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Cancer Communication Science: Intergroup Perspectives

Summary and Keywords

At the heart of cancer communication research is an effort both to increase knowledge and to identify practical strategies for improving cancer communication and for improving prevention and control of cancer, as well as for addressing cancer care issues from theoretical and applied communication perspectives across the continuum of cancer care. One important theoretical approach to consider in cancer communication science is taking an intergroup approach to cancer care. The challenge moving forward is to develop cancer communication research programs that combine important theoretical and applied perspectives, focusing on prevention strategies that can help reduce cancer risk, incidence, morbidity, and mortality, and to promote the highest quality of life for people of every age and every background.

Keywords: cancer communication science, cancer communication and aging, health communication, intergroup communication, social identity theory, communication accommodation theory, lifespan communication, intercultural communication, interpersonal communication skill

What Is Cancer Communication Science?

Cancer communication science is the concerted study and application of the use of strategically designed messages, delivered interpersonally and through carefully selected media, to convey relevant health information and to influence targeted audiences (health care consumers, cancer survivors, health care providers, researchers, patients, at-risk populations, and others). Cancer communication science informs health communication efforts to educate members of these key audiences about cancer prevention, treatment, and control. For example, carefully designed cancer communication programs (patient education activities) and health information dissemination tools (health websites, pamphlets, posters, etc.) are utilized to increase cancer screening and early detection activities, reduce cancer morbidity and mortality, and enhance the quality of life of those who are confronting cancer. Cancer communication science is a relatively young, but an increasingly important and rapidly advancing area of applied research and intervention.

Cancer communication science emerged from the larger rapidly growing field of health communication in the 1980s and 1990s. In fact, the initial arguments and insights about the powerful role of health communication were addressed by pioneering health communication scholars Jon Nussbaum, Gary Kreps, and Teri Thompson in the inaugural issue of Health Communication. As Jon Nussbaum (1989) stated “health communication as a legitimate field of inquiry has finally arrived.” In the same issue, Gary Kreps (1989) inquired, “What difference can the field of health communication make to the public?” (p. 35). Since those early days, health communication scholars have been investigating various contexts of health and cancer communication. Editor of Health Communication, Teri Thompson further noted that health communication deals with health care-related environments that give meaning to health status by assuming and defining its cause (Thompson, 2000). The Office of Disease Prevention and Health Protection (2000), in achieving the Healthy People 2010/2020 initiatives to educate the public on the nation’s major health priorities, put forth this definition of health communication:

The art and technique of informing, influencing, and motivating the individual, institutional, and public audiences about important health issues. The scope of health communication includes disease prevention, health promotion, health care policy, and the business of health care as well as enhancement of the quality of life and health of individuals within the community.

More simply stated, health communication involves creating shared meaning about health care and conditions (Sparks, 2013).

Cancer communication science has its roots in health communication as well as the efforts of several influential national professional organizations and federal government agencies. For example, the powerful influences of human and mediated communication on cancer prevention, treatment, and control was publicly promoted in 1999, when the American Society of Clinical Oncology (ASCO), the largest and most prominent national professional society for cancer care research and practice, identified communication as a key clinical skill for oncology practice. That same year, the National Cancer Institute (NCI), the largest and arguably the most influential institute in the U.S. Department of Health and Human Services’ National Institutes of Health, declared cancer communication to be one if the institute’s primary areas of emphasis, an “extraordinary opportunity” for conducting comprehensive cancer control research and outreach activities. The NCI’s identification of cancer communication as an area of extraordinary opportunity led to major federal investments in funding for large-scale cancer communication research initiatives that have significantly advanced the science of cancer communication, encouraged introduction of new cancer communication programs at major medical and research centers, and fostered development and implementation of improved cancer communication policies and practices that influence cancer prevention, detection, diagnosis, treatment, survivorship, and end-of-life care.

The NCI’s announcement in 1999, of the Extraordinary Opportunity in Cancer Communications, coincided with the NCI’s introduction of a new organizational unit that focused on promoting cancer communication research, the Health Communication and Informatics Research Branch (HCIRB). The HCIRB was established as part of the Behavioral Research Program within the NCI Division of Cancer Prevention and Population Sciences. It became the focal unit within the institute for developing and implementing new national research programs for fulfilling the overarching goals of the extraordinary opportunity in cancer communication to develop and apply new cancer communication programs, policies, and technologies to reduce the national burden of cancer in the United States. The HCIRB staff were charged with developing and conducting major new cancer communication research programs and did this through the introduction of a number of large-scale and innovative intramural and extramural NCI federal research initiatives.

