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Item Assessing Communication Effectiveness in Interprofessional Healthcare Teams(2019-07) Binion, Kelsey Elizabeth; Brann, Maria; Goering, Elizabeth; Hoffmann-Longtin, KristaInterprofessional education and practice is a collaborative approach in equipping health professional students with the skills to become effective team members to improve patient outcomes. This research study used a grounded theory approach to identify the communication characteristics and behaviors that influenced a team’s communication effectiveness. Two-hundred and twenty-two students participated in an interprofessional simulation at a Midwestern university. Ninety-two standardized patients assessed the students’ communication skills and their ability to collaborate as a team using a CARE Patient Feedback form, which served as data for the study. The study found four characteristics of effective interprofessional team experiences: aware of the patient’s situation, participate in the interaction equally, create a safe space, and nurture and strengthen a relationship. Students demonstrated an increase in communication effectiveness between encounter one and two; teams worked collaboratively rather than individually; students demonstrated five of the eight IPEC communication competencies; and negative and positive behaviors had a significant impact on patient outcomes. This study informs educators the need for repeated exposure of interprofessional practice experiences, such as simulation activities. These opportunities allow students to practice, learn, and refine their communication skills before entering their clinical practice.Item At a Loss for Words: Using Performance to Explain How Friends Communicate About Infertility(2023-06) Binion, Kelsey Elizabeth; Brann, Maria; Beckman, Emily; Bute, Jennifer J.; Longtin, Krista J.In the United States, approximately one in five women are unable to get pregnant after one year of trying. Due to the pervasiveness of pronatalism in Western society, having a child is widely assumed to be a natural and expected part of womanhood. Society’s master narratives reinforce these ideals and stigmatize the experiences of women who have infertility. This multi-phase research study examined how women discuss their infertility journey with their friends. The study’s aims were to understand friendships within the context of infertility, how the relationship affects a woman’s identity, and the communicative behaviors used in conversations. Fifteen interviews were conducted with women who experienced or are experiencing infertility and had discussed their past or current challenges with a friend. Results of a phronetic iterative analysis suggested that women who have personal experience with infertility (a) disclose to close/best friends, (b) communicate their identity as “broken,” (c) desire emotional support, and (d) strategically navigate conversations as they encounter positive and negative messages. These results were transformed into a performance, which included six monologues and a talkback. The purpose of the arts-based methodology was to disseminate results and assess the performance’s impact. Seventy-three individuals attended one of the two performances in April 2023, and 50 attendees completed the post-performance evaluation. The quantitative results suggest that attendees felt informed about the complexities of infertility, gained a new perspective, received advice about how to have future conversations, and did not feel offended by the content. Through a thematic analysis, four themes emerged from the two talkback sessions and evaluation comments: being informed about infertility as a health condition, appreciating the theatrical format to learn, connecting to the performance to understand the illness experience, and feeling comfortable navigating conversations about infertility. Despite the variance in infertility experiences, friends are essential social support figures as women navigate infertility, and there are best practices when having a conversation, as demonstrated in the performance. This study’s implications include providing communication strategies to support women with infertility and recognizing that an arts-based methodology can highlight counterstories, inform about a stigmatized health issue, and engage the community.Item Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction(Cureus, 2021-06-05) Shanks, Anthony L.; Brann, Maria; Bute, Jennifer J.; Borse, Vyvian; Tonismae, Tiffany; Scott, Nikki; Obstetrics and Gynecology, School of MedicineIntroduction; Delivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance. Methods: Previous OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the "do's and don'ts" of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges' g was used to assess mean scores and effect size. Results: A total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges' g was 0.37 (95% CI: -0.59 to 1.33). Conclusion: Residents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.Item Co-Ownership of Private Information in the Miscarriage Context(2014-12) Bute, Jennifer J.; Brann, MariaPregnancy loss due to miscarriage is a pervasive health issue. Although talking about the miscarriage experience with friends and family members has been linked to better adjustment, revealing this loss can be difficult because discussing a miscarriage often makes people uncomfortable. Moreover, couples often manage this information jointly as they decide whether to share the miscarriage with people outside the dyad. We conducted in-depth interviews with couples to explore the nature of co-ownership in the miscarriage context and to