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5 Questions with Cleveland Shields

Posted By Keeley Pratt, Tuesday, June 26, 2012

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Keeley Pratt: I met Dr. Shields when I was just a first year doctoral student in East Carolina University’s Medical Family Therapy program. We meet over breakfast, a meeting I anxiously initiated, at one of the annual American Association for Marriage and Family Therapy conferences. I learned of Dr. Shields work from literature I had read on families and health, but also because he worked and lived in Indiana- the state I grew up in. I have to admit looking back I was nervous to meet him; he clearly is an esteemed researcher and educator. However, quickly after meeting Dr. Shields it became evident that we shared a kinship for health and families, research, the Midwest (think cornfields and basketball), and sarcasm. I consider myself extremely fortunate to have had him as professional mentor, at a distance, for close to five years now. I was honored to interview him for the Medical Family Therapy blog series and to have the opportunity to share the pearls of wisdom he has relayed to me over the past five years with current and future Medical Family Therapists whom I’m sure will benefit.



1. What experience in your professional or personal life was most influential in your development as a medical family therapist?

I grew up in a family where we weren’t shielded from older folk’s illnesses. I was lucky to grow up right next to my grandparents. I was involved in taking care of my great-grandmother and an uncle in their last years. My sister, my cousins, and I were never shielded from aging, illness, or death. We were told the truth as it was appropriate to our age at the time. My parents helped us become comfortable the realities of life and death.

I was in the ministry for a few years, so I did a lot of visiting of older folks and some hospital work with ill people. During my time in seminary and church ministry, I learned about caring for people, read a lot of family therapy books, and spent a lot of time with sick people. That piqued my interest in becoming a marriage and family therapist. When I came to grad school (at Purdue), I discovered that I also had the skills to be a researcher.

I had not thought about doing health-oriented research work until I finished my degree at Purdue and started a faculty position at the University of Rochester Medical Center. I worked primarily in Family Medicine, and was immediately thrust into doing therapy with patients with complex medical problems. At the same time, I started conducting research on family relationships and health problems. I became a medical family therapist because of my work context, which involved seeing patients in exam rooms with physicians and having patients come to me who weren’t talking about their marriage. I was trained as an MFT but my patients wanted to talk about their diabetes, why they didn’t like their medication, their cancer, or whatever disease/illness they had. So, I suddenly had to learn about health. I learned by stopping a physician or a nurse practitioner in the hall and saying "What does this mean?” I got educated quickly by colleagues and from extensive reading.

I was at Rochester to build a research program, which because I had not been trained in health, required a huge amount of reading. At Rochester I wrote some papers with Lyman Wynne 1,2,3, worked on publications and book chapters on treating medical illness with Susan McDaniel4 published research with others. It was a great group of people there: Tom Campbell, Susan McDaniel, Barbara Gawinski, Sally Rousseau, Tziporah Rosenberg, David Seaburn5- and all of the physician collaborators and primary care doctors who are great people and great human beings, many who had also been trained as family therapists.

 

2. What do you consider your most important contribution to the medical family therapy field or literature?

When describing what it is I do, I say that I am a family therapist who studies the role of clinical communication in the management of chronic illness and the role of clinical communication in healthcare disparities. Clinical communication is a broad term that includes not just physicians but anyone (such social workers, nurses who give discharge instruction, and family therapists) who interact with patients and their family members. My research is between basic and applied, and I am very interested in turning research into interventions.

Toward the end of my time in Rochester, I started conducting research with Ron Epstein and Kevin Fiscella on physician-patient communication6-10. I have continued this research since coming to Purdue in 2006, and it has been the most fruitful and rewarding collaboration I’ve ever had.

Most of my research has been in relationships and health. I haven’t published much about therapy so I don’t think I contribute directly to the medical family therapy clinical literature. I see myself as doing more basic and applied research on healthcare focused on clinical communication. Now, working through the Purdue Regenstrief Center for Healthcare Engineering, I collaborate with hospitals and physicians in the state. Currently, I am doing a large physician–patient communication study funded by NIH with colleagues at Purdue, the University of Rochester, and Michigan. I am working with colleagues at IU and Duke to develop an intervention study to improve communication between physicians and adolescents about sexuality. I am an MFT, one of us is a communications PhD, and the other is a pediatrician. This is where the fun is, interdisciplinary research; reaching across disciplinary boundaries and expanding knowledge. I’d encourage every MFT to collaborate with people outside their own departments.

