There is a fundamental gap in how the presence of family companions in medical visits influences indicators of quality of care, such as patient-centered communication (e.g., communication that reflects respect for patients'values and incorporates patient's concerns and preferences into decision-making), specifically for patients with heart failure - a particularly vulnerable population by virtue of its high morbidity and mortality. The long-term goals of this project are to improve the quality and delivery of care and subsequent health outcomes for Heart Failure (HF patients). The overall objective here, which is our next step in pursuit of our long-term goal, is to determine whether family accompaniment influences processes of care within the medical visit and use this information to inform intervention development. The rationale for the proposed research is that once we know how family members influence quality and delivery of care we can fulfill the call to action of policy makers and health care models to """"""""create an integrated, coherent plan for ongoing medical care in partnership with patients and their families."""""""" The research strategy is built around the central hypothesis that involvement of family members in clinical care will facilitate patient-provider communication and potentially improve subsequent HF self-management behaviors.
The specific aims to achieve our overall objective are: 1) To investigate the impact of family companion's presence on patient centered communication as assessed by the following audio-tape measures: the patient-centeredness ratio (ratio of communication that furthers the patient's agenda to communication that furthers the provider's agenda), patient activation and engagement behaviors, and physician facilitation and patient activation behaviors;2) To assess the impact of family companion's presence on provider communication related to patient education and counseling about HF self-management behaviors (e.g., weighing, diet, symptom management, physical activity, and medication adherence);and 3) To use intervention mapping (IM) to design a family-involved HF intervention based on qualitative data and results of Aims 1 and 2, and pre-test the intervention. The mentored research, formal didactics, and planned presentations/publications will set the stage for independent funding as a clinician-scientist.

Public Health Relevance

The proposed research is relevant to public health by seeking to improve the delivery of patient/family centered care for patients with chronic illness by understanding how the patient-physician interaction is influenced by family member accompaniment to medical visits. Thus, the proposed research is relevant to NHLBI's mission to enhance the health of patients living with heart failure so that they can live longer and more fulfilling lives.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
Special Emphasis Panel (ZHL1-CSR-X (F1))
Program Officer
Cooper, Lawton S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
Zip Code
Cené, Crystal W; Haymore, Beth; Laux, Jeffrey P et al. (2017) Family presence and participation during medical visits of heart failure patients: An analysis of survey and audiotaped communication data. Patient Educ Couns 100:250-258
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2017) A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices. J Clin Hypertens (Greenwich) 19:351-360
Cené, Crystal W; Johnson, Beverley H; Wells, Nora et al. (2016) A Narrative Review of Patient and Family Engagement: The ""Foundation"" of the Medical ""Home"". Med Care 54:697-705
Cené, Crystal W; Dilworth-Anderson, Peggye; Leng, Iris et al. (2016) Correlates of Successful Aging in Racial and Ethnic Minority Women Age 80 Years and Older: Findings from the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 71 Suppl 1:S87-99
Cené, Crystal W; Haymore, Laura Beth; Enga, Zoe et al. (2015) Data Collection and Management in Community Engaged Research: Lessons Learned From Two Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 9:413-22
Cené, Crystal W; Haymore, Laura Beth; Lin, Feng-Chang et al. (2015) Family member accompaniment to routine medical visits is associated with better self-care in heart failure patients. Chronic Illn 11:21-32
Cené, Crystal W; Dennison, Cheryl R; Powell Hammond, Wizdom et al. (2013) Antihypertensive medication nonadherence in black men: direct and mediating effects of depressive symptoms, psychosocial stressors, and substance use. J Clin Hypertens (Greenwich) 15:201-9
Cené, Crystal W; Haymore, Laura Beth; Dolan-Soto, Diane et al. (2013) Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure. J Card Fail 19:202-10
Samuel-Hodge, Carmen D; Cene, Crystal W; Corsino, Leonor et al. (2013) Family diabetes matters: a view from the other side. J Gen Intern Med 28:428-35
Sussman, Steve; Levy, David; Lich, Kristen Hassmiller et al. (2013) Comparing effects of tobacco use prevention modalities: need for complex system models. Tob Induc Dis 11:2

Showing the most recent 10 out of 14 publications