Specific Communication Strategies Research Articles

Roger’s diffusion of innovations theory and the adoption of a patient portal’s digital anamnesis collection tool: study protocol for the MAiBest project

BackgroundGerman hospitals are legally obliged to implement digital patient portals within the next years. Systematic reviews show that the use of patient portals may be associated with improved patient-centeredness and workflows. However, mandatory digital healthcare innovations are sometimes not used by the target group as planned or even completely rejected. Based on Roger's theory of innovation diffusion, it can be assumed that the time factor is of particular importance for the adoption of the patient portal. The aim of the project is to assess determinants of patient portal adoption and to examine whether Roger’s theory can be confirmed.MethodsThe project investigates the use of the patient portal in three different clinics of a large academic teaching hospital in Germany using a longitudinal study design with three cross-sectional time points (pre, post, post). Doctors and patients are surveyed about factors that predict the use of the patient portal and whether the strength of these factors changes over time. They are also interviewed about possible barriers they experience when using the patient portal or about the reasons why the patient portal is not used. Regression models and content analyses are used to answer the research questions.DiscussionDeterminants of patient portal use will be discussed under the light of the temporal component of Roger's theory. At the same time, it is expected that some determinants will remain unchanged over time. Identifying determinants independent of time allows targeting the groups, enabling specific communication strategies to empower these groups to use the patient portal, contributing to an equal health care system.Trial registrationThe study was prospectively registered in the German register of clinical trials (DRKS00033125) in May 2024.

Investigating genetic counselors' communication with Lynch syndrome patients about cascade testing: Barriers, facilitators, and strategies.

Cascade testing is an imperative process to engage Lynch syndrome patients' at-risk relatives in early cancer risk reduction interventions. How genetic counselors communicate about cascade testing is crucial to patients' intentions of and actual involvement in family communication. Based on data from 20 interviews with genetic counselors, this qualitative study examined their perceptions of barriers and facilitators of offering cascade testing to at-risk relatives and the specific communication strategies they use to discuss cascade testing with patients. We identified patient-level, genetic counselor-level, and system-level barriers and facilitators of having discussions with Lynch syndrome patients about cascade testing. The qualitative data also revealed four prominent communication strategies that genetic counselors use for such discussions: build rapport, reframe the benefits of family communication, adapt communication, and provide various resources. These findings highlight genetic counselors' needs of practical and structural support to facilitate their communication about cascade testing, especially when patients are hesitant or lack resources or skills to notify at-risk relatives about cascade testing.

Public Communication for Effective Service Delivery to Refugees in Uganda. The Case of Kiryandongo Refugee Settlement

This study argues that Public Communication in Refugee Settlements, when managed professionally and structurally with a deliberate open feedback mechanism for the end-users of services provided by the government and its development partners, could be a great tool for the evaluation and enhancement of public services provided in Refugee Settlements. The study analyses the education and health sectors as parameters for the government’s service delivery in the case of the Kiryandongo Refugee Settlement. Taking a qualitative research methodology approach with the case of Kiryandongo Refugee Settlement, the study found that the Uganda Refugees Act (2006), which authorises service provision by the government to the refugees, has no specific public communication strategy or policy clearly spelled as a communication framework to support service provision feedback. Therefore, the study recommends a direct public engagement communication strategy involving refugees and relevant stakeholders in the public service provision with the ultimate goal of improving service delivery at Kiryandongo Refugee Settlement

Stakeholder Perspectives on the Role of Social Media in Urban Green Space, Land Management, and Resilience in Gilgit-Baltistan

The primary focus of this study is to explore stakeholders’ perspectives on how social media platforms like Facebook, WhatsApp, and Twitter influence land management practices and community engagement. Employing a qualitative methodology, this research delves into the complex interactions facilitated by social media, using thematic analysis to identify key themes related to communication, collaboration, empowerment, and awareness-raising among stakeholders such as local authorities, community members, environmental activists, and urban planners. The findings reveal that social media significantly enhances transparent communication channels, fosters collaboration among stakeholders, empowers local communities, and raises awareness about the importance of urban green spaces. However, challenges such as connectivity and literacy barriers persist, alongside opportunities for greater involvement and innovation. This study emphasizes the critical role of digital platforms in advancing sustainable land management practices, offering valuable insights for policymakers, urban planners, and community stakeholders. Future research should explore specific communication strategies, the impact of social influencers, and the integration of emerging technologies in urban planning. Ultimately, this research contributes to the understanding of how social media can support the development of environmentally friendly and resilient communities.

