issue of Patient Education and Counseling we publish a study by Heather M. Traino on the difficulties that many patients with chronic and end-stage renal disease (ESRD) experience in communicating with others about transplantation related issues [1]. Traino interviewed 63 ESRD patients and found that although a large majority of the patients reported to have had some discussions about transplantation issues, two thirds of them had had only limited conversations about the topic with friends, family or others. Many felt talking about transplantation to be quite difficult. The most frequently reported difficulty was asking directly about living donation, which was reported as difficult by 65 per cent of the sample, similar to findings from a European study a few years ago [2]. In Traino’s study patients also reported a number of other problems such as finding the right person to talk to, beginning the conversation and finding the right words. Perceived difficulties were significantly and inversely related to communication self efficacy [1]. Interestingly, the reluctance to discuss transplantation issues may also extend to clinical encounters. Boulware et al. reported a few years ago that only two-thirds of the dialysis patients in their sample had discussed transplantation with physicians, even if more than three quarters of the patients actually desired a transplant [3]. The reluctance to bring up the transplantation theme may be present both in the doctor and in the patient. Traino points out that her findings suggest a need for comprehensive communication skills training for patients [1]. Most often communication skills training for patients in a medical setting is intended to help patients be more actively involved in subsequent medical consultations, and has been found to have positive impact on adherence [4] as well as health outcomes [5]. Potential transplantation patients could also benefit from communications skills training aimed at helping them bring up the transplantation issue in private conversations, which could be crucial in the process of finding a potential donor. The negative association between difficulties in talking about transplantations and communication self-efficacy is interesting [1]. Communication self-efficacy has been most often studied in providers [6], but recently the interest for patient communication self-efficacy has increased, and measures have been developed [7,8]. In a paper in press in PEC, available on the net and to be published in the March issue, Farin et al. introduce a novel scale of patient communication competence, which turns out to be highly correlated with communication self-efficacy [9]. Farin et al. suggest that the convincing associations between communication self-efficacy and communication competence provide further evidence of the relevance of self-efficacy as a predictor of disease management. 0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.12.015
Patient communication self-efficacy is a promising novel concept, not the least because self-efficacy in general has been found to be amenable to change. Training the ESRD patients similar to those in Traino’s study in communication self-efficacy may be helpful in stimulating them to go into challenging conversations about transplantation in their informal social network. Traino does not discuss what other variables than low communication self-efficacy could be related to communication difficulties. ESRD patients is a vulnerable group, and we know of unmet needs in the area of psychological distress for these individuals [10]. It reasonable to believe that emotional distress may be one additional barrier for active communication with friends and family about difficult themes. Sometimes it will require a certain sensitivity to patients’ emotional distress to get started in bringing up difficult themes in the consultation, such as transplantation issues. In this issue of PEC Dean and Street present a model of patient centered communication for addressing cancer patients’ emotional distress, which is just as relevant for ESRD patients concerned with transplantation issues [11]. They propose a 3-stage model of recognition, exploration and therapeutic action to handle distress in the medical consultation. In medical interviews with ESRD patients doctors should take into account some of the findings referred to above. We cannot expect that patients themselves will bring up transplantation issues. Doctors and other providers should pick up patients’ concerns, take time to discuss issues of transplantation and provide encouragement and training for patients to talk about these issues with their families and others. If adequate care and training are provided, talking about transplantation issues should not need to be that difficult.
References [1] Traino HM. Communication selfefficacy. Perceived conversational difficulty, and renal patients’ discussions about transplantation. Patient Educ Couns 2014;94:180–6. [2] Kranenburg LW, Richards M, Zuidema WC, Weimar W, Hilhorst MT, Ijzermans JNM, et al. Avoiding the issue: patients’ (non)communication with potential living kidney donors. Patient Educ Couns 2009;74:39–44. [3] Boulware LE, Meoni LA, Fink NE, Parekh RS, Kao WHL, Klag MJ, et al. References, knowledge, communication and patient–physician discussion of living kidney transplantation in African-American families. Am J Transplant 2005;5:1503– 12. [4] Cegala DJ, Post DM, McClure L. The effects of communication skills training on compliance. Archiv Fam Med 2000;9:57–64. [5] Greenfield S, Kaplan S, Ware Jr J. Expanding patent involvement in care: effects on patient outcomes. Ann Intern Med 1985;102:502–8. [6] Parle M, Maguire P, Heaven C. The development of a training model to improve health professionals’ skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 1997;44:231–40.