In recent years, the Centers for Disease Control (CDC), the Federal Drug Administration (FDA), and international organizations including the World Health Organization (WHO), the United Nations (UN), and numerous others have jumped on the bandwagon with significant efforts to integrate health and cancer communication science into their list of priority initiatives.

Cancer Communication Research Initiatives

Health Information National Trends Survey

A , initiative of the NCI’s extraordinary opportunity in cancer communication and a major source for collecting national data about cancer communication in the United States, was the introduction of a repeated measure surveillance research project, the Health Information National Trends Survey (HINTS) research program. HINTS is a nationally representative, repeated measure, cross-sectional survey of the American public’s access to and use of relevant health information. It was developed to complement and build upon several other major national repeated administration federal surveys, including the Behavioral Risk Factor Surveillance Survey (BRFSS), the National Health Interview Survey (NHIS), and the National Health and Nutrition Examination Survey (NHANES). HINTS has become an important source of information tracking the state of public knowledge about cancer prevention and control.

With its first administration in 2003, HINTS was conducted every two years initially; now it is conducted annually to identify and track how well different segments of the U.S. population are being informed about relevant cancer issues (such as risks and causes of cancers, symptoms and screening methods, and the best forms of cancer treatment). HINTS research identifies which cancer topics are most confusing to different groups of people, where different segments of the population currently get cancer-related health information, and how they would prefer to access relevant information. In essence, HINTS tracks national cancer communication information access, use, needs, and opportunities. As the HINTS acronym suggests, this major research initiative provides important insights (hints) about the best ways to meet the American public’s health information needs. HINTS provides researchers, public health promotion professionals, and health policy makers with a continuing source of surveillance data to compare trends in health information usage over time. HINTS is most relevant to intergroup communication because it identifies the groups of people in the United States who are seriously uninformed or misinformed about cancer issues and can suggest the best communication strategies for providing members of these groups with relevant information. Furthermore, the HINTS research program informs health communicators about the best ways to communicate with different groups, which people or organizations members of these groups will trust, what channels of communication they like to use, and which message strategies are likely to communicate most effectively with them.

The survey also provides health communication scientists with periodic opportunities to conduct fundamental research into the basic relationships among cancer communication, knowledge, attitudes, and behavior. This is a wonderful opportunity for intergroup communication researchers to examine the influences of communication within and between different groups on the dissemination of relevant health information, engaging in health promoting behaviors, and achieving desired health outcomes. The HINTS research tools have been used to guide supplemental studies of different at-risk groups, such as immigrants, minority members, and people confronting serious health issues. Recent efforts have also been taken to expand the HINTS research program beyond the United States to other nations such as China, South Korea, and Germany, to provide more global assessments of the adequacy of cancer information dissemination and to promote international cooperation in the use of communication to promote cancer prevention and control.

In addition to the HINTS research program, the NCI introduced several other important cancer communication research initiatives as part of the Extraordinary Opportunity in Cancer Communications program. Some of the most influential cancer communication initiatives include the Centers of Excellence in Cancer Communication Research, the Digital Divide Pilots, the Health Communication Intervention Research Program, the Multimedia Technology and Health Communication Small Business Innovation Research and Small Business Technology Transfer (STTR) program, and the Cancer Information Service Research Consortium Program.

Centers of Excellence in Cancer Communication Research (CECCR)

The Centers of Excellence in Cancer Communication Research (CECCR) initiative established a cohort of major trans-disciplinary (combining multiple disciplinary research perspectives) research centers to conduct cutting-edge research to rapidly advance cancer communication research and practice. In 2003, the four original CECCR research centers were funded by the NCI for five-year terms. In 2008, the NCI renewed the CECCR grants for the four original research centers for another five-year term and funded a fifth (new) CECCR research center. Each of the CECCR research centers conduct several large interrelated cancer communication research projects (on issues such as the effective use of online cancer information systems, the influences of news coverage of cancer information on health beliefs and behaviors, communication strategies for reducing cancer health disparities with minority populations, and patient-centered cancer communication) to advance knowledge, research methods, theory, and applications, and to initiate new research projects and train the next generation of cancer communication researchers.

