Therapeutic misconception and participation in clinical research

In her column this week, Dr. Pauline Chen touches on a serious concern for clinical researchers: therapeutic misconception. Clinical research is dependent on the voluntary, informed participation of research participants. Researchers, coordinators and institutional review boards, put a great deal of time and effort into making sure that potentially participants are fully informed about the nature of their participation in research, including the fact that they themselves may not directly benefit from participating in the trial. But when potential participants face serious, life-threatening illnesses, they may view participation in the trial as their only hope, even if the researcher tells them there is only a small chance they will benefit. Dr. Chen's column ultimately explores the ethics of hope. Is it OK for researchers to enroll participants who are enrolling with unrealistic expectations, despite the researcher's best efforts at informed consent? Is there any way to prevent unrealistic expectations? Should we prevent unrealistic expectations if they give hope?

Physician and patient perspectives

The Wall Street Journal Health blog highlights two recently published surveys that point to the different perspective of physicians and patients. The differences highlight how different perspectives can affect the quality of communication between physicians and patients. A little perspective-taking, or thinking from the other person's view, can go along way in facilitating communication.

Looking for health information online

The New York Times had an article today about where to look for health information online and the dangers of hysterical hypochondria and subtle misinformation. Many of us want to research our own health issues before visiting our doctor, and the Internet can be a great source of information. But it is important to weed through the special interests and the hype to reach more objective information. Today's article points the reader to some good sources to get past the hype.

Worry about aging doctors

The New York Times had an article earlier this week about aging physicians and concerns about their abilities. It is a delicate social and communication task to talk to someone who has dedicated their life to a career that it may be time to give it up. Hospitals and governing bodies are wondering if the solution is to require reaccreditation or some other testing once physicians reach a certain age. But requirements for accreditation among physicians are not uniform and are difficult to enforce with any meaning. But whether testing is required or not, fellow physicians may find themselves in the position of having to discuss declining abilities with another physician. It is not an east conversation, but an important one.

Fear of colon cancer screening

The New York Times Well blog had a post today about the reason many people do not get recommended colon cancer screening: fear. The fact that so many cite fear as a reason for not getting or putting off the test presents a communication opportunity for physicians talking to their patients about colon cancer screening. Physicians should not downplay a patient's fears. but rather anticipate and validate emotions the patients may be feeling about the screening test. Take a few minutes to explore the emotion: is it fear of finding cancer or fear of complications from the test or something else? Communication can be the difference between a patient getting a needed test and not getting it.

Meanwhile, here's what Dave Barry had to say about getting a colonoscopy.

Finding the right metaphor

The ACRP Wire, the newsletter of the Association of Clinical Research Professionals, had an interesting article today on a study which looked at how language affects research participant understanding. The metaphors research coordinators use make a difference in participant understanding of concepts such as randomization. A metaphor that described randomization as similar to the flipping of a coin evoked the idea of winning or losing, while comparing randomization to the chance an expectant mother may have a boy or a girl was better understood.

The study points to the importance of effective communication, targeted to the literacy and health literacy of the potential research participants involved.

Communication research and education in 2011

2010 was a productive year for both my own research efforts and the research efforts of my multi-disciplinary team. 2011 holds just as much promise for exciting research projects.

On my list for 2011:

Informed consent: I am working on proposals for several projects exploring the role of communication in informed consent discussions. Informed consent is important to both health care and clinical research. Patients and potential research subjects are dependent on informed consent discussions and documents to educate and inform them about the risks and benefits of procedures, so that they may make an informed decision. But if they do not understand what is discussed, their consent cannot be truly informed. There is great potential for improved communication to facilitate informed consent.

Working in multi-disciplinary teams: I had the opportunity this year to speak to several different groups about communication in multi-disciplinary teams. This year, I will be expanding the topic to explore the specific task of coordinating the writing of scientific papers when working and communicating with multi-disciplinary research teams.

Communication theory: Once again, I will have the opportunity to teach an Introduction to Communication class at Marquette University. Though I am primarily a researcher, I value the opportunity to get into the classroom and introduce students to the complexity and possibilities in the field of communication. I get energy to continue with my research when exploring the basics of communication with students. I look forward to what this year's students will teach me.

2011 should be busy, but it is rewarding to keep moving forward in my field and to share my knowledge along the way.