Enhancing Patient-Oncologist Communication

描述(由申请人提供)：关于癌症治疗的交流对患者和医生提出了挑战，因为他们面临着从与潜在的可治愈疾病作斗争到意识到传统疗法不再有效的转变。患者经常面临强烈的恐惧和失落，导致治疗期间比其他任何时候都有更大的情感需求。由于肿瘤学家也在这种转变中苦苦挣扎，他们经常无意中阻止患者透露情感上的担忧，从而错失了有效沟通的机会，导致患者更大的焦虑。不幸的是，没有容易传播的教育干预措施来帮助肿瘤学家克服这些挑战。我们提出了一项随机对照试验，利用肿瘤学家自己记录的会面反馈来测试基于CD-ROM的交互式干预的有效性，以改善他们的沟通。在这项为期五年、两个地点(杜克大学和匹兹堡大学)的研究的基线上，我们将录音400次肿瘤学家(n=50)和晚期癌症患者(n=200)之间的门诊会面，他们正在讨论向姑息治疗的过渡。这些数字化的记录将被编码，供肿瘤学家用来引起患者的关注并对情感内容做出回应。 在基线评估后，我们将随机分配肿瘤学家进行干预和控制。干预肿瘤学家每人将收到一张个性化的用户友好型光盘，其中包含他们的编码对话，并与相关教育材料打包在一起。一名技术顾问将鼓励和促进他们使用材料。控制组将不会收到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(干预和对照)和新样本患者之间的另外400次诊所就诊，以衡量干预的影响。主要结果将是干预中强调的沟通行为，例如对移情机会的反应和引起患者关注的问题。该项目将通过确定可帮助患者度过困难过渡的关键沟通技能，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.