Reframing the experience of childbirth: Black doula communication strategies and client responses during delivery hospitalization

Doulas, or birth coaches, are said to be “changing the world, one birth at a time.” Black doulas have been suggested to mitigate against lack of representation in obstetric care, limited identity acknowledgement and accommodation, and obstetric racism. However, scientific inquiry into the specific communication strategies and messages used by Black doulas to advocate for clients was non-existent in extant literature. Guided by the Agency-Identity Model, we analyzed 20 diary-interviews of nine Black doulas who recently served Black clients. Specifically, we explored Black doulas' communication strategies and whether these strategies had an impact on client agency. We found that Black doulas prepare their clients for patient-provider interactions, including conversations about certain medical treatments and procedures and the risks for Black women and birthing people, the importance of informed consent, how to be heard, and how to resist neglect or abuse. We found that, in turn, most Black clients were able to enact agentic responses. We describe the specific doula messages, and contextualize our findings, considering how these collective interpersonal communication strategies of Black doulas, and their clients’ agentic transformations, may index a sociopolitical movement to reframe the experience of childbirth in America.

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review.

To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting. Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes. Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO. The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care. This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families. Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting. The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

Shame in patient-health professional encounters: A scoping review.

Shame can arise during patient-health professional encounters when discussing traumatising and stigmatising topics and can contribute to negative patient outcomes. This review aims to summarise what is known regarding shame in patient-health professional encounters. We conducted a scoping review using Levac and colleagues' approach and reported the findings using the PRISMA Extension for Scoping Reviews. We searched four databases (CINAHL, PsychINFO, PubMed and SocINDEX) for empirical studies that involved shame in patient-health professional encounters contextualised by trauma or stigma and were published in English. We categorised what is known regarding shame in empirical studies using inductive content analysis. We also collected stakeholders' perspectives on the review findings through an online survey. Our initial search yielded 3658 articles, of which 37 were included. We summarised the literature into four categories: (1) What health professionals say they do in patient-health professional encounters, (2) What health professionals think patients feel in patient-health professional encounters, (3) Patients' descriptions of their own shame during patient-health professional encounters and (4) Health professionals' descriptions of their own shame during patient-health professional encounters. Shame can arise in a variety of circumstances during patient-health professional encounters. More research is needed to identify what specific communication strategies used by health professionals during patient-health professional encounters contribute to or avoid patient shame.

De los me gusta al cambio: evaluación del impacto del compromiso ciudadano en las plataformas de redes sociales de la Comisión Europea

Introduction: The rise of social media has changed public institution communication, increasing dialogue with citizens and presenting challenges like privacy and misinformation. Aims/Objectives: To study how emotional resonance in communications from the European Commission on social media affects public engagement. Methodology: Analysis of the Commission's social media data (Feb 2019 - Apr 2023) using Fanpagekarma, evaluating participation metrics and sentiments with R. Results: Different emotional tones on platforms impact engagement; both positive and negative emotions correlate with increased interaction. Discussion: Emotional resonance enhances engagement, varying according to the platform, indicating the need for specific communication strategies. Conclusions: Emotional resonance and adaptation to platform norms are key in public engagement. Understanding these dynamics improves communication between the European Commission and the public.

