Empathic communication skills training to reduce lung cancer stigma in Nigeria

项目摘要 肺癌是全球男性和女性癌症相关死亡的主要原因，大约 其中70%的死亡发生在低收入和中等收入国家。撒哈拉以南非洲的先前研究 (SSA)显示，不幸的是，肺癌在2015-2018年间成为男性第三常见的癌症 以晚期表现(阶段3和阶段4)为特征，75%的患者仅在 高级阶段。在阻碍肺癌求医的众多因素中，耻辱是其中之一， 特别是在医疗会诊期间预期的肺癌污名。我们之前由NCI资助的癌症污名 研究人员开发了一种患者报告的肺癌污名测量方法(肺癌污名清单-LCSI) 并证明了在与肿瘤护理提供者(OCP)接触时经历的耻辱有助于 由于肺癌的症状表现和开始治疗的延迟。一种缓解感知的方法 肺癌患者所经历的耻辱是在医疗过程中进行移情交流的行为 来访。我们最近在纪念馆开发了一个移情沟通技能(ECS)培训模块 美国斯隆·凯特琳癌症中心。ECS培训模块侧重于解决通信问题 OCPs对肺癌患者吸烟行为和病史讨论的内在挑战 代表了一种很有希望的方法来减少肺癌的污名。使用ECS培训的初步研究已经 在改善OCP之间的沟通和提高患者满意度方面显示出令人鼓舞的结果。这个 目前的提案旨在检查尼日利亚患者的肺癌污名，并修改ECS以用于 尼日利亚的癌症护理机构。这项研究的目的是：(A)适应文化和区域相关性 患者报告的肺癌污名测量工具和移情沟通技能(N-ECS) 通过评估污名的性质和频率与治疗肺癌患者的OCP一起使用的培训 尼日利亚肺癌患者的经验，以及(B)审查该方案的可行性和可接受性 在尼日利亚治疗肺癌患者的OCP中进行N-ECS培训。对于目标1，研究人员将 调整LCSI和ECS培训模块，以包括肺癌特定的临床小插曲和其他 培训材料(触发视频)，描述了使用以患者为中心的反馈来自 来自尼日利亚伊巴丹和奥巴费米大学学院医院的20名肺癌患者代表 阿沃洛沃大学教学医院综合体，尼日利亚伊费岛。对于目标2，将从以下人员中招聘25名职业警察 同一医院参加2小时的N-ECS培训，并完成培训评估和措施 自我效能。对于技能吸收的客观测量，参与者将完成标准化患者 由MPI实验室的盲人工作人员编码的评估(SPA)。这项研究还寻求建立能力，以 计划的多层次临床试验，通过开发N-ECS，在尼日利亚减轻肺癌的耻辱，建立 基于美国高质量、循证的ECS培训的成功。

Project Summary Lung cancer is the leading cause of cancer-related deaths in men and women worldwide, and approximately 70% of these deaths occur in low- and middle-income countries (LMICs). Prior research in sub-Saharan Africa (SSA) indicates that lung cancer became the 3rd most common cancer in men in 2015-2018, unfortunately characterized by late stage presentation (Stages 3 and 4) with 75% patients seeking medical care only at advanced stages. Among the many factors that deter seeking medical treatment for lung cancer is stigma, particularly anticipated lung cancer stigma during medical encounters. Our prior NCI-funded cancer stigma work has developed a patient-reported measure of lung cancer stigma (Lung Cancer Stigma Inventory – LCSI) and demonstrated that stigma experienced during encounters with oncology care providers (OCPs) contributes to delays in symptom presentation and initiation of treatment in lung cancer. One way to mitigate perceived stigma experienced by patients with lung cancer is enactment of empathic communication during medical visits. We have recently developed an Empathic Communication Skills (ECS) training module at Memorial Sloan Kettering Cancer Center in the USA. The ECS training module focuses on addressing communication challenges inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients and represents a promising approach to reduce lung cancer stigma. Preliminary studies using the ECS training have shown encouraging results in improving communication among OCPs and improving patient satisfaction. The current proposal is designed to examine lung cancer stigma in patients in Nigeria and adapt the ECS for use in Nigerian cancer care settings. The aims of the study are (a) to adapt for cultural and regional relevance a patient-reported tool for measurement of lung cancer stigma and an empathic communication skills (N-ECS) training for use with OCPs who treat patients with lung cancer by assessing the nature and frequency of stigma experiences by patients with lung cancer in Nigeria, and (b) to examine the feasibility and acceptability of the N-ECS training among OCPs who treat patients with lung cancer in Nigeria. For Aim 1, study investigators will adapt the LCSI and the ECS training module to include lung cancer-specific clinical vignettes and other training materials (trigger videos) that portray stigmatizing interactions using patient-centered feedback from 20 lung cancer patient representatives from University College Hospital, Ibadan, Nigeria and Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. For Aim 2, 25 OCPs will be recruited from the same hospitals to participate in the 2-hour N-ECS training, and complete measures of training evaluation and self-efficacy. For objective measurement of skill uptake, participants will complete standardized patient assessments (SPAs) coded by blinded staff from the MPIs’ labs. The study also seeks to build capacity for a planned multi-level clinical trial to mitigate lung cancer stigma in Nigeria by developing the N-ECS, building upon the success of high-quality, evidence-based ECS training in the USA.