Digital Divide Pilot Projects

The NCI introduced the Digital Divide Pilot Projects to fund four demonstration research programs that test innovative and culturally sensitive communication strategies for implementing effective online health education programs to promote cancer prevention and control with vulnerable groups (including the poor, groups of people with low literacy levels, the elderly, immigrant groups, as well as rural, urban, and minority populations). These demonstration projects illustrated best practices for narrowing the digital divide and expanding access for at-risk groups by involving and working closely with various at-risk groups, showing them how to more effectively search and use relevant health information online as a way of promoting and understanding cancer prevention, treatment, survivorship, dealing with end-of-life difficulties, and general care. Similarly, the Health Communication Intervention Research Program funded seven innovative cancer communication intervention research studies to increase understanding about how targeted and tailored communication interventions can be used to promote cancer prevention and control, as well as to reduce the burden of cancer, particularly among those disproportionately affected. The diversity in theoretical approaches and intervention modalities used in these studies contributed broadly to understanding the role of communication in health promotion and disease prevention.

Health Communication Intervention Research Program

The NCI introduced the Health Communication Intervention Research Program in 2002, supporting a broad array of studies demonstrating that strategic communication can raise awareness about cancer risks, offer effective prevention strategies, bring about important behavior changes like wearing sunscreen or stopping smoking by equipping people with the most crucial information needed to make informed cancer-related decisions. Cancer communication research has shown that positive influences on relevant health behavior changes increase when targeted communication efforts are supplemented by community-based educational efforts. Other factors, including self-efficacy, skills to implement the change, convenience, and social and cultural mores all influence the decision and ability to make relevant behavioral changes. These research studies examined the utility of influencing the health behaviors of different at-risk groups, often employing intergroup communication interventions.

Multimedia Technology and Health Communication Small Business Innovation Research and Small Business Technology Transfer Programs

The NCI’s Multimedia Technology and Health Communication Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs fund science-based, theory-driven, user-centered grants and contracts with the goal of translating cancer research across the cancer continuum into programs, interventions, systems, networks, and products needed by professionals and the public to reduce cancer risk and improve the quality of life of cancer survivors. Still another influential NCI cancer communication initiative was the Cancer Information Service Research Consortium Program, which created an innovative collaboration between the NCI’s Cancer Information Service (CIS) health education information dissemination program and HCIRB. The NCI funded a large multi-study Program Project grant (PO1) that engaged both NCI staff and external researchers to conduct applied studies evaluating the effectiveness and impact of the CIS educational and outreach programs, the use of tailored educational materials and interventions for targeted groups of consumers, the use of online information systems and resources, cancer information seeking patterns, and communication strategies for promoting informed cancer prevention, detection, and treatment decision-making.

Through these NCI initiatives and related studies, a large body of cancer communication research has illustrated that strategic communication can raise awareness of cancer risks, prevention strategies, early detection, and can give people the information they need to make informed cancer-related decisions. Moreover, effective cancer communication can influence people to engage in recommended health behaviors that can improve their health, such as stopping smoking or undergoing screening for certain types of cancer. Cancer communication research has shown that, while the use of targeted media campaigns can produce behavioral change, the influences on relevant health behaviors are increased when communication efforts are supplemented by community-based educational efforts. The theoretical basis of this effect is that increased knowledge and understanding alone do not motivate a person to change entrenched health behaviors. Other factors, such as self-efficacy, skills to implement the change, convenience, and social and cultural mores all influence the decision and ability to make relevant behavioral changes.

Intergroup Approaches to the Cancer Communication Experience

Once diagnosed with cancer, a person may feel as if he or she is always with cancer, that every conversation, thought, or action is altered by this new state of being as a cancer patient (Sparks, 2003). Patients often feel as if healthcare providers are speaking another language, incomprehensible and difficult to understand. The patient and family may be sorting through what kind of cancer they have as well as what level of cancer staging might mean for decisions about treatment. They struggle to unscramble the excessive amounts of health information they are being bombarded with to comprehend the related risks, benefits, and side effects of different treatments and figure out what to do next to get through the nightmare diagnosis. Frequently, patients and family members in this situation are at a loss for words and simply do not know where to begin to ask questions that might help, as they are in shock just trying to digest the difficult news. Effective and sensitive communication processes can help families navigate this uncertain time and can serve as a guiding light in an otherwise dark pathway to exert some control in a sometimes uncontrollable situation, in an effort to achieve better health outcomes for the cancer patient.

Cancer communication science takes an evidence-based approach to the use of strategically designed messages delivered through carefully selected media to communicate relevant health information to targeted audiences, including patients, family caregivers, survivors, and health care providers from various backgrounds, ethnicities, genders, and experiences. The goal is to educate members of these key audiences about prevention, detection, diagnosis, treatment, control, and survivorship. Strategically designed cancer communication messages can be implemented to segmented audiences in an effort to encourage action towards these goals. Cancer communication stems from the broader field of health communication, which is emerging to be an increasingly important and rapidly advancing area of applied research and intervention.

