Carla L. Fisher is an assistant professor in the department of advertising in the UF College of Journalism and member of the STEM Translational Communication Center and UF Health Cancer Center. She was a predoctorate Fellow with the National Institute on Aging (NIA) with summer post-doc training from the National Cancer Institute (NCI).
Using a lifespan, developmental lens she examines the importance of family communication to health in the family environment and clinical setting. She believes that cancer is a family experience and must be treated from that perspective. Doing so will improve the health of the patient and potentially protect other women at risk.
What are your research interests?
What drives my research is looking at the intersection of family communication and health. In cancer care, whether it be treatment for cancer or even in decision-making, the family perspective is often excluded. It tends to be more biomedical or only patient-centered. I am really interested in how [breast cancer] is very much a family experience. I focus on talking with patients and families about their experiences in a way that highlights how their interactions, and the ways in which they communicate, affect their ability to make decisions and to cope, and how those communication patterns can actually impact health outcomes. Ultimately, I’m interested in helping families to communicate in healthier ways.
What are key themes found in your research for family communication around breast cancer?
People’s age or generation, the sociohistorical context in which they were raised, affect how they prefer to communicate. For example, I will talk to young daughters in their 20s and 30s whose mothers are in their 60s or older and have breast cancer. The daughters want to know everything and think they are entitled to that information, and they want that information so they can be there for mom in a supportive manner. But the flip side is, mom doesn’t necessarily want to share everything. Older generations of women tend to view health information as more private. A lot of that has to do with how they were raised and norms of privacy being different today than they were 30 years ago. So for mom having that sense of privacy is important to her, and for daughter that can be hard to understand. There is a negotiation that has to happen where you have to understand what works for you might not work for your mother or grandmother. In my work I strive to hear their stories so that we can better understand how to tailor communication in healthy ways. You often don’t think about age or generational differences as an influential factor but it is a big one.
Also, every family is different. So what works in one relationship might not in another. However, we also know that being open does facilitate healing. I’ve even found in my own work that those mothers and daughters who have a history of being more open also have better physical and relational health after diagnosis. We just have to keep in mind that HOW we facilitate that openness is going to be different based on relational role, mom or daughter, who is diagnosed, age, gender, etc. We have to keep those things in mind and at the same time, allow the person who is diagnosed to set the tone as to what works for them.
Part of what I do is gather that information for families so they can cope in better ways, but also get the health care system and community on board with the idea that you have to be treating the family as well as the patient.
What do you see as the biggest barrier for effective communication?
For me the biggest barrier is getting integrated into the health care system. They are already over-tasked and clinicians don’t always have time to work with the psychosocial side as much. But for me, family communication has to be a part of it. If I am able to cross that barrier and develop a mother-daughter communication program that provides a toolkit for mothers and daughters to go through, where they are reading the narratives and learning how to communicate in healthier ways and addressing the issues that are essential to both of their abilities to cope across the trajectory of cancer, that to me would change the landscape of cancer patients’ care. So that is what I’m hoping to create soon in my intervention development research. For me, the biggest barrier is getting the clinical community to be as concerned about the patient’s family interactions as I am and as families/patients are and how we integrate that into their care.
What are you working on next?
I am expanding my research program to better attend to how culture impacts mothers’ and daughters’ experiences. We know that culture, ethnicity, and race impact their experiences, as well as their relational expectations. I have some internal funding from the CTSI and STCC to interview African-American and Hispanic women about their mother-daughter coping experiences. I’m also adding a method called photovoice, where they will take pictures showing how their how breast cancer is a mother-daughter experience. I am working with Jill Sonke and the UF Center of Arts in Medicine on that project. We want to create a photo exhibit that we hope to showcase next year during Breast Cancer Awareness Month. We will invite clinicians and families to a public event and we hope the exhibit functions as a translational tool meaning it can help change their perspective of breast cancer as not just a woman’s experience, but a mother-daughter experience—a family issue. And at the same time it can be a communication tool by helping mothers and daughters understand each other’s experiences better. The photographs are a great way to add a richer layer that you just can’t get from the spoken or written word.
I also just got an National Institutes of Health (NIH) grant in collaboration with my colleague Kevin Wright at George Mason University through the Breast Cancer and the Environment Research Program (BCERP). There are various environmental risk messages out there as to what reduces your likelihood of getting breast cancer, but they don’t necessarily ever reach mothers and daughters or families, other than a poster or brochure. One of the things we advocated for was using more social media platforms like “mommy bloggers” to disseminate these messages to see if they change people’s attitudes and behavioral intentions in terms of risk but also get mothers and daughters talking about it. We are working with a group that has a relationship with “mommy bloggers” to disseminate these environmental messages created through NIH/BCERP by having the bloggers write a blog about them this month. We are seeing whether that changes the reader’s perspective, the blogger’s perspective, and how it impacts mother-daughter conversations about risk.
The second phase of that project involves interviewing bloggers and readers about how we can culturally tailor the messages. While they have the mother daughter messages in some of these printed messages, they don’t consider race and ethnicity – other than changing pictures – which absolutely does not attend to people’s variant needs. We will learn a little bit about how that dissemination channel might have changed people’s perspectives, but also what we can do to change the messages to make them more culturally salient to moms and daughters so they have better conversations and have the information they need to engage in healthy behavior.
A version of this Q&A originally appeared in Research & Insights, a newsletter and website that spotlights leading ideas and science at the forefront of journalism, public relations, telecommunication and advertising from the University of Florida College of Journalism and Communications.