We currently have three programs underway: our flagship program on interdisciplinary communication, a newly launched program on educating cancer patients about symptom management while on oral oncolytic therapy, and a project investigating epistemic network analysis and shared understanding between physicians and nurses.
Despite more than 50 years of research on the topic, poor communication between physicians and nurses remains one of the most frequent root causes of adverse events and a major challenge to improving patient safety. Effective communication involves the development of shared understanding that occurs in the moment-by-moment interaction between communicators. We have assessed the feasibility of using video reflexive ethnography to capture communication between physicians and nurses. During video review physicians and nurses focused on specific details of their communication practices, revealing their habits and gaps between what they said they did and what was actually done, providing the starting point to explore shared understanding.
Improving Adherence to Oral Oncolytic Therapy in Cancer Patients
Over 1.7 million patients are diagnosed with cancer in the United States annually, and many will be prescribed oral medications to treat their cancer. Oral oncolytic therapy represents a new frontier in cancer treatment, but the convenience of oral oncolytics over intravenous chemotherapy infusions may be offset by the wide range of symptoms and side effects that patients experience. In one study, up to 30% of patients reported medication non-adherence to oral oncolytic therapy with symptoms as the primary reason, despite receiving education from oncology clinicians on evidence-based symptom management strategies. Through the use of VRE we will develop a better understanding of the best educational approaches that engage patients and their informal caregivers to manage treatment-related symptoms effectively. VRE will also help us explore the factors that interfere with patients’ abilities to process and internalize information during education sessions for application once they are at home.
New Project!! Epistemic network analysis as a method to capture shared understanding between physicians and nurses: a secondary data analysis
Drs. Vitaliy Popov and Milisa Manojlovich are embarking on an exciting new project that will explore whether shared understanding between physicians and nurses can be identified using a new tool.
We will use Epistemic Network Analysis (ENA) to model communication between physicians and nurses. ENA uses statistical and visualization techniques to identify, quantify, and represent connections among coded behaviors as network models. Our epistemic frames can be compared to wearing glasses that help us to “see” the world in a different way. The data come from conversations between nurses and physicians that occurred during patient care rounds on inpatient medical and surgical units and that were video-recorded as part of a previous project. Specifically, we will quantify the co-occurrence of coded elements in our data (e.g., what physicians and nurses do, attend to, and say) within a certain temporal context. Resulting networks will provide visual representations of relationships (connections), as depicted in our hypothetical nurse epistemic network that shows how some relationships may be stronger than others. If we had a physician epistemic network available to display as well, we could then visualize differences as well as similarities between physicians and nurses in their worldviews. Gathering information regarding the factors that contribute to shared understanding could help identify causes of communication breakdowns and make it easier to develop strategies to overcome them.
We are grateful for support from the Undergraduate Research Opportunity Program (UROP) at the University of Michigan.