A large body of cancer communication literature demonstrates the powerful influences of communication interventions on a broad range of health behaviors and health outcomes. Research has shown the important influences of intrapersonal, interpersonal, group, organizational, and societal communications on health knowledge, behaviors, and outcomes. Similarly, studies have shown the positive influences of increased patient communicative involvement in treatment on desired health outcomes. Studies illustrate the positive influences of social marketing and diffusion-based strategies in encouraging at-risk populations to adopt important cancer prevention behaviors. Few studies, however, have taken into account the important impact of intergroup communication influences and related social identity affected by cancer.

Patients diagnosed with a chronic or terminal disease gain membership in a group of people who share a common set of symptoms, side effects, and challenges in dealing with providers. By communicating with others, patients diagnosed with an illness often see themselves differently and start to recognize that others may view them differently. Shifts in social identity and health can also have particular effects on medical decision-making in the patient-provider relationship. For instance, once a patient is diagnosed with cancer, the everyday conversations that were a part of their daily interactions often shift to frequent conversations about cancer with providers, but also with family members, friends, and colleagues. These newly diagnosed patients, via their communication with others, often experience dramatic shifts in their identities as they move through the stages of being healthy and well to being sick. Identification as someone who was previously healthy shifting to someone who is sick, identification as a patient, and identification as a survivor are all important aspects to consider. For example, cancer patients concerned about the stigma associated with a cancer diagnosis may pursue numerous strategies to avoid such stigma while they are fighting the disease. Such shifts in a patient’s social identity may greatly impact decision making and the way the patient and the various caregivers involved relate to the patient.

Providers use instrumental talk to give and receive information and maintain their in-group identity status. Patients enter the interaction with an existing social identity that, upon diagnosis, is often completely transformed. Through communicating with others, patients diagnosed with an illness often see themselves differently and start to recognize that others may view them differently as well. Some patients may experience identity shifts to take on a more active role in their own care by focusing on the goals of treatment as a process. Other patients might try to avoid dealing with illness through denial, or by not adhering to the recommended treatment plan. If a patient is uncomfortable being “labeled” with an illness such as cancer, then a shift toward denial is more likely to occur.

The shift in one’s group membership, from one that reinforces a “healthy” social identity to one that is “not healthy” as one is introduced to a new group membership of “cancer,” for example, is a crucial component to consider when communicating with patients. By understanding the complexities involved in patients shifting identities, providers can use more appropriate, effective, and understanding communication strategies in an effort to better relate to patients meeting them where they are along their cancer journey.

Social identity theory (SIT) explains responses to difficult health situations based on group memberships. From a broad socio-psychological standpoint, SIT illuminates the complex structure and function of intergroup relations and generally centers on identification with large social groups such as age, culture, sexuality, etc. Smaller and more specialized groups are also relevant to SIT, including such relationships as an organizational group, a family, or even a particular disease condition. The tenets of SIT are also important in terms of understanding the potential for shifts in identity, such as those experienced by some ill patients and their families. SIT helps illustrate how some people are motivated to maintain a positive view of themselves by identifying with groups they perceive to be desirable, and then comparing themselves and other in-group members to another set of people who are perceived to be out-group members. For instance, a person might view himself as young, or a member of the younger generation, and would then perceive the young generation as the in-group. Being a member of the younger generation would be viewed as more desirable than being a member of the older generation, or older adults, who are perceived to be an out-group.

Primary, Secondary, and Tertiary Identities

Three levels of identity typically exist in the health care context. At the primary level, individuals identify with large-scale social groups, and those identifications influence their susceptibility and ability to cope with illness. For instance, highly identified women might, under some circumstances, be more likely to engage in appropriate prevention strategies for their overall health, related to a proper and healthy diet, exercise, or relationships. Women who view their gender as a major part of “who they are” may also be more likely take part in activities such as the Susan B. Komen Race for the Cure, because that event focuses on women’s health issues. Highly identified women feel that their gender is one of their most important, defining characteristics. Women who do not strongly identify with their gender identity are still women, but the details of what it means to engage in the social and cultural roles of women may be less important, or less common.

At the secondary level, identifications with particular behaviors influence health communication processes. Secondary-level identification might mean a patient is less concerned with being recognized as a member of a particular social group, but more likely to feel the need to engage in certain behaviors over time. For example, even if a person does not see herself as a top-ranked tennis player, she may still feel a strong need to play tennis as a part of her overall exercise program. Her identity is shaped more by what she does than who she is as a person. Secondary identity is different from primary identity in that a behavior such as exercise may be central to a person’s identity at one phase of life but may become less important as time goes on.

