Enhancing Patient-Oncologist Communication

描述（由申请人提供）：关于癌症治疗的沟通对患者和医生提出了挑战，因为他们面临着从与潜在可治愈的疾病作斗争到意识到传统疗法不再有效的过渡。患者经常面临强烈的恐惧和损失，导致比治疗期间的任何其他时间都更大的情感需求。由于肿瘤学家也在努力应对这种转变，他们经常无意中阻止患者透露情感问题，从而错过了有效沟通的机会，导致患者更加焦虑。不幸的是，没有容易传播的教育干预存在，以帮助肿瘤学家克服这些挑战。我们提出了一个随机对照试验测试的有效性，互动的CD-ROM为基础的干预措施，使用反馈，从肿瘤学家自己的记录遭遇，以改善他们的沟通。在这项为期五年的两个研究中心（杜克和匹兹堡大学）研究的基线时，我们将在肿瘤学家（n=50）和晚期癌症患者（n=200）讨论过渡到姑息治疗时，对400例门诊患者进行录音。这些数字化记录将被编码，以供肿瘤学家引发患者的关注并对情感内容做出回应。 基线评估后，我们将肿瘤学家随机分配到干预组和对照组。每个干预肿瘤学家将收到一个个性化的用户友好的CD-ROM，其中包含他们的编码对话，与相关的教育材料包装。一名技术顾问将鼓励和促进他们使用这些材料。对照组将不会收到CD-ROM或任何其他支持。三个月后，我们将进行干预后评估，记录这些肿瘤学家（干预组和对照组）和新患者样本之间的另外400次门诊访视，以衡量干预的影响。主要结果将是在干预中强调的沟通行为，如对移情机会的反应和引起患者的关注。该项目将通过确定可能帮助患者度过困难过渡期的关键沟通技能，并通过创建易于传播的干预措施来帮助肿瘤学家实施这些技能，从而扩大肿瘤学家与患者沟通的领域。

DESCRIPTION (provided by applicant): Communication about cancer treatment challenges patients and physicians as they face the transition from fighting a potentially curable disease to realizing that conventional therapies are no longer effective. Patients often confront intense fear and loss, leading to greater emotional needs than at any other time during treatment. Because oncologists also struggle with this transition, they frequently, yet inadvertently, discourage patients from disclosing emotional concerns and thus miss opportunities to communicate effectively, resulting in greater patient anxiety. Unfortunately, no easily disseminable educational interventions exist to help oncologists overcome these challenges. We propose a randomized, controlled trial testing the efficacy of an interactive CD-ROM based intervention using feedback from the oncologists' own recorded encounters to improve their communication. At baseline of this five-year, two site (Duke and the University of Pittsburgh) study, we will audio record 400 outpatient encounters between oncologists (n=50) and patients with advanced cancer (n=200) as they discuss the transition to palliative care. These digitized recordings will be coded for the oncologists eliciting patients' concerns and responding to emotional content. After baseline assessment, we will randomly assign the oncologists to intervention and control arms. The intervention oncologists each will receive a personalized user-friendly CD-ROM that contains their coded conversations, packaged with related educational material. A technical advisor will encourage and facilitate their use of materials. The control group will not receive the CD-ROM or any other support. Three months later, we will conduct the post-intervention assessment by recording another 400 clinic visits between these same oncologists (intervention and control) and a new sample of patients to measure the intervention impact. Primary outcomes will be the communication behaviors emphasized in the intervention, such as responding to empathic opportunities and eliciting patient concerns. This project will expand the field of oncologist-patient communication by identifying key communication skills that may assist patients through difficult transitions and by creating an easily disseminable intervention to help oncologists implement these skills.