Chapter 2

Here is a list of movies that convey the patient experience. All descriptions are quoted from Netflix.

50/50 (2011). An otherwise healthy twenty-something has a comically early midlife crisis when he gets slapped with a cancer diagnosis—and a 50-50 chance of survival. But what's the meaning of life when you're not sure how long yours will last?

Angels in America (2003). Tony Kushner's groundbreaking, Pulitzer Prize–winning Broadway play about love, loss, and loneliness—the basis for this six-hour HBO miniseries—took more than 10 years to make it to the small screen. Starring Al Pacino (as real-life legal counsel Roy Cohn) and Meryl Streep, the drama examines the first few years of the AIDS epidemic in the mid-1980s, set against the moral absolutism and unresponsive backdrop of the Reagan Administration.

The Doctor (1991). Surgeon Jack MacKee (William Hurt) doesn't exactly have the most nurturing bedside manner; in fact, he regards his patients as specimens rather than people. In a reversal of fortune, MacKee learns that he has cancer and begins to aspire to a higher moral plateau of love and compassion with patients. He's helped in his mission via a special bond he forges with a fellow cancer victim (Elizabeth Perkins).

Whose Life Is It Anyway (1981). Sculptor Ken Harrison (Richard Dreyfuss) is paralyzed in a car accident and left unable to do anything but speak. Now, he just wants to die, but no one will allow it, including his doctor (Christine Lahti) and the hospital's chief of staff (John Cassavetes). Harrison's fight for the right to control his destiny takes him all the way to court.

Wit (2001). Emma Thompson stars as Vivian Bearing, a disciplined, esteemed English professor dealing with a sensitive issue—her health. After being diagnosed with ovarian cancer, Bearing is forced to reassess her life and decide what's really important. Directed by Mike Nichols and adapted from the Pulitzer Prize–winning drama by Margaret Edson, the film also tells the stories of the people Bearing touches, including her health care team.

Here is the link to a video and a story about a 15-year-old girl who defines patient-centered care: http://www.forbes.com/sites/

Here is the link to a doctor's blog on uncertainty: http://www.kevinmd.com/blog/

Chapter 3

In the scientific approach, social support measures primarily operationalize support in terms of social network size and/or frequency of interaction and are used to determine if a patient has high or low social support. Below is a list of social support measures that are commonly used:

• Medical Outcome Study Social Support Survey
• Multi-dimensional Scale of Perceived Social Support
• ENRICHD Social Support Instrument
• Inventory of Socially Supportive Behaviors
• Lubben Social Network Scale

Chapter 4

Teach-back Training Method: www.teachbacktraining.org

Chapter 5

Ho, E. Y., Bylund, C. L., Rosenbaum, M., & Herwaldt, L. A. (2009). Teaching health communication through found poems created from patients’ stories. Communication Teacher, 23, 93–98.

SPIKES: A Six-step Protocol for Breaking Bad News

Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES: A six-step protocol for breaking bad news: Application to the patient with cancer. The Oncologist, 5, 302–311.

Step 1: Setting up the interview

• Arrange for privacy
• Involve significant others if the patient chooses
• Sit down
• Make a connection with the patient (maintain eye contact, touch appropriately)
• Manage time constraints and interruptions

Step 2: Assessing the patient’s perception

• Use open-ended questions to assess the patient’s understanding and expectations
• “What have you been told about your medical situation so far?”
• “What is your understanding of the reasons we did this test?”

Step 3: Obtaining the patient’s invitation

• Many patients want full information about diagnosis, prognosis, and treatment; some do not
• Discuss patient’s desire for information as early as feasible (e.g., when ordering tests)
• “How would you like me to give you mention about your test results?”
• “Would you like all of the information or just an overview with a focus on treatment plan?”
• If patients don’t want details, offer to follow up with them later

Step 4: Giving knowledge and information to the patient

• Preview the bad news to lessen the shock (e.g., “Unfortunately, I’ve got some bad news to tell you”)
• Be sensitive to the comprehension and vocabulary of the patient
• Use non-technical words (e.g., “spread,” not “metastasized”)
• Avoid excessive bluntness
• Give information in small chunks and assess understanding periodically
• When prognosis is poor, do not use phrases such as “There is nothing we can do for you.” You can always focus on goals beyond treatment such as pain control and symptom relief.

Step 5: Addressing the patient’s emotions with empathic responses

• Observe for signs of patient emotion
• Identify the emotion (ask the patient if you are unsure)
• Identify the reason for the emotion (usually because of the diagnosis, but ask if unsure)
• Allow the patient to express emotion and then make a “connecting statement” to let the patient know you understand the emotion is related to the reason for the emotion (e.g., “I know this is upsetting news for you. I wish the news were better.”)