identify the privacy rules that couples develop to manage this information. We found that couples frame miscarriage as a shared but distinct experience and that both members exert rights of ownership over the information. Couples' privacy rules centered on issues of social support and others' need to know about the loss. Even though couples described their privacy rules as implicitly understood, they also recalled having explicit conversations to develop rules. We discuss how the management of co-owned information can improve communication and maintain relationships.Item Communicating Commitment within Monogamous Romantic Relationships(2020-01) Leverenz, Alaina Nicole; Goering, Elizabeth; Brann, Maria; White-Mills, KimThis study sought to better understand the communication of commitment in monogamous romantic relationships, including how one communicates his/her commitment to his/her partner and how one interprets messages from his/her partner. Focusing on the fundamentals of communicating commitment to one’s partner proves beneficial in understanding the commitment processes in daily life. In an effort to understand this concept, I used themes from interdependence theory and the investment model to formulate the interview questions and develop the findings. The findings and interpretations demonstrate that couples are communicating their commitment to each other in words/verbal expressions, especially in the beginning stages of the committed relationship; the commitment global construct employed most to communicate commitment in relationship is relational maintenance behaviors; and people perceive that nonverbal expressions of commitment are the best way to interpret messages of commitment from one’s partner.Item Communicating to promote informed decisions in the context of early pregnancy loss(Elsevier, 2017) Brann, Maria; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsObjective. To evaluate residents’ ability to engage standardized patients in informed decision making during a pregnancy loss scenario. Methods. Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. Results. Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. Conclusion. This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient’s decision. Practice Implications. Healthcare providers could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions.Item Communication to Cultivate a Culture of Health: Lessons From 5-Star Achievewell Organizations(2021-12) Martin, Natalie R.; Brann, Maria; Bute, Jennifer; Goering, Elizabeth; Staten, LisaCreating a culture of health within an organization offers benefits such as reducing costs and supporting employees in becoming and staying healthy. A variety of health and wellness programs within an organization are important for establishing a culture of health. These programs are supported communicatively to encourage employee participation and healthful behavior changes. Recognized for their success in creating a culture of health, a group of organizations, distinguished as 5-Star AchieveWELL organizations, offer an opportunity to identify messaging strategies effective at promoting health and wellness within the workplace and therefore, creating a culture of health. The goals of this study included learning successful organization’s communication strategies utilized to create a culture of health, understanding how new employees are socialized into this culture, identifying how employees may resist the culture, and exploring how resistance is addressed. Based on in-depth interviews with 19 5-Star AchieveWELL organizational representatives and grounded theory analysis of collected data, evident themes related to the goals of this study were identified. Key communication strategies to support a culture of health include using multiple communication channels, demonstrating leadership support, and being willing to adapt and change over time. New employees are socialized into the culture of health during the recruitment process as well as new employee orientation. Resistance to health and wellness occurs in the form of non-participation and employee push-back, with this resistance often being met with compassion. These results offer practical implications for organizations desiring to create a culture of health as well as theoretical implications for scholars studying organizational socialization.Item Dentist-patient communication: How do patients make sense of oral health information and translate it into action?(2016-01) Laorujiralai, Kamolchanok; Goering, Elizabeth M.; Brann, Maria; Bute, Jennifer JoPurpose: Patient-provider communication has been studied extensively in the last two decades, and many researchers have confirmed the importance of communication between patient and provider in medical contexts. In spite of increased research in patient-provider communication in dentistry, dental care providers still report that patients often do not accurately follow oral health recommendations. Thus, there is the need for additional study on how patients make sense of the oral health information they receive and how they translate that information into action. This study aimed to obtain insight into how dental care patients perceive and make sense of the information they receive from their dentist and how they translate that information into action. Methods: 16 patients and 8 dentists from Indiana School of Dentistry’s (IUSD) Graduate Prosthodontic Clinic in Indianapolis, Indiana were included. Two in-depth interviews, one immediately following the dental visit and one 7-10 days later, were conducted with the patients, and one short interview was conducted with each patient’s dental care provider. Interviews were