Empathic communication skills training to reduce lung cancer stigma in Nigeria

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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.