Leading in a Time of Crisis: The Coronavirus Effect on Leadership in America

In light of the COVID-19 pandemic, an unprecedented global health emergency, the study explores the vulnerabilities and challenges faced by leadership. The crisis, exemplified by issues such as the misinformation around Omicron Boosters in rural America, has brought to light the complex interplay between leadership, public health initiatives, and societal dynamics. This scenario underscores the study's aim: to analyze and understand the specific attributes, styles, and communication strategies that define effective crisis leadership within the American context. Adopting a quantitative research methodology, the study conducted a survey with 521 respondents, encompassing a diverse cross-section of American society, including members of minority communities, volunteers, students, healthcare workers, business owners, and residents of areas significantly impacted by the pandemic. The survey, focused on collecting data through a structured questionnaire, to assess the interplay between the independent variables (transparency, empathy, stakeholder engagement, context-sensitive leadership style, adaptable leadership styles, targeted communication, and culturally sensitive communication strategies) and the dependent variables (success of crisis leadership and improved crisis management), using Likert scale questions. The data collected were used to test the hypothesis, using regression analysis. The findings reveal significant insights: transparency, empathy, and engagement with stakeholders are crucial for successful crisis leadership; context-sensitive and adaptable leadership styles are more effective than rigid ones in diverse crisis scenarios; and targeted, culturally sensitive communication strategies significantly improve crisis management outcomes. These results underscore the multifaceted nature of crisis leadership and the importance of nuanced, adaptable approaches in times of uncertainty while the study agrees with the assertions of McGregor Burns (2004) and Kouzes and Posner (2023) on the leader’s competencies as key to successful leadership in moments of crisis, this study further reveals the vitality of stakeholders’ engagement and contributions in crisis leadership. Also, while the study’s findings align with those of Erickson (2021) on transparency in communication, the study further reveal that exhibiting empathy along with transparency is very essential in crisis leadership. Therefore, the study recommends developing leadership qualities that emphasize transparency, empathy, and stakeholder engagement, and enhancing adaptability in leadership styles. Additionally, it highlights the need for culturally sensitive communication strategies, tailored to diverse audiences.

Criteria for Implementation of Circular Economy: Experiences from China and Implications for Vietnam

The global trend towards the development of a circular economy (CE) is of great significance, including for Vietnam. In recent years, Vietnam has made efforts to establish and improve its legal and policy framework related to CE. This research study aims to examine the evaluation criteria used for assessing CE development in China, a country that has achieved remarkable progress in this area. The findings of this study can provide valuable insights and serve as a crucial reference for Vietnam as it strives to formulate an evaluation criteria set for the effective implementation of the CE policies in the future. Building upon the experiences and lessons learned from the implementation of evaluation and monitoring criteria in China, this study also offers several recommendations for Vietnam's forthcoming implementation efforts. These recommendations encompass the development of comprehensive guidelines for data collection and computation of the evaluation index set, along with the establishment of transparent monitoring and auditing mechanisms for locally sourced data. Furthermore, fostering collaboration among relevant government agencies in data collection and consolidation is crucial. Specific communication strategies and reporting mechanisms tailored to local contexts should be devised, and nationally standardized reference values for evaluation criteria need to be established. Additionally, there is a need to design an evaluation criteria set specifically for the implementation of circular economy practices at the industrial park and enterprise levels in Vietnam.
 Keywords: Evaluation criteria, circular economy, China.

Factors influencing the engagement of older adults with neurocognitive disorders in the design of decision aids: A qualitative descriptive study

ObjectiveTo identify factors influencing the engagement of older adults with neurocognitive disorders (NCDs) in the design of decision aids (DAs). MethodsWe conducted a qualitative descriptive study using semi-structured interviews with 23 older adults with NCDs who were accompanied by 27 caregivers. This is a secondary analysis of a published study to identify the features of DAs designed for this population and their caregivers. ResultsSeveral behaviours and attitudes of caregivers and researchers hindered the older adults’ engagement in the DA design process. Specific communication strategies can be employed to support their engagement and overcome the communication challenges inherent to this population, such as memory, attention, hearing, or visual impairments. Adopting the appropriate attitude, taking the time, and providing guidance to the older person can help them focus on the topic, while developing trust between participants is a facilitator to obtain their feedback. ConclusionFindings from this project could serve to inform the communication and co-design of DAs with older people with NCDs and their caregivers. Practice implicationsCaregivers and researchers have key roles to play in facilitating communication with older persons with NCDs so they are empowered to help in co-designing DAs.

Health Care Provider Perceptions of Using Social Media to Improve Sexual Health for Adolescent and Young Adult Cancer Survivors.

This study explored (1) health care provider (HCP) perceived barriers and facilitators to social media communication about sexual health with adolescent and young adult survivors, and (2) strategies that can help HCPs navigate social media use for this purpose. Thematic analysis of 11 semistructured HCP interviews resulted in four themes and suggests that social media platforms offer a promising avenue to foster sexual health communication but that resources and training are needed to improve HCP capacity to use this approach ethically and effectively. Future studies are needed to determine specific communication strategies and whether these strategies would lead to improved outcomes.