I recently became Director of the Center on Poverty and Health Inequities (COPHI). COPHI's mandate is to examine in the US and internationally the effects of socio-economic status, race and ethnicity, national origin, religion, poverty, education, and geography on health care inequities. The Center’s faculty includes scholars from public health, counseling psychology, communication, and consumer sciences. With less than half of our faculty being born in the U.S., our meetings are like a mini UN, which makes our meetings a lot of fun.

Dr. Melissa Franks and I are conducting a study on unnecessary hospital readmissions of patients with Type 2 diabetes. We are examining whether hospital discharge instructions and involvement of family members in discharge planning predicts unnecessary readmission to the hospital. We hope this study could lead to interventions to improve discharge planning, which fits nicely with the recommendations we made in our recent JMFT paper11.

Not everybody needs family therapy, but many families can benefit from family interventions delivered within the healthcare system. Family therapists can devise simple interventions for healthcare providers to involve family members. Interventions can be as simple as encouraging family members to ask questions, encouraging their involvement, and giving them information that will help them provide care adequately.

Clearly there are people who need family therapy, but a lot of people would benefit from psycho-educational interventions that involve the family. So, there is plenty of therapy work to do, but there is also plenty that a healthcare professional with a family-orientation can do to improve healthcare. Family therapist are needed when there is a full-fledged relationship problem that needs intervention, but if you are just trying to get healthcare providers to incorporate the family then we (family therapists) can design programs to do that, but we don’t need to be the ones doing all of it. That’s my position and what we argued in the JMFT article11.

 

3. What does the field of medical family therapy most need to move into the mainstream of healthcare?

From my perspective, we need a research base, its one thing to say we need to do this or that, but we should be plowing ahead and doing research similar to other professions like Health Psychology. I think it is important to establish when it’s important to involve family members and when it’s not; not every problem requires a family member to be intimately involved- lots of individuals can take medication for their bronchitis without a family member reminding them. Major lifestyle changes probably do involve family members, so it is particularly important to develop family oriented interventions to improve the management of chronic diseases. There is a fair amount of basic research on this, but we need to know how to help family members provide needed support12,13.

 

4. What advice do you have for future medical family therapy students or young professionals who are interested in getting into research?

If they want to get into research, they should really know the methodology literature. They should find a mentor, and if they are a marriage and family therapy student and they have to find a mentor in another department, don’t hesitate to do that. They need to find a content expert in their research. They should take advantage of National Institute of Health (NIH) health-focused research conferences. They need to go to research conferences, for example the Society of Behavioral Medicine, because most marriage and family therapy conferences include little research. Find a conference about the health problem they want to study, and go to it. Learn as much about the medical issues involved in their chosen topic. Our focus is around the behavioral issues in managing those diseases, we’re not going to change someone’s medication- we’re not physicians, but we can help change their behaviors such as diet, exercise, medication adherence, and improve family interactions to increase support for changing and maintaining these new behaviors.

We need to be part of interdisciplinary teams. You can’t do research in this area without collaborating with all kinds of people. We need to think that we are bringing a family systems perspective to other areas, but we have just as much to learn from them. We have tons to learn from epidemiology, public health, nutrition science, engineering, economics, and all the other professions involved; and we need to learn to collaborate with them. Every project I am doing is a collaborative project. MFT programs should encourage their new faculty to develop interdisciplinary relationships at their universities.

 

5. What about choosing where to publish: healthcare journals, MFT journals, disease specific journals- How do you decide?