Identification with health-specific identities becomes more important at the tertiary level. At this level the major factor is how a person views his or her social identity as it relates to the symptoms and prognosis of a particular disease. If patients view themselves as fighters, they will view serious illnesses differently than if they see themselves as weak or unable to carry on. At this level it is less about who we are or what we do, and more about how we choose to frame our behaviors in difficult health situations.

Coping with Negative Patient Identities

Social identity theory (SIT) sheds light on the consequences of identity threat for cancer patients. Specifically, SIT suggests that when a person perceives that an identity is devalued or does not provide rewards, as often is the case with a cancer diagnosis, three potential coping mechanisms are available. The stress associated with negative patient identities requires the use of these coping strategies to minimize or eliminate association with the undesirable “cancer” group. The choice among these three coping strategies is grounded in the level of identification an individual has with the group, the degree to which boundaries between the group and other groups are open or closed, and the degree to which the power structure is viewed as legitimate and stable.

Social Mobility

In situations of low identification and open boundaries, the path of least resistance is for an individual to leave a stigmatized or unrewarding group (social mobility). This may take the form of actually “leaving” or of psychologically “passing” (e.g., invisible illness). In terms of a patient’s identity, actually leaving the undesirable social group of their illness may not be entirely possible until the illness is eliminated, but in general the mobility option can be exercised in two ways. First, there is an obvious desire for a patient to move towards living without cancer dominating every conversation and health appointment, and in so doing to leave their cancer patient identity behind. In the long term, regaining full health and getting rid of an illness, such as cancer, is a form of social mobility.

This mobility strategy is obviously differentially available depending on the type and severity of the illness; some illnesses are temporary and some, like cancer tend to be chronic, particularly during the treatment phase. Beyond this issue, however, the extent to which this strategy is perceived to be available may differ. In particular, older people may perceive this strategy to be more difficult to achieve, and/or those around them may be less likely to view it as an option. Older adults may treat certain early detection cancer symptoms with less concern, attributing the problems to their age, and then, due to stereotyping, may be denied proper cancer diagnosis and treatment options compared to younger people. In addition, failure to disclose diagnosis, concealing side-effects of treatment, and lying about absences from work can also be understood as social mobility strategies. Patients concerned about the stigma associated with a cancer diagnosis may pursue numerous strategies to avoid such stigma while they are fighting the disease.

The social mobility option is typically not effective for individuals who value their group membership strongly. When identification is high, mobility is unlikely, and one of the other two options will be adopted. When identity is low, which is likely the case for most people diagnosed with cancer, mobility may indeed be the preferred option. Mobility is also unlikely in situations where the boundaries are closed because people are unable to leave, as other groups will not accept them.

Social Creativity

This coping mechanism involves using cognitive restructuring to reframe the nature of what it means to be ill. Social creativity generally involves one of three strategies. First, instead of taking any direct action, the patient may alter the perceptions of illness by finding creative ways to make in-group/out-group comparisons. People may seek out some dimension on which their group is valued, despite its generally low status. For instance, “I am not happy that I have cancer, but I am happy I am losing weight!” Second, some patients may redefine their values to allow for a positive assessment of in-group characteristics (e.g., a breast cancer survivor may put a Komen “pink ribbon” bumper sticker on her car). The third approach to social creativity is to target alternative out-groups. For instance, some people target other, less well-off, in-group members to achieve positive identities. In the case of patients, this might mean that cancer patients feel fortunate in comparison to patients with more aggressive or visible illnesses.

For people who have recovered, the “survivor” identity may be intrinsically a highly rewarding identity, so there would be no reason to pursue any mobility/creativity strategies. For example, many breast cancer survivors join the Susan G. Komen foundation and attend related events, from fundraisers to 5k races, as a way of showing they identify strongly with the survivor identity. Age may again moderate responses to survivors—a younger survivor may be viewed as a hero, whereas an older survivor may still carry some residual aura of illness and decline. Such patterns would yield information on whether and how identification with being a survivor displaces or complements other identities, and hence the ways in which identifying with those other groups provides salve to the threat of, for instance, mental health identity.

Social Competition

In contrast to social creativity, when the power structure is seen as illegitimate or unstable, people will engage in social competition. Social competition is defined as any collective action to change the status quo. At the level of social competition, people are publicly seeking a change in the status quo in an effort to gain more status and resources for their group. Campaigns and awareness programs all fall into this area; perhaps the most visible in the cancer context is the pink ribbon campaign for breast cancer, or the purple ribbon campaign for pancreatic cancer.

