
Carma BylundHamad Medical Corporation | HMC · Medical Education
Carma Bylund
PhD
About
255
Publications
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Introduction
Skills and Expertise
Publications
Publications (255)
Objectives:
Healthcare provider self-disclosures are common although sometimes controversial. Providers have unique opportunities to self-disclose for the purpose of conveying empathic concern during Dignity Therapy sessions. We examine the topics of empathic self-disclosures (ESDs) during Dignity Therapy sessions.
Methods:
We analyzed 203 audio...
Objective
Inequities in pediatric emergency department (ED) care may be influenced by disparities in clinician communication. We sought to examine, from the perspective of parents from marginalized racial and ethnic backgrounds, how clinician–parent communication is characterized during pediatric ED visits.
Methods
We conducted and analyzed in‐dep...
Dignity Therapy (DT) is designed to preserve patient dignity through a life story-legacy interview guided by a trained provider. Given the evidence on the important role of empathy in provider-patient interactions, we focused on the provider in dignity therapy interviews with older adults and aimed to assess: 1) relative frequency of use of varying...
Objectives
Diagnostic reconciliation is the collaborative process between patients and clinicians to create and reconcile evidence-based, feasible, and desirable care plans. However, the specific components of this process remain unclear. The objective of this study was to develop the first comprehensive framework to elucidate the diagnostic reconc...
Objective
As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and ca...
Objectives
Patient dignity is a key concern during end-of-life care. Dignity Therapy is a person-centered intervention that has been found to support patient dignity interviews focused on narrating patients’ life stories and legacies. However, mechanisms that may affect utility of the Dignity Therapy have been little studied. In this study, we eval...
Background
Colorectal cancer (CRC) screening uptake among South Asian immigrants in the US is the lowest (61.1%) of all immigrant groups (e.g., 65.9% among East Asians and 71.3% among Hispanics). Culture-specific factors influence their reluctance to screen for CRC, despite the availability of easily accessible, non-invasive screening tools, like t...
BACKGROUND
Recruitment to cancer clinical trials (CCTs) is low, particularly for underrepresented groups such as uninsured or low-income patients and individuals of minoritized race and ethnicity. A significant barrier is that treating oncologists often fail to inform patients about the possibility of clinical trial participation as an option for q...
371
Background: Identity development is the process that informs how an individual views oneself and develops a sense of self. A cancer diagnosis during adolescence and young adulthood (AYA; ages 15-39) disrupts AYAs’ identity development and creates identity distress. Identity development is a key developmental task during AYA. It is a recognized...
Background
The presence of a family caregiver during medical visits is common and can be important to ensure quality cancer care. Yet, little is known about caregivers' perspectives and experiences navigating triadic medical visits, including communication between caregivers, patients (or individuals with cancer), and clinicians. Using a multiple-g...
Secure messaging (SM) is an important aspect of communication for patients with cancer. SM fosters patient-clinician communication and helps patients with symptom management and treatment support. However, patients are uncertain about how to phrase messages appropriately and have expressed the need for guidance. In response, we designed a user-cent...
Objectives
Only 5–8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists’ communication skills may enhance the frequency and quality of their discussions with patients about CCTs, consequently increasing participation. However, little is known about interest...
Background
This study explores social media (SM) usage and trust in information among cancer patients and their caregivers. We compare socio-demographic characteristics to identify groups more likely to rely on social media for treatment decisions and those less inclined to validate social media information with their provider.
Methods
A national...
This exploratory survey study used quantitative and qualitative analyses to (a) identify challenges communicating with siblings that adult child caregivers of a parent with a blood cancer encounter and (b) examine how these challenges are related to caregivers’ burden, social support, family openness, and clinical communication quality. A total of...
Objective
Cancer treatment misinformation (CTM) is pervasive and impacts patient health outcomes. Cancer clinicians play an essential role in addressing CTM. We previously identified four self-reported responses that characterize the communication process clinicians engage in to address CTM. Clinicians 1) work to understand the misinformation; 2) c...
e13659
Background: Secure messaging (SM) enables patients to ask clinicians questions asynchronously. Benefits include enhancing patient engagement, contributing to oral chemotherapy adherence, and lowering symptom distress. However, patients are unsure how to address concerns effectively, and clinicians find it challenging to decipher patients’ ne...