Think about the articles you want to write and see where similar articles have been published. So if you find a really good research article that really speaks to the kind of research you want to do- look at where it was published and then go look that the reference list and see where those papers were published. Your goal is to publish at the highest level possible. Most NIH panels are not going to be familiar with most family therapy journals, so try to publish in non-MFT as well as MFT journals. Publish in disease specific journals. If your area is diabetes, then try to publish in Diabetes Care or Diabetes Educator, which are behaviorally oriented diabetes journals. Finally, new researchers need to learn to write persuasively and scientifically, which is argumentative writing and quite different than describing a new clinical approach.

 

Selected Bibliography

1. CG Shields & LC Wynne. (1997). The strength–vulnerability model of mental health and illness in the elderly. Brunner/Mazel.

2. CG Shields, LC Wynne, SH McDaniel, BA Gawinski. (1994). Conceptual and structural marginalization: Challenges and opportunities for the field of family therapy [A rejoinder to Hardy and Anderson]. Journal of Marital and Family Therapy 20 (3), 297-300.

3. CG Shields & SH McDaniel. (2007). Family Therapy Pioneer, Researcher, and Mentor: Lyman C. Wynne, MD, PhD 1923–2007. Journal of Marital and Family Therapy 33 (2), 132-133.

4. CG Shields & SH McDaniel. (1992). Process differences between male and female therapists in a first family interview. Journal of Marital and Family Therapy 18 (2), 143-151.

5. D Seaburn, B Gawinski, J Harp, S McDaniel, D Waxman, C Shields. (1993). Family systems therapy in a primary care medical setting: The Rochester experience. Journal of Marital and Family Therapy 19 (2), 177-190.

6. CG Shields, CJ Coker, SS Poulsen, JM Doyle, K Fiscella, RM Epstein & JJ Griggs. (2009). Patient-centered communication and prognosis discussions with cancer patients. Patient Education and Counseling, 77, 437–442. doi:10.1016/j.pec.2009.09.006

7. CG Shields, GR Morrow, J Griggs, J Mallinger, J Roscoe, JL Wade, SR Dakhil, S. R., et al. (2004). Decision-making role preferences of patients receiving adjuvant cancer treatment: A University of Rochester Cancer Center community clinical oncology program. Supportive cancer therapy, 1(2), 119–126.

8. CG Shields, KW Ziner, SA Bourff, K Schilling, Q Zhao, P Monahan, G Sledge & V Champion. (2010). An intervention to improve communication between breast cancer survivors and their physicians. Journal of Psychosocial Oncology, 28(6), 610-629. DOI:10.1080/07347332.2010.516811

9. CG Shields, RM Epstein, P Franks, K Fiscella, P Duberstein, SH McDaniel & S Meldrum. (2005) Emotion language in primary care encounters: reliability and validity of an emotion word count coding system Patient Education and Counseling, 57: 232-238

10. RM Epstein, T Hadee, J Carroll, SC Meldrum, J Lardner, CG Shields. Could this be something serious? (2007) Journal of general internal medicine 22 (12), 1731-1739.

11. CG Shields, MA Finley & N Chawla & P Meadors. (2012). Couple and family interventions in health problems. Journal of Marital and Family Therapy, 38(1), 265-280. doi:10.1111/j.1752-0606.2011.00269.x

12. MM Franks, CG Shields, L Sands, E Lim, S Mobley & CJ Boushey. (2012). I will if you will: Similarity in health behavior change of married partners. Health, Education, & Behavior. 39:324-331. DOI: 10.1177/1090198111402824

13. MM Franks, CG Shields, L Sands, E Lim, S Mobley & CJ Boushey. (2012). I will if you will: Similarity in health behavior change of married partners. Health, Education, & Behavior. 39:324-331. DOI: 10.1177/1090198111402824


 

Cleveland Shields

Cleveland Shields, PhD is an Associate Professor in the Department of Human Development and Family Studies at Purdue University in West Layfayette, IN. Dr. Shields’ main research interests include: families and health, couple and family interventions in health, patient-centered care in medical settings, and couples and cancer. He has published extensively in the area of family/patient/physician communication and family/couple intervention development, and has recently been awarded a grant by the National Cancer Institute to examine social and behavioral influences on clinical communication and pain management.


 


 

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