audio taped and transcribed. Results: The results show both patients and providers perceived the interaction during consultation positively. The majority of patients were able to accurately recall information they received from their dentists and made sense of new information through the lens of their previous experiences. Four additional factors that explain patients’ adherence with health advice were also found in addition to the previous studies. Conclusions: Successful dentist-patient interaction could be thought of as a match between what dentists think patients need to know, what patients think they want/need to know, and what patients actually know. Thus, some barriers that can keep dentists and patients from reaching information equilibrium are discussed. The study concludes by offering practical and theoretical implications.Item The Development and Psychometric Testing of an Inventory to Measure Health-Focused Perceived Family Support and Communication Behaviors with Chronic Disease Patients: A Three-Phase Study(2019-06) Harsin, Amanda M.; Brann, Maria; Head, Katharine J.; Bute, Jennifer J.; Rawl, Susan M.Hospitals and policymakers acknowledge the importance of the family in improved healthcare outcomes. Although there has been an increase in policies and research to bring families into planning, delivery, and evaluation of healthcare, there has not been a means to assess health-focused perceived support and communication behaviors. Without a means of assessing these factors, healthcare professionals cannot succinctly evaluate support and communication in a family system or provide recommendations for engaging family members in providing beneficial health-focused support and communication. This study involved the creation of the Inventory for Family Health-Focused Perceived Support and Communication Behaviors (Family HF-PSCB). Informed by family systems theory, social support literature, and health communication behaviors research, this three-phase study consisted of (a) generating items for the Family HF-PSCB, (b) establishing test-retest reliability, and (c) establishing a factor structure and convergent validity. Because of the increase of chronic disease in the United States, the Family HF-PSCB was created and tested with samples of individuals having chronic disease(s). Using a mixed methods approach, in-depth interviews with 12 participants generated 91 items for psychometric analysis. These items were tested through expert content review, and in pilot testing (n = 23), the remaining 84 items demonstrated test- retest and internal reliability. Through factor analysis (n = 209), two factors emerged to explain 72.1% of the variance. The final Family HF-PSCB contains 13 items, which indicates an individual’s perception of family health-focused support and communication behaviors. The factor explaining 63.2% of the variance has 8 items demonstrating healthfocused communication behaviors, and the second factor has 5 items demonstrating health-focused instrumental support. The developed scale suggests that family healthfocused communication behaviors may be a more explanatory variable in the family system for someone with chronic disease(s). The 13-item Family HF-PSCB demonstrates convergent validity through significant correlations with the Perceived Social Support Family Scale and the General Functioning Scale of the McMaster Family Assessment Device. Future studies should explore the correlation of the Family HF-PSCB with health outcomes attributed to symptom management in populations of chronic disease patients.Item Development of a Theory-Informed Patient Decision Aid to Facilitate Consent to Genetic Testing in the Neonatal Intensive Care Unit(2024-05) Higley, Keeley; Head, Katharine J.; Brann, Maria; Bute, Jennifer J.Genetic testing is an essential diagnostic tool in the neonatal intensive care unit (NICU) that can shorten infants’ stays, improve accuracy and effectiveness of medical care, and overall improve quality of life. However, there are challenges involved in the process of recommending life-saving and care-changing genetic testing in the NICU, including parental concerns around issues of paternity, guardians’ decisional anxiety, low health literacy, limited understanding of genetic testing, and receiving conflicting information from different healthcare providers. These challenges are exacerbated by the urgency guardians face in the NICU; guardians’ first exposure to genetic testing often occurs immediately before they are asked to decline or consent to it while in an extremely emotional state and fraught environment, creating a sense of urgency that affects decision-making. Current patient-provider communication practices in the NICU could benefit from improved, streamlined communication tools to help guardians make thoughtful decisions about genetic testing for their hospitalized infants. One potential strategy to streamline communication about genetic testing in the NICU is incorporating self-determination theory into patient decision aids. A series of three iterative interview rounds with NICU guardians and new guardians of infants younger than three years old were conducted. Following each round of interviews, recordings were transcribed, and feedback from participants was used to revise a patient decision aid guided by self-determination theory. After completing all three rounds of interviews and revisions, thematic analysis was conducted on all transcribed interviews to identify salient themes to NICU genetic testing decision-making. The final version of the patient decision aid developed from this study will serve as a starting point for integrating this important tool into the NICU.