9029
Background: Cancer clinical trials (CCTs) are vital to advancing treatment yet only 5-8% of people with cancer ever participate, with even lower rates among underserved groups. Teaching oncologists in training how to communicate about CCTs may improve the frequency and quality of patient-oncologist communication about CCTs and increase partici...
Purpose
The overall goal of this review was to identify what is known about triadic (clinician–patient–caregiver) communication in mild cognitive impairment (MCI) and dementia care settings throughout the care continuum.
Methods
Using a structured search, we conducted a systematic scoping review of relevant published journal articles across 5 data...
Objectives
To describe patients’ and surrogate information seekers’ experiences talking to clinicians about online cancer information. To assess the impact of clinicians telling patients or surrogate seekers not to search for information online.
Design
Cross-sectional survey.
Sample
A total of 282 participants, including 185 individuals with canc...
Objective
During Dignity Therapy a trained provider guides a patient to share their life story and legacy. Providers can demonstrate empathy through empathic self-disclosure (ESD), sharing something substantial and personal about themselves in response to the patient. The current study aims to identify the topics of ESDs and determine whether ESD f...
Considering one’s legacy is usual in later life but may be accentuated after receiving a serious and terminal cancer diagnosis. This may be particularly true when timing of the diagnosis is nonnormatively early, evoking the sense of losing future years of life. Acknowledging the severity of one’s illness may also promote focus on legacy. We investi...
Background: Tele-oncology became a widely used tool during the COVID-19 pandemic, but there was limited understanding of how patient-clinician communication occurred using the technology. Our goal was to identify how communication transpired during tele-oncology consultations compared with in-person appointments. Methods: A convergent parallel mixe...
Introduction: Cancer clinical trial (CCT) accrual is only 5-8%, and barriers to participate can be more acute for underserved groups. Enrollment of racial/ethnic minorities, older adults, adolescents, and young adults is not adequate to understand treatment outcomes unique to these populations. Education before seeing an oncologist can increase pat...
Background
Spouses are the most common type of cancer caregiver and a primary source of support across the cancer continuum. While studies show that cancer can impact caregivers’ health outcomes, less is known about how blood cancer impacts the spousal relationship.
Objective
We sought to examine the impact of blood cancer on the relational connec...
Nearly 600,000 older Americans die a cancer-related death annually. Maintaining dignity is central to their quality of life. Dignity Therapy (DT; Chochinov, 2005) was designed to preserve dignity despite health declines. Patients report benefits of DT but mechanisms have not been empirically investigated. Grounded in gerontological life review rese...
Even with improved prognostic transparency (Chochinov et al., 2000) individuals struggle to acknowledge a serious-terminal prognosis. Patients who acknowledge their condition, however, show less distress and increased end-of-life planning (Ray et al., 2006). Aims were to: (1) examine extent older adults with serious cancer acknowledge their illness...
Crafting a legacy is meaningful activity in later life (McAdams et al., 1993). Threat of dying affects how individuals frame their life legacy (Hunter, 2007). We argue feeling one’s life is being “cut short” may promote greater communion in legacies. Older individuals with cancer may, however, need to acknowledge their illness to create a communion...
Family caregivers (FCs) of a patient with chronic lymphocytic leukemia (CLL) can encounter unpredictable challenges and care demands. They can experience high levels of burden, a loss of self-care, and poor quality of life. Their receipt of social support and ability to communicate with clinicians may impact their burden. FCs would benefit from edu...
Background
Recruitment of cancer clinical trial (CCT) participants, especially participants representing the diversity of the US population, is necessary to create successful medications and a continual challenge. These challenges are amplified in Phase I cancer trials that focus on evaluating the safety of new treatments and are the gateway to tre...
Purpose:
Complementary and alternative medicine (CAM) use during cancer treatment is controversial. We aim to evaluate contemporary CAM use, patient perceptions and attitudes, and trust in various sources of information regarding CAM.
Methods:
A multi-institutional questionnaire was distributed to patients receiving cancer treatment. Collected i...
Objectives:
This study investigated the challenges and support needs of adults aged 75 and older during and after treatment for a blood cancer to aid targeted supportive resource development.
Methods:
Adults aged 75 and older with a blood cancer participated in in-depth, semi-structured interviews about challenges and unmet support needs. Partic...
Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. Th...
Rationale:
Parents of a child or adolescent (CA) or young adult (YA) diagnosed with a hematologic cancer often face uncertainty. Managing uncertainty is critical to reduce the psychosocial burden of illness-related stressors.
Objective:
This study sought to identify: 1) sources of uncertainty among parents of a child diagnosed with a hematologic...
Objective:
Summarize frameworks to understand diagnostic conversations and assessments of diagnostic conversations in practice.
Methods:
We systematically searched MEDLINE, Scopus, Cochrane, and other databases from inception to July 2022 for reports of diagnostic conversations. Two authors independently reviewed studies for eligibility, assesse...
Simple Summary
Breast cancer is a shared experience for diagnosed mothers and their young adult caregiving daughters (YACDs). They struggle to talk about cancer and receive no guidance for navigating challenging but critical care conversations. Daughters in young adulthood also tend to avoid cancer-related talk, which is associated with poorer biop...
Purpose
Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicate...
Adult-child caregivers of an aging parent living with a blood cancer describe struggling to communicate with one another and within the family system. They may avoid critical care conversations, which may impede care and their ability to receive social support. We examined what approaches adult-child caregivers of a parent diagnosed with a blood ca...
Objective:
To investigate determinants of telemental health (TMH) providers' openness to discuss and confidence to use online mental health information with patients, focusing on providers' eHealth literacy and perceived usefulness of online MH information.
Methods:
TMH providers (N = 472) completed a web-based survey with questions about discus...
Objective:
Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging.
Methods:
A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identi...
Objective:
Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication.
Methods:
We used the Empathic Commun...
Cancer clinical trials (CCTs) are imperative for advancing cancer treatment and providing treatment options for patients; however, many barriers exist to offering and enrolling interested and eligible patients. It is crucial to equip patients and caregivers with communication skills that help them initiate and navigate conversations about the optio...
OBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We perfo...
Purpose:
Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices.
Methods:
In 2018 and 2019, we conducted a cross-sectio...
Data about the quality of cancer information that chatbots and other artificial intelligence systems provide are limited. Here, we evaluate the accuracy of cancer information on ChatGPT compared with the National Cancer Institute’s (NCI’s) answers by using the questions on the “Common Cancer Myths and Misconceptions” web page. The NCI’s answers and...
Chronic lymphocytic leukemia (CLL) caregivers play a central role in disease management—a role that has been heightened during the COVID-19 pandemic given the healthcare system’s reliance on frontline family caregivers and CLL patients’ increased risk of infection and mortality. Using a mixed-method design, we investigated the impact of the pandemi...
Accurate information about cancer treatment is critical for individuals to make informed decisions about their health. Unfortunately, the rise of the internet and social media combined with patients' desire for autonomy as well as the increased availability and marketing of unproven/disproven therapies has made it easy for misinformation about canc...
Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-cente...
PURPOSE
Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on cli...
Complementary and integrative health (CIH) use is diverse and highly prevalent worldwide. Prior research of CIH communication in biomedical encounters address safety, efficacy, symptom management, and overall wellness. Observational methods are rarely used to study CIH communication and avoid recall bias, preserve ecological validity, and contextua...
Background
In the United States, human papillomavirus (HPV) vaccination rates remain low. The President’s Cancer Panel suggests that effective messaging about the HPV vaccination focus on the vaccine’s safety, efficacy, ability to prevent cancer, and recommendation at ages 11- to 12-years. We aimed to develop messages about HPV vaccine that include...
PurposeTo characterize the feedback of patients with thyroid nodules receiving care using a shared decision making (SDM) tool designed to improve conversations with their clinicians related to diagnostic options (e.g. thyroid biopsy, ultrasound surveillance).Methods
Investigators qualitatively analyzed post-encounter interviews with patients to cha...
The vast majority of individuals with dementia want to receive a diagnosis. Research suggests, however, that only a fraction of individuals with dementia receive a diagnosis and patients and families often feel the information is poorly explained. We thus aimed to assess clinician-reported barriers to dementia disclosure and recommendations for giv...
Background
We recently developed a Thyroid NOdule conversation aid (TNOC), a conversation tool that supports communication about management options between patients with thyroid nodules and their clinicians. TNOC uses an interactive electronic interface to support conversations about thyroid cancer risk in patients with thyroid nodules and manageme...
