Innovative research partnership: LJ & Allison build new way to measure clinical communication quality

Innovative research partnerships: Healthcare edition is a series of profiles about collaborations between Ph.D. communication researchers and healthcare clinicians, and is a part of the broader Innovative research partnerships series. I consider these partnerships innovative because of the creativity involved in initiating and sustaining cross-sector and multidisciplinary collaborative research. Through separate interviews of both partners in the collaboration, I share the unique stories behind such partnerships and their fruits. 

LJ’s perspective

L.J. Van Scoy, M.D., who is now a physician and associate professor of medicine, humanities, and public health sciences at Penn State Milton S. Hershey Medical Center, was frustrated after a long day in 2014 spent searching medical research databases in vain for what she needed: a way to evaluate the quality of end of life communication. In other words, how can you tell when there has been a “good” or a “bad” conversation when discussing end-of-life preferences? But none of the medical research seemed to provide a valid approach – most of it focused on behaviors rather than her concern: had a rich and substantive conversation occurred? With 5 p.m. looming after a long day, LJ abandoned the fancy search engines and turned to Google. Finally, she found something of interest: Allison’s dissertation about end-of-life communication quality. LJ printed it and took it home, finding herself reading the dissertation in the bath tub that night. “It changed my life,” LJ reflected, adding that Allison’s research was a “goldmine.”

Allison’s perspective

Allison Gordon, Ph.D., who is associate professor of communication at University of Kentucky, received a call from LJ soon afterward without knowing it would lead to four years (and counting) of collaboration. Allison studies how the quality of people’s communication with others affects their health decisions. Partnering with LJ has allowed Allison to study communication between patients and their medical providers and to more fully develop the measure of communication quality. Together, she and LJ have tested, measured, and applied multiple goals theory, which claims that people pursue various goals – often simultaneously – through their communication. These goals include relational, task, and identity goals.

About the project

Together, Allison and LJ have developed and refined the communication quality assessment (CQA), which Allison calls the “gold standard methodology for assessing clinical communication about difficult topics.” Their partnership has yielded at least five academic publications so far, and they have received an R21 grant from National Institute of Health to further develop CQA and compare alternate methods of coding communication interactions in pursuit of a more streamlined process. Given that there are few tools in medical research that are both theoretically-driven and well-attuned to communication quality, LJ believes CQA “belongs in medical culture,” adding that she wants to spread the word among clinicians about this approach to understanding and improving communication with patients.

About the partnership

The partnership between Allison and LJ has worked because they are “united by the common goal of wanting to improve clinical communication,” according to Allison. While partnerships between social scientists and physicians may be rare, Allison and LJ describe the partnership as one marked by trust and mutual respect. Both agree that their complementary areas of expertise are central to the quality of their research accomplishments. Allison acts as social scientific theorizer who provides insight and explanation about human communication, and LJ serves as the clinical expert who provides valuable insight from the clinical side and oversees application of research in context. Their work together has refined CQA by adding two new dimensions to the measure to better account for specific communication in clinical encounters. Further, LJ and Allison’s work styles seem to complement one another’s as well. LJ said that neither of them are “egocentric or arrogant,” adding that Allison had been “generous” in sharing her method and soliciting LJ’s input. Allison admires LJ’s detail-oriented “get things done” approach, adding that she is “happy to be [LJ’s] co-pilot” as LJ pursues grants and new projects.

Disclosure: I have assisted with two of Allison and LJ’s research projects, including one project currently as of October 2018, in which I serve as a paid coder.

Innovative research partnership: Lisa and Roger develop a tool to help patients make complex decisions

Innovative research partnerships: Healthcare edition is a series of profiles about collaborations between Ph.D. communication researchers and healthcare clinicians, and is a part of the broader Innovative research partnerships series. I consider these partnerships innovative because of the creativity involved in initiating and sustaining cross-sector and multidisciplinary collaborative research. Through separate interviews of both partners in the collaboration, I share the unique stories behind such partnerships and their fruits. 

Roger’s perspective

Roger Strair, M.D., Ph.D., who is a chief of blood disorders and medical oncologist at the Cancer Institute of New Jersey, was concerned about the complex decisions his patients face. He wanted to give his patients more tools to make important and complex medical decisions. For example, he described the following hypothetical scenario: a patient faces the choice between two potential therapies. The first is relatively easy to give, and results in 40% of patients being cured. Second, the patient could choose to undergo a bone marrow or stem cell transplant, increasing their chance of being cured to 65%. Yet, a percentage of patients undergoing transplant will have a lifelong disability and some patients who go through the procedure will die sooner.

Lisa’s perspective

Lisa Mikesell, Ph.D., who is assistant professor of communication at Rutgers University, studies patient engagement including the process of complex decision-making. Roger approached her and her colleague, Mark Aakhus Ph.D., several years ago about working together. For this research, Lisa has focused on finding ways to resolve the tensions faced by doctors and patients: patients want optimism (sometimes they don’t want to know their likelihood of mortality) whereas doctors want to provide realistic information to patients without depriving patients of hope. Lisa said patients in this situation often face great uncertainty and decisional conflict. The aim of this research project is to help prevent patients from regretting their medical decision by feeling better prepared to make such a complex, life altering decision.

About the project

The research team conceptualized a multimedia tool that provides these patients who face complex medical decisions with stories of other patients who’ve made similar decisions. To develop and evaluate the tool, they gathered a team including information scientists (Sunyoung Kim, Ph.D., has since joined the team), designers, and an advisory board comprised of patients and clinicians. Their goal is to help patients to make sense of their medical situation by hearing others’ stories and developing their own coherent narrative. Lisa and her colleagues began by collecting pilot data exploring how patients and clinicians report handling the tensions of communicating about complex medical decisions. The team has also developed videos with patient stories that patients can revisit and utilize in different ways over the changing course of their illness trajectory.

About the partnership

Roger said he is generally “untrained” in communication so he appreciates Lisa and her colleagues’ expertise. Roger said they try to have fun while doing this work. He joked that you can’t trust the communications experts because they know how to manipulate words. He said, “you don’t want to play a casual game of cards with a L.A. card dealer, you know what I mean?” Lisa described members of the partnership as “malleable” in that there is openness to working with differing perspectives. Further, people are willing to balance varying priorities and show mutual respect. Roger said, “we don’t agree on everything but we do agree on the fact that there is a great unmet need and it’s a worthy area of study.”