Incorporating Verbal and Nonverbal Aspects to Enhance a Model of Patient Communication in Cancer Care: A Grounded Theory Study
First author: Timothy C. Guetterman, Ph.D., associate director of Mixed Methods and associate professor in the Department of Family Medicine; as well as Rae Sakakibara, and Srikar Baireddy, all from the University of Michigan, and Professor Wayne A. Babchuk, Ph.D., of the University of Nebraska-Lincoln.
Researchers have proposed an enhanced model of communication focusing not only on what is said in the clinic but also nonverbal communication of the doctor and how doctors in turn interpret patients’ nonverbal cues.
The paper, “Incorporating verbal and nonverbal aspects to enhance a model of patient communication in cancer care: A grounded theory study,”(link is external) was recently published in the journal, Cancer Medicine. The study aimed to develop a conceptual model of communication that accounts for nonverbal communication, such as ‘mirroring,’ silence, distance, smiling, nodding and leaning.
The authors assert that nonverbal communication is an area of study that lacks exploration on its impact on how medical staff can communicate with patients in an effective and empathetic way in often-stressful situations. Read the full story produced by Family Medicine here.
Special Journal of Mixed Methods Issue Dedicated to Michael D. Fetters
The July 2024 issue of the Journal of Mixed Methods Research (JMMR) is dedicated to the memory of past JMMR Co-Editor in Chief, Michael D. Fetters (“Mike”), who passed away in July 2023. This special issue is a celebration of Mike’s contributions to scholarship in general and to mixed methods research in particular. The issue is a representation of Mike’s numerous relationships, collaborations, and ideas related to mixed methods methodology. The issue includes 19 articles with methodological contributions to mixed methods. In this editorial, we describe these articles, and we announce the Michael Fetters JMMR Best Paper Award. Access the issue here.
MYHealth – Training the Next Generation of Researchers
Melissa DeJonckeere, Ph.D., Principal Investigator
The Michigan Youth Health (MYHealth) Science Education Partnership Award (SEPA) program will foster researcher identity, science self-efficacy, scientific literacy, and leadership and teamwork self-efficacy among historically underrepresented high school students in Southeastern Michigan to increase persistence in science toward research careers. Participants, students in grades 9-11, are recruited through community partners such as the Washtenaw Intermediate School District, Wolverine Pathways, Edward Ginsberg Center for Community Service and Learning, and Center for Education Design, Evaluation & Research (CEDER). Students in the MYHealth Program will be trained as co-researchers and conduct a research project using the MyVoice text message poll of youth.
MYHealth is a Science Education Partnership Award funded by the National Institute of General Medical Sciences and National Institutes of Health (R25GM137361).
Read the story about MYHealth's second cohort and their Impact Projects, presented in May 2024 here.
Understanding Barriers and Facilitators of Remote Patient Monitoring with a Health Equity Lens
Timothy Guetterman, Ph.D., M.A., associate director of the Mixed Methods Program and associate professor in the Department of Family Medicine, has received the Institute for Healthcare Policy and Research’s Timely Topics in Telehealth/e-Health Research Seed Funding for the project, “Understanding Barriers and Facilitators of Remote Patient Monitoring with a Health Equity Lens.”
The overarching goal of Guetterman’s proposal is to better understand the barriers and facilitators of remote patient monitoring (RPM) implementation for post-acute care. RPM is a type of telehealth that represents what many in the medical field consider a “substantial advance” over monitoring devices such as home blood pressure cuffs. Remote patient monitoring now typically includes a SIM-enabled tablet and connected devices that automatically transmit to the electronic health record. Examples of devices include blood pressure cuffs, scales, pulse oximetry, and temperature. Read the full story on the Family Medicine website here.
A Mixed Methods Study Protocol to Enhance Virtual Reality Tools in Medical Education
Communication between medical providers and patients has been shown to be an essential component of the patient-provider relationship. Research has long established that more than 50% of human communication is nonverbal, yet the nonverbal aspect of the patient-provider relationship is relatively little studied. With the advent of technology-based avatars and virtual humans to improve providers' communication with patients, a team led by MMP Research Fellow Dr. Analay Perez, Dr. Timothy Guetterman, Associate Director of the MMP, and other MMP faculty, are working to produce a nonverbal communication behavior model and automated assessment for use in virtual human simulation exercises. Using a multi-stage mixed methods design, the team plans to explore the most critical elements of verbal and non-verbal communication by analyzing MPathic-VR data, coding video interactions, and conducting interviews with oncology providers. Ultimately, Dr. Perez and her co-authors hope that their findings will enhance patient-provider communication through VR technologies and improve health information dissemination.
Resilience And Resistance In The Face Of Stigma And Trauma: A Qualitative Study Of Transgender People’s Reactions To Interactions With The Healthcare System
Publication:
Stroumsa Daphna, Maksutova Mariam, Indig Gnendy, Ballard Jesse Y, Trammell Racquelle, Elliot E Popoff, Wu Justine P, Gamarel Kristi, SAT393. "Resilience And Resistance In The Face Of Stigma And Trauma: A Qualitative Study Of Transgender People’s Reactions To Interactions With The Healthcare System." Journal of the Endocrine Society, 7, Issue Supplement_1, October-November 2023, bvad114.2064 https://doi.org/10.1210/jendso/bvad114.2064
An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study
Publication:
Lin YK, Aikens JE, de Zoysa N, Hall D, Funnell M, Nwankwo R, Kloss K, DeJonckheere MJ, Pop-Busui R, Piatt GA, Amiel SA, Piette JD. An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study. JMIR Form Res 2023;7:e50374 doi: 10.2196/50374
Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark.