Step 6: Strategy and summary

• Patients who have a clear plan for the future are less anxious and uncertain
• Ensure that patients are ready to discuss the next steps (e.g., treatment plan)
• Explore the patient’s knowledge, expectations, and hopes and align discussion accordingly
• Understand the patient’s specific goals and frame hope in terms of what is possible to accomplish

Chapter 6

This article discusses the growing use of medical interpreters and how they fit within a healthcare organization:
Larson, L. (2009, July). Word for word, culture to culture. Hospital & Health Networks. Retrieved from http://hhnmag.com

Possible symptoms for in-class activity #1:

• Scratchy, swollen throat; runny nose; hot forehead
• Sharp, shooting pain in your foot
• Nauseated; headache that feels like there is a banging inside your head
• Stomach pain, possibly from something you ate last night
• Blurred vision

Chapter 7

Here is a link to the Short Test of Functional Health Literacy in Adults: http://www.nmmra.org/resources/

You can find the list of National Standards on Culturally and Linguistically Appropriate Services (CLAS) at this website: https://www.thinkculturalhealth.hhs.gov/

Learn more about the Affordable Care Act here: https://www.healthcare.gov

Here is a link to a YouToons video that explains the Affordable Care Act in less than 7 minutes! https://www.youtube.com/watch

A great website focusing on health literacy from a communication perspective: http://www.health.gov/communication/

Chapter 8

Journal of Communication, 63(1). Special Issue: Communication Strategies to Reduce Health Disparities

The PEN-3 model has had an evolution in terminology (see http://bbh.hhdev.psu.edu/lab/global-health-culture). It was too late to change the chapter, so we're including the update here:

1. health education = cultural identity,
2. educational diagnosis of health behavior = relationships and expectations
3. cultural appropriateness of health behavior = cultural empowerment

Link to article from Psychology Today on the diagnosis of ADHD in American versus French children: http://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd

Chapter 9

CDC Programs that Work. The CDC.gov website provides links to effective prevention programs in numerous categories. For instance, the one for HIV/AIDS is listed below:

Replicating Effective Programs Plus in HIV/AIDS. http://www.cdc.gov/hiv/prevention/

The CDC NPIN (National Prevention Information Network) also provides links to programs and information relating to many health needs and diseases. http://www.cdcnpin.org

NREPP is SAHMSA's National Registry of Evidence-Based Programs and Practices. This searchable database has links to almost 300 interventions in the areas of substance abuse prevention, substance abuse treatment, and mental health. http://www.nrepp.samhsa.gov

http://www.kissfmseattle.com/onair/the-bender-nation-43930/29-yearold-oregon-woman-will-die-12841709/

http://www.huffingtonpost.com/2014/10/08/brittany-maynard-death-dignity_n_5952724.html?ncid=fcbklnkushpmg00000063

Chapter 10

Here is a list of movies that deal with mental illness. All descriptions are quoted from Netflix.

Prozac Nation (2001). This adaptation of Elizabeth Wurtzel's memoir stars Christina
Ricci as a girl on the verge of losing her grip on life after she leaves her emotionally unstable home for college. Her psychiatrist prescribes Prozac ... but is that her only choice?

It's Kind of a Funny Story (2010). Being a teenager is too much for 16-year-old Craig, who shocks his parents by checking himself into a mental health clinic for a little R & R. But when the youth ward is unexpectedly closed, he's forced to live among the adult patients.

Helen (2009). Ashley Judd stars as Helen, an adored wife, mother and successful music professor who also struggles to mask her debilitating depression until a breakdown lands her in the hospital. But this apparent setback offers Helen a new perspective on life and her condition in the form of Mathilda (Lauren Lee Smith), a fellow patient with whom Helen forms a potent bond.

Take Shelter (2011). Michael Shannon stars in this thriller as a small-town family man who, determined to protect his wife and deaf daughter from impending disaster, builds an impenetrable storm shelter in the safety of his own backyard. (Additional information: He experiences a series of disturbing dreams of horrifying storms, which compel him to begin obsessively constructing the storm shelter. Are his dreams prophetic, or are they signs that he is developing paranoid schizophrenia, like his mother did at his age?)

Here is an excerpt from “ADHD and the Value of Uncertainty,” by Claudia M. Gold, MD. (http://www.kevinmd.com/blog/2014/03/adhd-uncertainty.html)

Consider Jacob, a five-year-old boy I saw recently in my behavioral pediatrics practice. He was adopted, and two biological relatives had bipolar disorder. A pediatrician, his adoptive parents and a neurologist suspected that he too had the disorder. But with space and time to hear the story, the following emerged.