For patients, social competition might mean staging a protest against a healthcare policy. When a patient’s self-concept is threatened by a negative group identity, members of the group may mobilize to bring attention to that characterization. However, when patients communicate with their providers, they may not have the force of a mobilized patient group behind them, thereby leaving the patient alone to deal with the consequences of his or her patient identity. Social competition may have indirect effects on the patient provider interaction until the group’s efforts lead to large-scale changes in the way illness is depicted and treated in health care environments.

The Future of Cancer Communication Science From an Intergroup Perspective

There is a great need for cancer communication research to direct cancer prevention and care. For example, in cancer prevention and detection, there is a need to conduct controlled trials that compare different forms and intensities of communication-based interventions to promote behavior change and to examine the use of tailored, interactive, computer-based health communications programs that can contribute to an improved understanding of these new technologies. Research on consumer-provider communication can help identify strategies for increasing accurate exchange of relevant health information, promote cooperation in the cancer treatment process, and enhance the quality of care for people confronting cancer. Further cancer communication research is urgently needed to fill in knowledge gaps about information needs in cancer prevention and control, as well as to capitalize on the unusual opportunity presented by advanced communication technologies to help achieve cancer prevention and detection goals. A significant increase in the size of the cancer communication research enterprise is needed to develop the next generation of research and interventions. At the same time, the enterprise must be informed by a greater understanding of the mechanisms by which these communications work.

Cancer communication research from an intergroup perspective can uniquely inform cancer prevention, detection, treatment, survivorship, and end-of-life care. Intergroup communication perspectives, particularly social identity theory (SIT), provide unique utility and applicability for all communication related to health and illness because of the potential damage illness causes to the identity of ill individuals. The overwhelming, uncontrollable, and unpredictable feeling that follows diagnosis of illness often paralyzes a person’s ability to act and manage their life based on pre-diagnosis norms. Further, it is especially worth noting that responses to illness that affect social identity may impact decisions made by patients and those caring for them.

Intergroup approaches can uniquely contribute to cancer prevention efforts, which typically involve designing and implementing strategic communication campaigns to promote healthy behaviors (such as refraining from smoking or using tobacco products, following a low-fat, high-fiber diet, and engaging in a program of regular exercise). Cancer prevention efforts typically involve the development and distribution of persuasive and informative cancer education programs and materials, as well as the development of behavioral intervention programs to influence health behaviors that are often entrenched.

It is through interaction that we effectively inform and motivate people to seek screening for early detection of cancers. Understanding intergroup communication perspectives in the cancer communication context can provide unique insights into more effective and connected cancer care, from prevention, to treatment, to survival, and end-of-life. Effective interaction is essential for encouraging audiences to engage in early detection and screening behaviors, to promote the development and adoption of screening programs in different health care and organizational settings, and for monitoring cancer trends to determine the best opportunities for screening and cancer detection. Promotion of early cancer detection and screening often involves the use of communication campaigns, educational materials, and behavioral intervention programs.

Communication is critical for gathering and interpreting diagnostic cancer information from patients. Due to the complexity of many cancer diagnoses, interpersonal and intergroup communication are often part of an indispensable social processes for interpreting and clarifying diagnostic information. Once a diagnosis is reached, human interaction is the most important channel for presenting the diagnosis and plans for treatment to patients. Care must be taken to communicate cancer diagnoses as clearly and as sensitively as possible to help patients overcome the initial shock of receiving a cancer diagnosis, understand the intricacies of the diagnosis, and begin evaluating different plans for treating the condition.

Cancer treatment is an active and, ideally, a collaborative communication process between health care providers and consumers. Providers must explain treatment options, and refinements to treatment strategies, to their patients to help them make informed decisions about the best available programs of treatment. Once an initial cancer treatment regimen is implemented, the patient’s response to specific treatments must be carefully monitored and evaluated, so the treatments can be refined to produce the best effects and cause the least possible discomfort to the patient. Interpersonal and intergroup communication are essential processes for seeking information about patients’ responses to treatments and making informed decisions about revised treatment strategies.

There is a growing population of long-term cancer survivors today, due to advances in early cancer detection and improved cancer treatments. A recent report in the journal Cancer Epidemiology, Biomarkers, & Prevention stated that, as of January 2012, there were approximately 13.7 million cancer survivors in the United States, a number that is expected to rise by 31% to 18 million by 2022. Cancer survivors have unique communication needs to help them cope with the many uncertainties of living with cancer. For example, cancer survivors typically have to cope with the fear of their cancer recurring. Survivors also need to access social support and relevant information to help them live with side effects of cancer treatments. Peer support from others who have adapted to living with cancer can often help cancer survivors overcome both physical and psychosocial challenges and enable them to readjust to their everyday lives.