Publication:
Borchmann O, N Weis, Hansen AE, Storgaard M, Fetters M, Chandanabhumma PP, Moseholm E. Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark. BMJ Open 2023; 13: e077303
Parents' and professionals' perspectives on school-based maltreatment prevention education for children with intellectual and developmental disabilities
Publication:
Bődi, C. B., Ortega, D. P., Hawkins, L. B., James, T. G., & Bright, M. A. (2023). "Parents' and professionals' perspectives on school-based maltreatment prevention education for children with intellectual and developmental disabilities. "Child Abuse & Neglect, 145, 106428
Equity in virtual care: A mixed methods study of perspectives from physicians
Publication:
Guetterman TC, Koptyra E, Ritchie O, et al (2023). "Equity in virtual care: A mixed methods study of perspectives from physicians." Journal of Telemedicine and Telecare. Aug 28. https://doi.org/10.1177/1357633X231194382
Mi Health Mi Choice: Improving Contraceptive Care for Women With Medical Conditions
Justine P. Wu, M.D., M.P.H., Principal Investigator. Funded by National Institutes of Health (read more on Dr. Wu's award)
Adult women with chronic conditions have a higher rate of unintended pregnancy than adult women without chronic conditions. Chronic conditions and unintended pregnancy are both associated with pregnancy-related complications and adverse maternal and child health outcomes. Prior studies show that women with chronic conditions are not receiving adequate contraceptive counseling, particularly regarding highly effective contraceptive methods. There is an urgent need to improve contraceptive counseling and services for women with chronic conditions in order to decrease the rate of unintended pregnancy and improve reproductive health outcomes among this population.
This mixed methods, multi-phase study will first 1.) identify key factors on the patient-, provider-, and practice-level that are critical to the design of a contraceptive intervention for women with chronic conditions in primary care. The research team, led by Wu, will then develop an interactive, web-based contraceptive decision aid for women with chronic conditions, their PCPs, and implementation in primary care. Finally, a pilot randomized controlled trial (RCT) will be conducted to measure the feasibility of the decision aid as a potential large-scale intervention.
Protocol Citation: Wu JP, Damschroder LJ, Fetters MD, et al. A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study. JMIR Research Protocols. 2018;7(4). doi:10.2196/resprot.9249.
Modeling Professional Attitudes and Teaching Humanistic Communication in Virtual Reality (MPathic VR)
Michael D. Fetters, M.D., M.P.H., M.A., Principal Investigator
Funded by The National Institutes of Health
The M-Pathic VR II project will rigorously evaluate the extent that the newly successful "virtual reality" software program (developed in Phase I) can enhance medical school curricula in professionalism, empathy, and in patient-centeredness (using verbal and non-verbal communication skills) as well as the ACGME competencies when treating a terminally ill cancer patient.
Telemonitoring Enhanced Support for Depression Self-Management
James E. Aikens, Ph.D., Principal Investigator
Funded by The National Institutes of Health
The goal of this study is to develop a telephone-based system called CarePartners to improve depression outcomes by training a family member or close friend to support the depressed person from long distance. This project will determine whether CarePartners is more effective than usual care at improving the patient’s depression symptoms and other key outcomes.
Telemonitoring Enhanced Informal Caregiving to Support Diabetes Self Management
James E. Aikens, Ph.D., Principal Investigator
Ananda Sen, Ph.D., Co-Investigator
Funded by National Institutes of Health
We propose a community-based RCT to test the hypothesis that providing formal support to "CarePartners" (CPs) (non-household family members) improves glycemic control, diabetes mellitus (DM)-related distress, and DM self-management.
Early Audiology Referral in Primary Care (EAR-PC): Improving Detection of Hearing Los
Philip Zazove, M.D., Principal Investigator
Funded by the National Institutes of Health, National Institute on Deafness and Other Communication Disorders, Department of Health and Human Services ($1,624,469)
Dr. Zazove is lead investigator of this R21/R33 study, which seeks to increase hearing loss screenings for patients 55 and older by utilizing electronic clinical management tools in primary care setting and multimedia. The MiChart research team has designed a Best Practice Alert (BPA) which notifies primary care providers (PCPs) of HL assessment opportunities and allows clinicians to refer directly and efficiently to audiology specialists. The multimedia project, guided by Micheleen Hashikawa, M.D., also created a video to address physicians’ mental models of hearing loss. The investigation has expanded to look at patients’ decision-making around hearing testing and adoption of hearing aids. The EAR-PC study has partnered with the Beaumont Family Medicine network and Elie Mulhem, M.D., Associate Professor, Oakland University William Beaumont School of Medicine to successfully include 5,500 patients in the pilot study. Dr. Zazove anticipates over 20,000 patients in the R33 phase.
The research is guided by three aims, to:
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Evaluate whether the EAR-PC program increases PCP identification of patients with mild to moderate HL compared to baseline data.
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Evaluate whether the EAR-PC program increases appropriate PCP referral of patients with mild to moderate HL to audiology specialists.
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Utilize both qualitative and quantitative inquiry to investigate how successful PCPs implement the intervention, identifying processes and tools that will allow this project to successfully scale