Jacob had been an easy baby. Then when he was about two, he experienced a number of significant losses. A foster child with whom he was very close was removed from the home because of behavior problems. Just weeks after his adoptive mother, Alice, learned she was pregnant, her sister died suddenly of a cerebral hemorrhage. Jacob’s maternal grandmother, in the face of the loss of her own daughter, threw herself into caring for Jacob’s baby sister.

Jacob’s mother wept in my office as she spoke of her own loss, not only of her sister, but also of her mother who withdrew in the face of her grief. Shortly after these events, Jacob’s behavior problems began in earnest. He became alternatively clingy and aggressive. When I saw the family, no one had slept through the night for a long time.

Jacob might very well have a biological vulnerability to emotional dysregulation inherited from his parents who carried the bipolar label. But multiple losses, subsequent disruptions in attachment relationships, sleep disruption, and other factors had significant roles to play in the  development of his symptoms. Had he, like William, been prescribed medication for his symptoms, this story, and the meaning of his behavior, would not have been heard. For every child I see in my practice, there is a story, often equally complex, behind the symptoms.

Rather than offer time and space for the nuances, complexities, and uncertainties of human behavior and relationships, the DSM (Diagnostic and Statistical Manual of Mental Disorders) paradigm, with its diagnoses of disorders based on symptoms, often followed by prescribing of medication, creates an aura of certainty, as in “you have X and the treatment is Y.” But there is virtually no evidence of any known biological processes corresponding to either ADHD or bipolar disorder (or any other DSM diagnoses, for that matter). This certainty implied in the giving of a diagnosis and prescribing of medication has a kind of comfort, but also a real danger. There is no room for curiosity, for wonder, for not knowing. Jacob’s behavior was a form of communication. Giving medication to control his behavior is in effect a silencing of that communication.

Link to article from Psychology Today on the diagnosis of ADHD in American versus French children: http://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd

Chapter 11

Link to the Belmont Report: http://www.hhs.gov/ohrp/

Link to advance directions: Five wishes: http://www.agingwithdignity.org/

Practitioner orders for life-sustaining treatment: http://www.njha.com/media/

Students can go here to find their state's specific advance directive form:
http://www.caringinfo.org/

Here is a link to an NPR story on the ethics of blood donation: http://www.radiolab.org/

If you would like the entire story on blood, here is the link:  http://www.radiolab.org/story/

Chapter 12

Here are two systematic reviews that may help to supplement the chapter.

Ekeland, A. G., Bowes, A., & Flottorp, S. (2010). Effectiveness of telemedicine: A systematic review of reviews. International Journal of Medical Informatics, 79, 736–771.

Ye, J., Rust, G., Fry-Johnson, Y., & Strothers, H. (2010). E-mail in patient-provider communication: A systematic review. Patient Education and Counseling, 80, 266–273.

Here is the website on the HON Code of Conduct for medical and health websites: http://www.hon.ch/HONcode/

Here is the list of physician blogs recommended by Torrieri (2011):

• KevinMD: www.kevinmd.com
• Medinnovation: medinnovationblog.blogspot.com
• Dr. David's Blog: Musings of a Pediatric Oncologist: doctordavidsblog.blogspot.com
• Family Webicine: blogs.webmd.com/all-ears
• Dr. Leslie Greenberg: drlesliegreenberg.com
• db's Medical Rants: www.medrants.com
• MomMD: www.mommd.com/blogs
• The Doctor Weighs In: www.thedoctorweighsin.com
• Dr. Wes: drwes.blogspot.com

Chapter 13

Here is a link to a story on news coverage of vaccines: http://www.npr.org/blogs/

The University of Kentucky Institute for Rural Journalism and Community Issues http://www.ruraljournalism.org/

Information about DTCA from the FDA http://www.fda.gov/ForConsumers/

Chapter 14

Below are three particularly useful articles that review issues related to campaigns and interventions:

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202. doi:10.1146/annurev.publhealth.19.1.173

Noar, S. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication: International Perspectives, 11(1), 21–42. doi:10.1080/10810730500461059

Randolph, W., & Viswanath, K. (2004). Lessons learned from public health mass media campaigns: Marketing health in a crowded media world. Annual Review of Public Health, 25, 419–437. doi:10.1146/annurev.publhealth.25.101802.123046

Chapter 15

Noar, S. M., & Harrington, N. G. (Eds., 2012). eHealth applications: Promising strategies for behavior change. New York, NY: Routledge.

This edited volume reviews the research evidence for a whole range of eHealth applications, including Internet, mobile, and health video games.

Chapter 16

For an amusing look at emergency preparedness, check out this YouTube video: https://www.youtube.com/watch

Crisis and Emergency Risk Communication Manual http://www.bt.cdc.gov/cerc/resources/pdf/cerc_2014edition.pdf

Preparedness 101: Zombie pandemic http://www.cdc.gov/phpr/