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Editorial / Patient Education and Counseling 94 (2014) 141–142
[7] Clayman ML, Pandit AU, Bergeron AR, Cameron KA, Ross E, Wolf MS. Ask, understand, remember: a brief measure of patient communication self-efficacy within clinical encounters. J Health Commun 2010;15(Suppl. 2):72–9. [8] ten Klooster PM, Oostveen JCM, Zandbelt LC, Taal E, Drossaert CHC, Harmsen EJ, et al. Further validation of the 5-item Perceived Efficacy in Patient–Physician Interactions (PEPPI-5) scale in patients with osteoarthritis. Patient Educ Couns 2012;87:125–30. [9] Farin E, Schmidt E, Gramm L. Patient communication competence:development of a German questionnaire and correlates of competent patient behavior. Patient Educ Couns 2013. http://dx.doi.org/10.1016/j.pec.2013.11.005. [10] Vecchio M, Palmer SC, Tonelli M, Johnson DW, Strippoli GFM. Depression and sexual dysfunction in chronic kidney disease: a narrative review of the
evidence in areas of significant unmet need. Nephrol Dial Transplant 2012;27:3420–8. [11] Dean M, Street Jr RL. A 3-stage model of patient-centered communication for addressing cancer patients’ emotional distress. Patient Educ Couns 2014; 94:143–8.
Arnstein Finset E-mail address: arnstein.fi[email protected] (A. Finset).
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Editorial
Talking about transplantation issues—Does it need to be difficult?
In this issue of Patient Education and Counseling we publish a study by Heather M. Traino on the difficulties that many patients with chronic and end-stage renal disease (ESRD) experience in communicating with others about transplantation related issues [1]. Traino interviewed 63 ESRD patients and found that although a large majority of the patients reported to have had some discussions about transplantation issues, two thirds of them had had only limited conversations about the topic with friends, family or others. Many felt talking about transplantation to be quite difficult. The most frequently reported difficulty was asking directly about living donation, which was reported as difficult by 65 per cent of the sample, similar to findings from a European study a few years ago [2]. In Traino’s study patients also reported a number of other problems such as finding the right person to talk to, beginning the conversation and finding the right words. Perceived difficulties were significantly and inversely related to communication self efficacy [1]. Interestingly, the reluctance to discuss transplantation issues may also extend to clinical encounters. Boulware et al. reported a few years ago that only two-thirds of the dialysis patients in their sample had discussed transplantation with physicians, even if more than three quarters of the patients actually desired a transplant [3]. The reluctance to bring up the transplantation theme may be present both in the doctor and in the patient. Traino points out that her findings suggest a need for comprehensive communication skills training for patients [1]. Most often communication skills training for patients in a medical setting is intended to help patients be more actively involved in subsequent medical consultations, and has been found to have positive impact on adherence [4] as well as health outcomes [5]. Potential transplantation patients could also benefit from communications skills training aimed at helping them bring up the transplantation issue in private conversations, which could be crucial in the process of finding a potential donor. The negative association between difficulties in talking about transplantations and communication self-efficacy is interesting [1]. Communication self-efficacy has been most often studied in providers [6], but recently the interest for patient communication self-efficacy has increased, and measures have been developed [7,8]. In a paper in press in PEC, available on the net and to be published in the March issue, Farin et al. introduce a novel scale of patient communication competence, which turns out to be highly correlated with communication self-efficacy [9]. Farin et al. suggest that the convincing associations between communication self-efficacy and communication competence provide further evidence of the relevance of self-efficacy as a predictor of disease management. 0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.12.015