Purpose
Patient-centered communication (PCC) in cancer care is helpful to nurture the patient-clinician relationship and respond to patients’ emotions. However, it is unknown how PCC is incorporated into electronic patient-clinician communication.
Methods
In-depth, semi-structured qualitative interviews with clinicians were conducted to understand...
Introduction:
An older parent's blood cancer diagnosis impacts the entire family system, including adult siblings, an often overlooked subsystem of the family. Yet, adult siblings are typically involved in their parents' care needs. We explored sibling-related experiences adult child caregivers identify while caring for a parent diagnosed with a b...
Systematic reviews and meta‐analyses serve the important function of organizing and synthesizing previous research studies, providing a foundation for researchers to advance research. These reviews use explicit, accountable, and rigorous methods to answer a specific research question. This is done by a thorough examination of published studies, and...
Burnout is a syndrome of emotional exhaustion, a sense of detachment from others, and reduced personal accomplishment caused by prolonged high levels of occupational stress and is prevalent within the healthcare profession. Higher burnout levels have been shown to impact communication skills, patient‐centeredness, and patients' health outcomes. Man...
This entry provides a brief overview of burnout within the context of caregiving, background on the current landscape of caregiving and factors that may contribute to burnout, as well as important points related to signs of stress and prevention. As rates of prevalent illnesses that require caregiving continue to increase, so will the need for info...
Background:
The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships wi...
Patient skills training programs have been developed to help individuals communicate more effectively with clinicians. These programs and interventions educate patients about different behavioral strategies such as asking questions and expressing concerns that can be used to enhance communication with clinicians. Patients possessing these skills fe...
Introduction
The management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of febrile infants, there remains substantial variabili...
Background
A greater understanding of the county-level differences in human papillomavirus (HPV) vaccination rates could aid targeting of interventions to reduce HPV-related cancer disparities.
Methods
We conducted a mixed-methods study to compare the stakeholder-reported barriers and efforts to increase HPV vaccination rates between counties with...
Objective
The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view.
Methods
A first draft of the questionnaire was compiled based on skills reflecting good physician–patient communication identified in the literature. The questionnaire was critically...
Low HPV vaccinations rates lead to missed opportunities to prevent cancer. Specifically, some parents (12–76%) report never receiving a recommendation for their child to receive the vaccine. Current models for talking about HPV vaccination fall short in that they focus primarily on how to introduce the vaccine with limited guidance on how to follow...
Objectives
Studies that use meditation-interventions (MIs) and mind–body practices (MBPs) typically highlight health-enhancing benefits whereas health-inhibiting adverse effects (AEs) have been largely underreported. The primary aim of this review was to identify articles outlining health-inhibiting AEs and synthesize the findings narratively. Rand...
Objective
Family members are important sources of support for patients with cancer. They access, evaluate, and engage with online information and discuss it with a cancer clinician. This study validates the 4-dimensions, 18-item Transactional eHealth Literacy Instrument (TeHLI) and proposed to include Clinical eHealth Literacy as a 5th dimension....
Purpose:
A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systema...
Background
Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking.
Objective
We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents...
BACKGROUND
Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking.
OBJECTIVE
We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents...
Secure messaging (SM), asynchronous communication between patients and clinicians, is an increasingly popular tool among patients to contact clinicians about their care. Despite patients' enthusiasm, clinicians have been hesitant to embrace the technology to communicate with patients. Using the theoretical and methodological framework of Grounded P...
Objective:
We examined the effects of the family communication environment (conversation orientation) on adult child caregivers' burden and clinical interactions and if the effects are mediated by openness to communicate about cancer, avoidant cancer communication, and social support.
Method:
Caregivers of a parent diagnosed with a blood cancer...
Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and...
Objective
Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits.
Methods
Across four academic...
Background: Coronavirus disease 2019 (COVID-19) immediately impacted patient-clinician communication, particularly in the oncology setting. Relatedly, secure messaging (SM) usage greatly increased, yet it is unknown what was discussed and whether the technology was utilized to disseminate information. Aims: This study aimed at identifying the most...
BACKGROUND
COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in person visits. Pre-pandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care f...
Background:
COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in person visits. Pre-pandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care...