Fighting cancer with morale

Jeffrey D. Robinson, associate professor of communication at Portland State, recently obtained a $340,000 grant from the National Cancer Institute to investigate how the initial communication between breast-cancer patients and their surgeons influences a patient’s psychosocial health during treatment and recovery.

 “What I’m predicting, and what I’m hoping to show, is that certain types of patterns of communication can actually improve women’s psychosocial health,” Robinson said.

According to Robinson, a fair amount of scientific research indicates that a person’s psychosocial health affects his or her mortality. Although the scientific community has not yet identified the mechanism connecting one’s psychosocial state to one’s physiological state—that is, connecting one’s morale to one’s immune system—the existence of such a connection is abundantly obvious.

“There’s some research that has shown that, for instance, the more hopeful patients are about their cancer and their ability to survive, the longer they actually live and the less likely they are to have a recurrence of cancer,” he said. 

A patient’s sense of hope is liable to increase or decrease, depending on the quality of her first interaction with her physician, Robinson said. A decrease in hope often accompanies a heightened sense of fear, fatalism, uncertainty and other negative feelings. If a woman’s morale is sufficiently damaged, she may begin to make what the medical community views as bad decisions.

“For instance, if a woman goes into a surgeon’s office feeling extremely distraught, fearful and uncertain, and she leaves more fearful and uncertain, research shows that that woman may opt not to have surgery,” Robinson said.

However, according to Robinson, if the patient leaves feeling more hopeful, less fearful and more certain, then she is more likely to make timely treatment decisions. 

The bulk of the research conducted on patient-physician communication focuses only on the mid- or post-treatment stage of cancer recovery. Robinson’s research, on the other hand, will focus on women’s state of mind during the pre-treatment stage so as to “get as close to the beginning of the recovery process as possible.”

For this reason, Robinson is mostly collecting data from women who have been diagnosed within 72 hours. It is also the reason Robinson is observing the interaction between patients and surgeons, which are usually women’s first “specialist point-of-contact” after being diagnosed, according to Robinson.

Robinson’s method consists of giving patients a psychosocial health questionnaire immediately before they consult with their surgeon and then immediately afterward. These questionnaires ask the patients to rate their current level of anxiety. The consultation itself is videotaped and then later transcribed.

By comparing a patient’s pre- and post-consultation anxiety scores, Robinson can determine if her level of anxiety has changed as a direct result of the conversation with her surgeon, thereby relating a surgeon’s communication patterns to changes in his or her patient’s self-rated anxiety scores.

Although Robinson is the principal investigator on this study, two PSU graduate students in communication—Maryjane Dunne and Claire Gregory—are carrying out a considerable portion of the work.

According to Dunne, she and Gregory are primarily responsible for recruiting patients, transcribing the consultation and entering survey data. Soon they will begin analyzing the transcribed conversations and, later, learn how to actually code the raw survey data.

“This study allows me to have one of those jobs where I feel like I can make a difference in the world,” Gregory said.

Robinson’s grant—which took roughly 18 months to acquire—is known as a “pilot grant” and lasts for two years, during which Robinson must report his preliminary findings and present them at conferences. When the grant is slated to expire, he must produce an end-of-grant report discussing his results, which he expects to publish widely in peer-reviewed medical journals.

If this study proves fruitful and his findings hold up, Robinson will apply for a larger grant to study a wider sample of breast cancer patients and perhaps broaden the scope of his research to include more diverse cancer contexts. And if the evidence confirms his hypothesis, Robinson believes that his results could have an influence on other situations involving patients facing potentially life-threatening diagnoses.

Robinson hopes to demonstrate which communication practices on the part of physicians tend to improve the health of their patients.

Additionally, Robinson hopes to eventually create and implement training programs in interpersonal communication for physicians that can be realistically and feasibly incorporated into the medical industry. 

“The industry knows very well that these more human, relational, communicative sides of care matter for health care. If for no other reason besides their own bottom line, improving physician-patient communication matters for their insurance premium,” he said. 

Although Robinson believes that the medical industry stands to benefit from his findings, he knows that it takes a long time to change medical training and medical practice.

Robinson has been exploring patient-physician communication for the last 11 years. Before he transferred to PSU, he conducted some preparatory work at Rutgers University. He later presented his data to the National Cancer Institute, which decided that continued research in this field represented a promising investment.

“We were lucky that he was already working on his grant and invested in it before he came to Portland State,” said Cynthia-Lou Coleman, chair of the communications department at PSU. 

Coleman said that Robinson’s grant is exciting because it is good for the communications department to be able to demonstrate that it’s doing  important work.?