Patient communication self-efficacy is a promising novel concept, not the least because self-efficacy in general has been found to be amenable to change. Training the ESRD patients similar to those in Traino’s study in communication self-efficacy may be helpful in stimulating them to go into challenging conversations about transplantation in their informal social network. Traino does not discuss what other variables than low communication self-efficacy could be related to communication difficulties. ESRD patients is a vulnerable group, and we know of unmet needs in the area of psychological distress for these individuals [10]. It reasonable to believe that emotional distress may be one additional barrier for active communication with friends and family about difficult themes. Sometimes it will require a certain sensitivity to patients’ emotional distress to get started in bringing up difficult themes in the consultation, such as transplantation issues. In this issue of PEC Dean and Street present a model of patient centered communication for addressing cancer patients’ emotional distress, which is just as relevant for ESRD patients concerned with transplantation issues [11]. They propose a 3-stage model of recognition, exploration and therapeutic action to handle distress in the medical consultation. In medical interviews with ESRD patients doctors should take into account some of the findings referred to above. We cannot expect that patients themselves will bring up transplantation issues. Doctors and other providers should pick up patients’ concerns, take time to discuss issues of transplantation and provide encouragement and training for patients to talk about these issues with their families and others. If adequate care and training are provided, talking about transplantation issues should not need to be that difficult.
References [1] Traino HM. Communication selfefficacy. Perceived conversational difficulty, and renal patients’ discussions about transplantation. Patient Educ Couns 2014;94:180–6. [2] Kranenburg LW, Richards M, Zuidema WC, Weimar W, Hilhorst MT, Ijzermans JNM, et al. Avoiding the issue: patients’ (non)communication with potential living kidney donors. Patient Educ Couns 2009;74:39–44. [3] Boulware LE, Meoni LA, Fink NE, Parekh RS, Kao WHL, Klag MJ, et al. References, knowledge, communication and patient–physician discussion of living kidney transplantation in African-American families. Am J Transplant 2005;5:1503– 12. [4] Cegala DJ, Post DM, McClure L. The effects of communication skills training on compliance. Archiv Fam Med 2000;9:57–64. [5] Greenfield S, Kaplan S, Ware Jr J. Expanding patent involvement in care: effects on patient outcomes. Ann Intern Med 1985;102:502–8. [6] Parle M, Maguire P, Heaven C. The development of a training model to improve health professionals’ skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 1997;44:231–40.
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Editorial / Patient Education and Counseling 94 (2014) 141–142
[7] Clayman ML, Pandit AU, Bergeron AR, Cameron KA, Ross E, Wolf MS. Ask, understand, remember: a brief measure of patient communication self-efficacy within clinical encounters. J Health Commun 2010;15(Suppl. 2):72–9. [8] ten Klooster PM, Oostveen JCM, Zandbelt LC, Taal E, Drossaert CHC, Harmsen EJ, et al. Further validation of the 5-item Perceived Efficacy in Patient–Physician Interactions (PEPPI-5) scale in patients with osteoarthritis. Patient Educ Couns 2012;87:125–30. [9] Farin E, Schmidt E, Gramm L. Patient communication competence:development of a German questionnaire and correlates of competent patient behavior. Patient Educ Couns 2013. http://dx.doi.org/10.1016/j.pec.2013.11.005. [10] Vecchio M, Palmer SC, Tonelli M, Johnson DW, Strippoli GFM. Depression and sexual dysfunction in chronic kidney disease: a narrative review of the
evidence in areas of significant unmet need. Nephrol Dial Transplant 2012;27:3420–8. [11] Dean M, Street Jr RL. A 3-stage model of patient-centered communication for addressing cancer patients’ emotional distress. Patient Educ Couns 2014; 94:143–8.
Arnstein Finset E-mail address: arnstein.fi[email protected] (A. Finset).