Social support for overcoming fear of contagion at the start of the COVID-19 pandemic. Cross-sectional study in Latin America.

The psychological impact of the COVID-19 pandemic on healthcare professionals has been widely studied, along with different strategies to minimize it. However, professionals' assessment of the social support received and the factors that mitigated their fear of contagion have not been described. This study aimed to assess healthcare professionals' satisfaction with the social support and information received and their efforts to self-isolate to avoid infecting loved ones in Chile, Colombia, and Ecuador. A cross-sectional online survey, conducted from July to September 2020 in three Latin American countries, elicited healthcare professionals' satisfaction with social support from colleagues, their community, the media, and scientific societies; as well as the information received about the evolution of the pandemic and measures to avoid contagion. The EASE scale was used to measure acute stress. Survey responses were received from 700 professionals. The response rate per country exceeded the estimated sample size except in the case of Colombia, which was 81.4%. In general, peer support was highly valued, though satisfaction was lower in high-risk units (p < 0.001). Those who directly assisted COVID-19 patients perceived the least community support (p = 0.023). Professionals from high-risk units (p = 0.013) and those who experienced greater acute stress (p = 0.05) assigned the lowest rating to the information offered by the centre on the pandemic. Men perceived more support from colleagues and better information from the centre than women (p < 0.05). Just 10.7% of professionals changed their residence during the pandemic, but those who worked in high-risk areas self-isolated more frequently (p = 0.026). In the early stages of the COVID-19 pandemic, healthcare professionals in Chile, Colombia, and Ecuador greatly valued the support received from their peers. Being infected with COVID-19, working in high-risk areas, experiencing higher self-reported acute stress, and having an infected co-worker were predictors for self-isolation to protect their relatives. These results point to the appropriateness of putting in place institutional resources based on peer support and specific communication strategies and action protocols to build resilience and responsiveness to future health crises.

Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service.

In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients' internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician's online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients.

“An invitation to think differently”: a narrative medicine intervention using books and films to stimulate medical students’ reflection and patient-centeredness

BackgroundNarrative medicine purports to improve medical students’ communication skills, self-reflection, empathy and professional development. These interpersonal skills and attitudes can facilitate more patient-centered care and positively impact patients’ treatment outcomes. However, current studies report mainly on small study populations, leaving the efficacy of narrative medicine in larger study groups unknown. Therefore, this study aimed to evaluate a mandatory narrative medicine lesson in a large sample of medical students. We assessed if this narrative medicine lesson stimulated meaningful self-reflection on patient-centeredness in medical students.MethodsAll fourth-year medical students of a Dutch medical school participated in this mandatory narrative medicine lesson. The four-step activity consisted of an introductory lecture, close reading and watching of a book and film, a discussion group and a short reflective writing exercise. Students were divided over three thematic pairings (or book and film combinations): ‘The doctor as a patient,’ ‘The mysterious brain,’ and ‘Until death do us part.’ A mixed-methods design was used. First, we qualitatively analyzed the content of 203 essays from the reflective writing exercise. A quantitative analysis of the reflective quality was conducted using a scoring-system based on the REFLECT rubric.ResultsStudents demonstrated reflection on a professional level and connected this to future intentions as medical practitioners, for example to use specific communication strategies or to deliver healthcare in a broader sense. They also reflected on a personal level by questioning their own worldview or beliefs. Furthermore, they stressed the importance of individual patient stories to gain understaning of patients’ perspectives. Approximately half of the students showed an in-depth and authentic reflection, according to the REFLECT rubric. Additionally, reflection levels differed between book and film pairings.ConclusionsThis study supports the value of narrative medicine in the medical curriculum by validating its outcomes in a larger study population and in a mandatory course. Students reflected on themes related to the principles of patient-centeredness, namely personal attitudes towards patients and the uniqueness of patient stories. In additon, the majority of students demonstrated higher levels of reflection, which suggests that this exercise contributes to self-awareness and self-reflection, important qualities for delivering patient-centered healthcare.