Communicating with patients and their loved ones during the end-of-life process is a very challenging part of cancer care for all involved parties. Death is not easy for most people to communicate about, yet the uncertainties surrounding death demand sensitive and caring communication. The quality of communication at the end of life is critical to providing effective cancer care for patients who are dying. Increasing attention in recent years has been directed toward the role of communication in palliative cancer care, especially at the end of life. The hospice movement has also focused attention on the unique communication needs of cancer patients and their loved ones during the transition to end of life. Intergroup communication processes can greatly contribute to better understanding of identity shifts that cancer patients experience through the varied conversations with formal and informal providers, including family, friends, and colleagues across the continuum of cancer care from diagnosis to end-of-life.

New cancer communication research combining theoretical approaches such as intergroup communication can inform applied cancer communication contexts in unique ways that will increase knowledge, understanding, decision-making, and will identify practical strategies for enhancing cancer communication and improving prevention and control of cancer. The challenge ahead is to develop effective evidence-based cancer communication research programs that draw on important theoretical and applied approaches to the complex cancer care arena to more effectively help reduce cancer risk, incidence, morbidity, and mortality and promote the highest quality of life for people confronting cancer.

Further Reading

Giles, H., Reid, S., & Harwood, J. (Eds.). (2010). The dynamics of intergroup communication. New York: Peter Lang.Find this resource:

    Harwood, J., & Sparks, L. (2003). Social identity and health: An intergroup communication approach to cancer. Health Communication, 15, 145–170.Find this resource:

      Kreps, G. L. (1989). Setting the agenda for health communication research and development: Scholarship that can make a difference. Health Communication, 1, 11–15.Find this resource:

        Kreps, G. L., Neuhauser, L., Sparks, L., & Villagran, M. (Eds.). (2008). Translational community-based health communication interventions to promote cancer prevention and control for vulnerable audiences [Special issue]. Patient Education and Counseling, 71(3), 315–350.Find this resource:

          Kreps, G. L., & Sparks, L. (2015). Cancer communication. In G. A. Colditz, (Ed.), The Encyclopedia of Cancer and Society (2d ed., pp. 220–225). Newbury Park, CA: SAGE.Find this resource:

            Nussbaum, J. F. (1989). Directions for research within health communication. Health Communication, 1, 35–40.Find this resource:

              O’Hair, H. D., Kreps, G. L., & Sparks, L. (Eds.). (2007). Handbook of communication and cancer care. Cresskill, NJ: Hampton.Find this resource:

                Sparks, L. (Ed.). (2003). Cancer communication and aging [Special issue]. Health Communication, 15(2).Find this resource:

                  Sparks, L. (2007). Cancer care and the aging patient: Complexities of age-related communication barriers. In H. D. O’Hair, G. L. Kreps, & L. Sparks (Eds.), Handbook of communication and cancer care (pp. 233–249). Cresskill, NJ: Hampton.Find this resource:

                    Sparks, L., & Harwood, J. (2008). Cancer, aging, and social identity: Development of an integrated model of social identity theory and health communication. In L. Sparks, H. D. O’Hair, & G. L. Kreps, (Eds.), Cancer communication and aging (pp. 77–95). Cresskill, NJ: Hampton.Find this resource:

                      Sparks, L., & Leahy, A. (2017). Conversing with cancer: How to ask questions, find and share information, and make the best decisions. New York: Peter Lang Publishers.Find this resource:

                        Sparks, L., & Nussbaum, J. F. (2008). Health literacy and cancer communication with older adults. Patient Education and Counseling, 71(3), 345–350.Find this resource:

                          Sparks, L., O’Hair, H. D., & Kreps, G. L. (Eds.). (2008). Cancer, communication and aging. Cresskill, NJ: Hampton.Find this resource:

                            Thompson, T. L. (2000). The nature and language of illness explanations. In B. B. Whaley (Ed.), Explaining illness: Research, theory, and strategies (pp. 3–40). Mahwah, NJ: Erlbaum.Find this resource:

                              Wright, K. B., Sparks, L., & O’Hair, H. D. (2013). Health communication in the 21st century (2d ed.). Oxford: Blackwell.Find this resource:

                                References

                                Giles, H., Reid, S., & Harwood, J. (Eds.). (2010). The dynamics of intergroup communication. New York: Peter Lang.Find this resource:

                                  Harwood, J., & Giles, H. (2005). Intergroup communication: Multiple perspectives. New York: Peter Lang.Find this resource:

                                    Harwood, J., & Sparks, L. (2003). Social identity and health: An intergroup communication approach to cancer. Health Communication, 15, 145–170.Find this resource:

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                                              Kreps, G. L. (2003). Opportunities for health communication scholarship to shape public health policy and practice: Examples from the National Cancer Institute. In T. Thompson, R. Parrott, K. Miller, & A. Dorsey (Eds.), The handbook of health communication. Hillsdale, NJ: Lawrence Erlbaum.Find this resource:

                                                Kreps, G. L. (2005). Cancer communication research for health promotion at the National Cancer Institute: A case study. In M. Haider (Ed.), Global public health communications: Challenges, perspectives, and strategies. Sudbury, MA: Jones & Bartlett.Find this resource:

                                                  Kreps, G. L., & Chapelsky Massimilla, D. (2002). Cancer communications research and health outcomes: Review and challenge. Communication Studies, 53(4), 318–336.Find this resource:

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                                                      Kreps, G. L., Gustafson, D., Salovey, P., Perocchia, R. S., Wilbright, W., Bright, M. A., et al. (2007). The NCI digital divide pilot projects: Implications for cancer education. Journal of Cancer Education, 22(Suppl. 1), S56–S60.Find this resource:

                                                        Kreps, G. L., Neuhauser, L., Sparks, L., & Villagran, M. (Eds.). (2008). Translational community-based health communication interventions to promote cancer prevention and control for vulnerable audiences [Special issue]. Patient Education and Counseling, 71(3), 315–350.Find this resource:

                                                          Kreps, G. L., & Sparks, L. (2015). Cancer communication. In G. A. Colditz, (Ed.), The encyclopedia of cancer and society (2d ed., pp. 220–225). Newbury Park, CA: SAGE.Find this resource:

                                                            Kreps, G. L., & Viswanath, K. (2001). Communication interventions and cancer control: A review of the National Cancer Institute’s health communication intervention research initiative. Family and Community Health, 24(3), ix–xiii.Find this resource:

                                                              Kreps, G. L., Yu, G., Zhao, X., Chou, W.-Y., & Hesse, B. W. (2017). Expanding the NCI Health Information National Trends Survey from the US to China and beyond: Examining the influences of consumer health information needs and practices on local and global health. Journalism and Mass Communication Quarterly, 94(2).Find this resource:

                                                                Marcus, A., Morra, M., Bright, M., Fleisher, L., Kreps, G. L., & Perocchia, R. (2005). The CIS model for collaborative research in health communications: A brief retrospective from the current generation of research. Journal of Health Communication: International Perspectives, 10(S1), 235–245.Find this resource:

                                                                  Mayer, D. K., Terrin, N. C., Kreps, G. L., Menon, U., McCance, K., Parsons, S. K., et al. (2007). Cancer survivors’ information seeking behaviors: A comparison of survivors who do and don’t seek information. Patient Education and Counseling, 65(3), 342–350.Find this resource:

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                                                                        Rutten-Finney, L., Hesse, B., Moser, R., & Kreps, G. L. (Eds.). (2011). Building the evidence base for cancer communication. Cresskill, NJ: Hampton.Find this resource:

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                                                                                Sparks, L. (2007). Cancer care and the aging patient: Complexities of age-related communication barriers. In H. D. O’Hair, G. L. Kreps, & L. Sparks (Eds.), Handbook of communication and cancer care (pp. 233–249). Cresskill, NJ: Hampton.Find this resource:

                                                                                  Sparks, L. (2008). Family decision making. In W. Donsbach (Ed.), The international encyclopedia of communication (Vol. 4, pp. 1729–1733). Oxford: Wiley-Blackwell.Find this resource:

                                                                                    Sparks, L. (2013). Health communication and caregiving research, policy, and practice. In R. C. Talley & S. S. Travis (Eds.), Multi-disciplinary coordinated caregiving (pp. 131–175). New York: Springer.Find this resource:

                                                                                      Sparks, L. (2008). Cancer, aging, and social identity: Development of an integrated model of social identity theory and health communication. In L. Sparks, H. D. O’Hair, & G. L. Kreps, (Eds.), Cancer communication and aging (pp. 77–95). Cresskill, NJ: Hampton.Find this resource:

                                                                                        Sparks, L., & Nussbaum, J. F. (2008). Health literacy and cancer communication with older adults. Patient Education and Counseling, 71(3), 345–350.Find this resource:

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                                                                                              Villagran, M. M., & Sparks, L. (2010). Social identity and health contexts. In H. Giles, S. Reid, & J. Harwood (Eds.), The dynamics of intergroup communication (pp. 235–248). New York: Peter Lang.Find this resource: