Empathic Communication Skills Training to Reduce Lung Cancer Stigma

项目总结 几乎所有(95%)被诊断为肺癌的患者都报告感觉到耻辱，定义为 可归因于肺癌诊断的自我和他人的负面评价和贬值的内在化。 先前的研究表明，48%的肺癌患者在临床上遭遇耻辱。 他们的肿瘤护理提供者(OCP)，这可能被OCP潜在地触发和/或加剧 常规的吸烟史评估。感觉到的耻辱对患者的心理健康有负面影响- 以及他们的医疗结果。促进移情交流似乎是一种潜在的 有效的干预目标，以帮助减少患者在临床接触中对耻辱的感知；然而， 没有任何正式的培训侧重于向OCP教授移情交流。为了满足这一关键需求， 我们制定了一项针对沟通挑战的移情沟通技能(ECS)培训 OCPs对吸烟行为和肺癌患者病史的讨论中所固有的。建立在 之前R21(R21CA202793)的有利结果，我们的目标是在全国范围内进行ECS培训试验，以 通过去污名化促进改善肺癌患者的医疗和心理社会护理 与OCP的交互。我们将在16个肺癌护理服务地点进行整群随机试验， 160名胸科医生ECS培训(干预组)与候补对照组(WLC)的比较 肿瘤内科医生和高级实践提供者)和960名肺癌患者(每名临床医生6名患者)。 ECS培训将远程提供，包括所有说明性和体验式培训材料， 都是为试点试验而开发的。为了增加我们试验的实际通用性，我们将利用两个 国家社区肿瘤学实践网络，由以下机构协调的连续护理卓越中心 我们的肺癌患者倡导伙伴Go2肺癌基金会和 由美国癌症协会支持的肺癌社区医疗结果(ECHO)网站 回声中心。本研究的目的是(1)评估ECS训练对OCP初级结果的影响 (沟通和移情技能吸收)和次要结果(培训评估--相关性、新颖性、 清晰度、自我效能感、与患者沟通的态度)；(2)评估ECS的影响 关于患者报告的主要结果(肺癌污名)和次要结果的培训与WLC的比较 (感知到的临床医生同理心、沟通满意度、心理困扰、社会孤立和 患者的临床接触经历)。此外，接受转介戒烟(目前 将探索(针对吸烟者)和预防复发(针对曾经吸烟者)；以及(3)审查潜力 OCP和患者预后的调节者。我们的中心假设是ECS培训将证明 临床医生移情技能和自我效能感的显著改善，并将优于WLC 关于患者报告的污名、临床医生同理心、满意度和总体体验的测量。

PROJECT SUMMARY Nearly all (95%) patients diagnosed with lung cancer report perceiving stigma, defined as a perception and internalization of negative appraisal and devaluation by self and others attributable to a lung cancer diagnosis. Prior research indicates that 48% of patients with lung cancer experience stigma during clinical encounters with their oncology care providers (OCPs), which may be potentially triggered and/or exacerbated by OCPs’ routine assessment of smoking history. Perceived stigma has negative effects on patients’ psychological well- being as well as their medical outcomes. Promoting empathic communication appears to be a potentially effective intervention target to help reduce patients’ perceptions of stigma within clinical encounters; however, no formal trainings exist that focus on teaching empathic communication to OCPs. To address this key need, we developed an Empathic Communication Skills (ECS) training focusing on the communication challenges inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients. Building upon favorable findings from a prior R21 (R21CA202793), our goal is to conduct a national trial of ECS training to facilitate improvements in the medical and psychosocial care of lung cancer patients through de-stigmatizing interactions with OCPs. We will conduct a cluster randomized trial at 16 lung cancer care delivery sites, comparing ECS training (intervention group) with a Waitlist Control Group (WLC) among 160 OCPs (thoracic oncology physicians and advance practice providers) and 960 lung cancer patients (6 patients per clinician). The ECS training will be offered remotely and include all the didactic and experiential training materials that were developed for the pilot trial. To increase the real-world generalizability of our trial, we will leverage two national networks of community oncology practices, the Care Continuum Centers of Excellence coordinated by our lung cancer patient advocacy partner, the Go2 Foundation for Lung Cancer and the Extension for Community Healthcare Outcomes (ECHO) sites for lung cancer care, supported by an American Cancer Society ECHO Hub. The aims of this study are (1) to evaluate the impact of the ECS training on OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (training appraisal – relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); (2) to evaluate the impact of the ECS training vs. WLC on patients’ reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with communication, psychological distress, social isolation, and patients’ experience of clinical encounter). Additionally, acceptance of referral to tobacco cessation (for current smokers) and relapse prevention (for former smokers) will be explored; and (3) to examine potential moderators of OCP and patient outcomes. Our central hypothesis is that the ECS training will demonstrate significant improvements in clinicians’ uptake of empathic skills and self-efficacy and will be superior to WLC with regards to patient reported measures of stigma, clinician empathy, satisfaction, and overall experience.