Promoting trust in HAVs of following manual drivers through implicit and explicit communication during minimal risk maneuvers

The successful integration of highly automated vehicles (HAV) in future mixed traffic environments will depend, among other things, on their seamless, safe, and accepted interaction with other road users. Therefore, appropriate combination of light signals, as external human-machine interface (eHMI), and driving behavior, as dynamic human-machine interface (dHMI), is required consistently in order to develop trust of following manual drivers in HAVs. Especially, in borderline traffic scenarios where HAVs are confronted with challenges, such as loss of connectivity, so-called minimal risk maneuvers (MRMs) are performed abruptly. Here, understanding communication via eHMI and dHMI is crucial for road safety, as drivers need to prepare for maneuvers themselves. Therefore, two consecutive, explorative online video studies were conducted. Firstly, the appropriate braking dynamics for an MRM were evaluated. Secondly, insights into the eHMI communication strategy of an HAV during an MRM were gained. The overall aim of this work is to present strategies for implicit and explicit communication channels of an HAV in order to promote learned trust during MRMs from the perspective of drivers who follow them. The results show that adding novel eHMI designs (e.g., warning sign, 360° LED light-band) to conventional light signals positively affects the user experience in a first contact interaction. The findings could have a positive impact on the development of trust in HAVs. In conclusion, specific eHMI communication strategies can be highly supportive for following manual drivers in MRM scenarios, which may lead to legislative considerations in the future.

A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers.

To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care. A qualitative, phenomenological design was used. Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019. A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs. Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users. Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

Emotional Experiences of Vulnerable Groups During COVID-19

Abstract: Introduction: The study focuses on the prevalent emotions and specific experiences of three particularly vulnerable groups in the Bulgarian pandemic context. The target groups include working parents with small children (0–12 years), people who lost their jobs because of the COVID-19 crisis, and people with chronic diseases. Methods: To determine the experiences and sources of stress, we conducted semistructured in-depth calendar interviews ( N = 45) in late 2021. Narratives of representatives of the three groups generated authentic retrospective textual data, amounting to 221,883 words. To identify prevalent emotions in their speech, we did an automated qualitative data analysis of the three text corpuses and built a 10-category dictionary for basic emotions in accordance with Carroll Izard’s (1991) differential emotions theory, including synonyms, similar, and related words. Results: Content analysis showed that the most prominent emotion was fear, followed by interest, sadness and enjoyment. Lack of consistent and reliable information, the feeling of uncertainty, fear of the unknown and constant changes in the restrictive measures were significant sources of stress for all groups included in the study. At the same time, the three vulnerable groups differed both in the sources and in the content of the expressed fears. Discussion: Both practical and future research implications are discussed. Perhaps, these findings are valid for other types of crises and can serve as a central line for elaborating specific measures and crisis communication strategies targeting concrete vulnerable groups in society. Conclusion: Although the prevalent emotion in the narratives was fear, both the sources and the content of the fears were very different for the three groups. Findings suggest that specific measures and policies for the different vulnerable groups might be more effective in case of crisis.

Barriers and strategies for engagement and retention of rural Latino and Native American dyads in psychosocial interventions after stroke

• Diverse/rural dyads experience barriers to engagement and retention in interventions. • These barriers can be overcome by providers using specific communication strategies. • Effective communication builds trust and may lead to better outcomes.

Methodological innovations to strengthen evidence-based serious illness communication

Background/ObjectiveA growing population of those affected by serious illness, prognostic uncertainty, patient diversity, and healthcare digitalization pose challenges for the future of serious illness communication. Yet, there is paucity of evidence to support serious illness communication behaviors among clinicians. Herein, we propose three methodological innovations to advance the basic science of serious illness communication. ResultsFirst, advanced computation techniques – e.g. machine-learning techniques and natural language processing – offer the possibility to measure the characteristics and complex patterns of audible serious illness communication in large datasets. Second, immersive technologies – e.g., virtual- and augmented reality – allow for experimentally manipulating and testing the effects of specific communication strategies, and interactional and environmental aspects of serious illness communication. Third, digital-health technologies – e.g., shared notes and videoconferences – can be used to unobtrusively observe and manipulate communication, and compare in-person to digitally-mediated communication elements and effects. Immersive and digital health technologies allow integration of physiological measurement (e.g. synchrony or gaze) that may advance our understanding of patient experience. Conclusion/practice implicationsNew technologies and measurement approaches, while imperfect, will help advance our understanding of the epidemiology and quality of serious illness communication in an evolving healthcare environment.